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Idiopathic Nightmares and Dream Disturbances Associated with Sleep–Wake Transitions
Abstract
Nightmares and other common disturbances of dreaming involve a perturbation of emotional expression during sleep. Nightmares, the most prevalent dream disturbance, are now recognized as comprising several dysphoric emotions, including especially fear, although some argue that existential (or grief) dreams should be considered a separate entity. A genetic basis for nightmares has been demonstrated and their pathophysiology involves a surprising underactivation of the sympathetic nervous system in many instances. Personality factors, such as nightmare chronicity and distress and coping styles, are mediating determinants of their clinical severity, as are drug and alcohol use. Many treatments have been described, with much support for the effectiveness of short-term cognitive and behavior interventions such as systematic desensitization and imagery rehearsal. Several related dream disturbances occur at the transitions into or out of sleep and involve dysphoric emotions ranging from malaise to fear to frank terror. These disturbances include sleep starts, terrifying hypnagogic hallucinations, sleep paralysis, somniloquy with dream content, false awakenings, and disturbed lucid dreaming. The distinctive nature of these disturbances may be mediated by immediately preceding waking state processes (e.g., consciousness, sensory vividness) that intrude upon or carry over into dreaming.
... Míg az utóbbi elsősorban az alvás első harmadában és ennek megfelelően mély, lassú hullámú alvás során jelentkezik, a rémálmok az alvás aktiváltabb szakaszaiban: a gyors szemmozgás (rapid eye movement -REM) fázisban vagy az alvás második fázisában (Stage 2) jelentkeznek. Továbbá az adott alvászavar alatti corticalis aktiváltság szintjének megfelelően, a rémálmokra jellemző élénk álombeszámolókkal szemben, az alvási rémület zavart megtapasztaló személyek többnyire nem képesek beszámolni az ébredést megelőző mentális élményről [5]. Habár a DSM-IV-TR magyar nyelvű fordítása sajnálatos módon a rémálom zavarra a "lidérces álom zavar" kifejezést használja [1], a rémálom zavar elkülönítendő a néphagyományban "lidércnyomásnak" nevezett jelenségtől. ...
... Habár a DSM-IV-TR magyar nyelvű fordítása sajnálatos módon a rémálom zavarra a "lidérces álom zavar" kifejezést használja [1], a rémálom zavar elkülönítendő a néphagyományban "lidércnyomásnak" nevezett jelenségtől. Ez utóbbi tudományos megfelelője az alvásparalízis, amely a REM-fázis és az ébrenléti működés idegrendszeri sajátosságainak egyidejű megjelenéséből fakad [5]. ...
... Kisgyermekkorban, két-és hatéves kor közt viszonylag ritkák a rémálmok, és nem jellemzőek a nemi különbségek. A szülői beszámolók alapján fiúk és lányok esetében is 3 és fél éves kor körül mutatkoznak a leggyakrabban rémálmok, ami nagyjából egybeesik az első részletesebb gyerekkori álombeszámolók megjelenésével [5,14]. Ezt követően a kamaszkorig a rémálmok gyakorisága folyamatosan növekszik, majd 13-14 éves kortól a fiatal felnőttkorig a fiúk esetében csökkenő, míg a lányok esetében növekvő tendenciát mutat. ...
Nightmares are intense and unpleasant dream experiences that characterize approximately 4 percent of the adult population at least on a weekly basis. Nightmare frequency is often co-morbid with other mental complaints; however, recent results indicate that nightmare disorder is independent from waking mental dysfunctions. Nightmare disorder is intimately related to poor subjective sleep quality, and according to polysomnographic studies nightmare subjects' sleep is characterized by increased sleep fragmentation and hyper-arousal. These findings suggest that instead of the psychopathological perspective nightmare disorder should be viewed as a specific sleep disorder that requires targeted treatment. Nevertheless, in order to choose the adequate treatment procedure clinicians should examine the co-morbid mental disorders as well taking into consideration the severity of nightmare distress, the latter supposed to be the mediator between nightmare frequency and waking mental dysfunctions. Orv. Hetil., 2013, 154, 497-502.
... Conversely, the incidence of nightmares is highest during late adolescence and early adulthood. 31 Moreover, detailed studies examining the prevalence of nightmares at all ages have shown that the prevalence of nightmares is lower in older adults than in younger adults. [32][33][34] Drugs other than suvorexant affect the incidence of dreams and nightmares. ...
Aim
Suvorexant is an orexin receptor antagonist (ORA) for the treatment of insomnia. The antagonistic action of suvorexant on orexin receptors is associated with an increase in rapid eye movement (REM) sleep, which can potentially lead to nightmares depending on the patient's condition. However, the precise risk factors for nightmares among patients taking ORAs, such as suvorexant, have yet to be identified. In this retrospective study, we aimed to identify the risk factors for the development of nightmares in patients treated with suvorexant.
