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Seek medical review if : Nightmares are severe, frequent, or significantly affecting your quality of life You experience other concerning symptoms such as mood changes, severe anxiety, or depression You have symptoms requiring urgent care such as severe chest pain or severe headaches (call 999 for emergency symptoms or NHS 111 for urgent non-emergency advice) You suspect another medication might be contributing to the problem You take insulin or sulfonylureas and experience night-time symptoms that could suggest hypoglycaemia Your GP may refer you to a sleep specialist if nightmares persist despite addressing potential contributing factors