Does Gabapentin Cause Nightmares?
No, gabapentin does not cause nightmares—in fact, it is used to treat nightmares, particularly in patients with PTSD, and was generally well-tolerated in clinical studies without nightmares reported as an adverse effect. 1
Evidence from Nightmare Treatment Guidelines
The American Academy of Sleep Medicine's position paper on nightmare disorder specifically evaluated gabapentin as a treatment option for nightmares, not as a cause of them. 1
Clinical Evidence Supporting Gabapentin's Safety Profile
In a retrospective case series of 30 veterans with PTSD treated with gabapentin for insomnia and nightmares, 77% showed moderate or marked improvement, with "most" experiencing decreased frequency and/or intensity of nightmares. 1
The reported side effects in this study included mild sedation, excessive daytime sedation, mild dizziness, and one episode of nonspecific "swelling"—nightmares were not listed as an adverse effect. 1
Mean effective dose was 1,344 mg daily for responders, and gabapentin was described as "generally well-tolerated." 1
Mechanism of Action Related to Sleep
The American Academy of Sleep Medicine notes that gabapentin binds to α2δ subunits of voltage-gated calcium channels, inhibiting excitatory neurotransmitter release, and does not act at GABA receptors. 2, 3
This mechanism actually improves sleep architecture by increasing slow-wave sleep and REM sleep while decreasing awakenings. 4, 5
Studies show gabapentin increases sleep efficiency and decreases spontaneous arousal, which would theoretically reduce rather than increase nightmares. 4
Important Clinical Caveat
One isolated case in the trazodone literature mentioned a patient who discontinued treatment due to "more vivid nightmares," but this was with trazodone, not gabapentin. 1 This distinction is critical—do not confuse medications used to treat nightmares with each other.
Common Side Effects to Monitor
The actual side effects of gabapentin that clinicians should monitor include:
Nightmares are not among the recognized adverse effects of gabapentin in any of the guideline literature or clinical trials reviewed. 1, 2