Methods
The risk factors were determined by comparing parameters between the nightmare group and the nonnightmare group. This study included 440 patients who received suvorexant at the University of Miyazaki Hospital from April 2014 to January 2021.
Results
We found that 9.1% (n = 40) of the patients experienced suvorexant‐induced nightmares. There was a significant difference in the median age, which was lower in the nightmare group than in the nonnightmare group (p < 0.01). Furthermore, both multiple logistic regression analysis and Cox proportional hazards regression analysis revealed increased odds ratios for nightmares for individuals aged 20–39 years.
Conclusions
This study revealed that elderly patients taking suvorexant had fewer nightmares than nonelderly patients did.
... However, it is plausible that we can experience PEs or surprise in response even to internally generated dream events and sensations, not only sensations that filter into the dream from the sleeping body. For example, nightmares can surprise us when an unexpected, scary event occurs or an object appears Nielsen & Zadra, 2011;Robert & Zadra, 2014) -in fact, being woken by surprising or scary content is part of what makes a dream a nightmare (Blagrove et al., 2004). While, undoubtedly, some visual stimuli, like light and colours, can 'infiltrate' the dream, it is unlikely that many visual experiences are primarily caused by the external world. ...
It is widely known that dreams can be strongly affected by traumatic events, but there may be other ways in which dreams relate to trauma. In this paper, we argue that different types of dreams could both contribute to trauma and alleviate it according to the prediction errors that occur either in dreams or in response to them after waking. A prediction error occurs when an experience contradicts one’s expectation and it is often accompanied by surprise. Prediction errors are involved in memory updating processes that can be long-lasting. Not only nightmares but also unpleasant, and surprisingly, even neutral and pleasant dreams have the potential to contribute to trauma, affecting our waking lives in a similar way to waking traumatic experiences. We postulate that certain dreams can also be beneficial for trauma alleviation. Further, clinical evidence suggests that working with prediction errors that occurred in dreams and during our response to dreams after waking can assist in alleviating the negative effects of trauma.
... However, it is plausible that we can experience PEs or surprise in response even to internally generated dream events and sensations, not only sensations that filter into the dream from the sleeping body. For example, nightmares can surprise us when an unexpected, scary event occurs or an object appears Nielsen & Zadra, 2011;Robert & Zadra, 2014) -in fact, being woken by surprising or scary content is part of what makes a dream a nightmare (Blagrove et al., 2004). While, undoubtedly, some visual stimuli, like light and colours, can 'infiltrate' the dream, it is unlikely that many visual experiences are primarily caused by the external world. ...
Michelle Maiese: Trauma, dissociation, and relational authenticity
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Aisha Qadoos: Ambiguous loss: A loved one's trauma
Alberto Guerrero Velazquez: El trauma está en la respuesta. Hacia una visión post-causal en la definición de trauma psicológico
Clarita Bonamino, Sophie Boudrias, and Melanie Rosen: Dreams, trauma, and prediction errors
Gabriel Corda: Memoria episódica y trastorno de estrés postraumático en animales no humanos: una propuesta metodológica
María López Ríos, Christopher Jude McCarroll, and Paloma Muñoz Gómez: Memory, mourning, and the Chilean constitution
Sergio Daniel Rojas-Sierra, and Tito Hernando Pérez Pérez: Subjetividades rememorantes, marcas narrativas y trauma cultural en la construcción de memoria de desmovilizados de las FARC-EP en el AETCR Pondores
Germán Bonanni: Y después de la guerra... ¿Qué?
... 12 Nightmares are usually described by frequency, level of distress caused, and chronicity. 32,33 Research examining nightmares in children and adolescents is limited, 34 but existing work suggests that nightmares are common, especially in younger youth. Approximately 22-28% of children ages five through 11 experience nightmares, with a prevalence up to 41% for children in psychiatric care, 35,36 while 8% of older adolescents (15)(16)(17)(18) year-old) experience frequent nightmares. ...
... Yet, these expressions are not necessarily tied to affective dream experiences, at least not in healthy participants (Clé et al., 2019;Maranci et al., 2021;Rivera-García et al., 2019). With regard to physiological responses, whereas some studies have reported associations between dream affect and autonomic activation during REM (e.g., Hauri and Castle, 1973;Paul et al., 2019), evidence for these associations is weak (Nielsen & Zadra, 2011;Schredl, 2018). Thus, existing research suggests that affective dream experiences are not necessarily consistently coupled with specific behavioral or physiological responses. ...
