Varenicline is a drug used for smoking withdrawal symptoms. It reduces cravings by binding to alpha4-beta2-nicotine-acethylcholine-receptors of the central nervous system. Side effects are nausea, headache, sleeping disorders. Patients with PTSD complain of depressions, social isolation, insomnia, nightmares and flashbacks. These symptoms often cause a severe drug abuse. We present two patients complaining of sleeping disorders caused by nightmares. These symptoms were significantly reduced under treatment with Varenicline due to a nicotine abuse.

Patient A was a woman with a history of sexual abuse in childhood. Besides a drug abuse of benzodiazepines she presented a nicotine addiction. She was increasingly affected by nightmares and insomnia. Patient B was a woman, who grew up in a children's protectory, where she was involved in violence. A PTSD was accompanied by alcohol and benzodiazepine abuse. The PTSD caused episodes of depression with suicidal ideation, nightmares and insomnia.

Both patients were treated with Varenicline for smoking cessation. After few days of treatment, they reported improved sleeping behaviours and diminished nightmares.

Currently only few studies confirm the effectiveness of alpha1-receptor-agonists (Prazosin) in PTSD-associated nightmares. Our case reports demonstrated the effectiveness of Vareniclin in the treatment of nightmares and sleeping disorders in two patients. The treatment with Vareniclin lead to modified dreaming behaviours with positive, less threatening dreams. Therefore a placebo-controlled study to assess the effectiveness of Vareniclin in the treatment of nightmares is necessary.