Affective scientists traditionally have focused on periods of active wakefulness when people are responding to external stimuli or engaging in specific tasks. However, we live much of our lives immersed in experiences not related to the current environment or tasks at hand—mind-wandering (or daydreaming) during wakefulness and dreaming during sleep. Despite being disconnected from the immediate environment, our brains still generate affect during such periods. Yet, research on stimulus-independent affect has remained largely separate from affective science. Here, we suggest that one key future direction for affective science will be to expand our field of view by integrating the wealth of findings from research on mind-wandering, sleep, and dreaming to provide a more comprehensive account of affect across the wake-sleep cycle. In developing our argument, we address two key issues: affect variation across the wake-sleep cycle, and the benefits of expanding the study of affect across the full wake-sleep cycle. In considering these issues, we highlight the methodological and clinical implications for affective science.
... They also argue that in the active sleep states, motor responses and body pattern displays are only partially suppressed. Alternatively, parasomnias are involuntary episodes associated with unintended motor and behavioral activity in the transition to and from sleep (Pavlova et al., 2015); dream disturbances and nightmares such as those associated with PTSD (Campbell & Germain, 2016) are typically correlated with sleep state transitions (Nielsen & Zadra, 2010). It is unknown if cephalopods display these behaviors. ...
This paper presents some unusual behaviors observed in one single specimen of O. insularis. While nothing can be concluded rigorously from such data, we share the data and our analysis with the community, in the hope that others will be on the lookout for such rare events. Sleep is a fundamental biological function that is present in all tested vertebrates and most invertebrates. Cephalopods, such as octopuses, are cognitively complex animals that display active and inactive sleep states similar to those of vertebrates. In particular, octopuses have active sleep states during which they display sequences of camouflage patterns and modulation of basal rhythms, while remaining relatively unresponsive to outside stimuli. Some scientists have speculated that these states could be analogous to dreaming in mammals, involving episodic recall with a narrative structure. The convergent evolution of sleep in neurologically complex animals is a striking possibility, but its demonstration requires overcoming significant challenges. Towards this end, capturing abnormal sleep-associated episodes and other parasomnias in cephalopods can provide further insight into the biology of their sleep. This study reports abnormal behavioral episodes associated with transitions between activity states and sleep states observed in a male Octopus insularis. The study used continuous video monitoring to characterize the animal's activity patterns and detect rare behavioral episodes. Over the course of a month, four brief episodes (duration range: 44-290 seconds) were identified during which the octopus abruptly emerged from quiescent or active sleep, detached itself from its sleep position, and engaged in antipredator and predatory behaviors (with no predator present). The longest of these episodes resembled the species-typical response to a predatory attack, suggesting that the animal may have been responding to a negative episodic memory or exhibiting a form of parasomnia. These findings, in conjunction with recent evidence for sleep in octopuses, highlight the complexity of possible sleep-associated behavioral episodes. Investigating sleep in invertebrates is crucial to understanding the evolution of sleep across distantly related species.
... Upon awakening, full alertness is regained with a clear recall of mentation, which has a substantial negative effect on sleep quality, and could also influence one's overall psychological well-being [2,3]. The prevalence of weekly nightmares is 2-6% in the general population, which might be an indicator of further psychopathological processes; nevertheless, a greater quantity of nightmares can be observed in childhood and less in the elderly, while female nightmare reports are more frequent than male ones [2,[4][5][6]. Dysphoric dreaming is even more common in psychiatric populations [7], and indicates the severity of psychopathology [8]. Nightmares due to trauma exposure are considered distinct from idiopathic nightmares, which are clearly not related to specific traumatic experiences and their etiology remains unknown [2]. ...
Nightmare disorder is characterized by dysfunctional emotion regulation and poor subjective sleep quality reflected in pathophysiological features such as abnormal arousal processes and sympathetic influences. Dysfunctional parasympathetic regulation, especially before and during rapid eye movement (REM) phases, is assumed to alter heart rate (HR) and its variability (HRV) of frequent nightmare recallers (NM). We hypothesized that cardiac variability is attenuated in NMs as opposed to healthy controls (CTL) during sleep, pre-sleep wakefulness and under an emotion-evoking picture-rating task. Based on the polysomnographic recordings of 24 NM and 30 CTL participants, we examined HRV during pre-REM, REM, post-REM and slow wave sleep, separately. Additionally, electrocardiographic recordings of resting state before sleep onset and under an emotionally challenging picture-rating task were also analyzed. Applying repeated measures analysis of variance (rmANOVA), a significant difference was found in the HR of NMs and CTLs during nocturnal segments but not during resting wakefulness, suggesting autonomic dysregulation, specifically during sleep in NMs. As opposed to the HR, the HRV values were not significantly different in the rmANOVA in the two groups, implying that the extent of parasympathetic dysregulation on a trait level might depend on the severeness of dysphoric dreaming. Nonetheless, in the group comparisons, the NM group showed increased HR and reduced HRV during the emotion-evoking picture-rating task, which aimed to model the nightmare experience in the daytime, indicating disrupted emotion regulation in NMs under acute distress. In conclusion, trait-like autonomic changes during sleep and state-like autonomic responses to emotion-evoking pictures indicate parasympathetic dysregulation in NMs.
... In support of evidence for discontinuity in emotional processing, it has been suggested that nightmares hinder sleep-dependent corrective experience (Foa & Kozak, 1986;Levin & Nielsen, 2009). Nightmares are most often studied as clinical constructs including posttraumatic nightmares or nightmares experienced in parasomnias (Nielsen & Zadra, 2011;Robert & Zadra, 2014), but they have been understudied within the general population. Idiopathic nightmares-nightmares that do not result from psychological trauma or sleep disorders-are a common form of disturbed dreaming and occur in nonclinical samples (Köthe & Pietrowsky, 2001). ...
The current naturalistic study used a novel multilevel lagged regressed change analysis to compare how different dream types predict distinct patterns of change in negative emotion during next-day wakefulness. For up to 21 mornings, 191 adults used an online dream log to report whether they had dreamed and—if so—which emotional content categories of dream they had experienced; next, they rated their current level of negative emotion. Aligning with theory suggesting a behavior-dependent emotional processing function of dreaming, it was hypothesized that nondisturbed dreams and bad dreams would aid in emotional processing because the dreamer stays asleep, whereas idiopathic nightmares would inhibit emotional processing because the dreamer wakes up and ceases sleep-dependent processing. As predicted, nondisturbed dreams predicted next-day decreases in negative emotion. Surprisingly, idiopathic nightmares also predicted next-day decreases in negative emotion, whereas bad dreams did not pre- dict change in negative emotion. Bad dreams and nightmares within the same night pre- dicted next-day increases in negative emotion. These findings are discussed in relation to dream memory functioning as an emotional integration mechanism that can support change toward wakeful emotional equilibration.
... Dreamers undergo paralysis (Schredl, 2010), being a passive observer of dream D I J o R events (Occhionero & Cicogna, 2011;Rosen & Sutton, 2013), and feeling as if their dream-body is moving on its own (Rosen, 2015). Nightmares in which dreamers attempt to run or shout but are unable to are especially common in children (Nielsen & Zadra, 2011). Paralysis, however, may be somewhat less common than dream reports lead us to believe since it is highly salient, likely to wake us up and be remembered (Robert & Zadra, 2014). ...
The conscious experiences we have during sleep have the potential to improve our empathetic response to those who experience delusions and psychosis by supplying a virtual reality simulation of mental illness. Empathy for those with mental illness is lacking and there has been little improvement in the last decades despite efforts made to increase awareness. Our lack of empathy, in this case, may be due to an inability to accurately mentally simulate what it’s like to have a particular cognitive disorder. Dreaming can help mitigate these deficits by placing the dreamer directly into a realistic virtual simulation and thus increase their capacity for empathy. Increasing empathy would go some way towards reducing the stigma and discrimination faced by people in this group. Recent work suggests that virtual reality can increase empathy towards a variety of marginalised groups, however, this technology is limited in its ability to simulate mental illnesses such as delusions. Dreams, however, are at times virtual reality delusion simulators. They can replicate, to a reasonable degree, delusions and psychosis, and through these experiences, we can learn ‘what it’s like’ to have these conditions. It is essential that we recognise these experiences for what they are, attempt to remember and reflect on them. Instead of disregarding dreams due to their unusualness and bizarreness, we can learn from these experiences and expand our understanding of the human condition and its many forms.
... The rapid eye movements observed during REM sleep, for example, appear to reflect visual scene scanning in dreams (Arnulf, 2011;Leclair-Visonneau, Oudiette, Gaymard, Leu-Semenescu, & Arnulf, 2010;Sprenger et al., 2010) and dream visual imagery changes (Andrillon, Nir, Cirelli, Tononi, & Fried, 2015). Hypnic jerks, the sudden start a sleeper may experience as they are transitioning from wakefulenss to N1, are often accompanied by dream imagery such as falling (Nielsen & Zadra, 2010). These are very common and are experienced "by almost everyone at one time or another" (Walters, 2007(Walters, , p.1265. ...
The understanding of biological functions of sleep has improved recently, including an understanding of the deep evolutionary roots of sleep among animals. However, dreaming as an element of sleep may be particularly difficult to address in non-human animals because in humans dreaming involves a non-wakeful form of awareness typically identified through verbal report. Here, we argue that parallels that exist between the phenomenology, physiology, and sleep behaviors during human dreaming provide an avenue to investigate dreaming in non-human animals. We review three alternative measurements of human dreaming – neural correlates of dreaming, ‘replay’ of newly-acquired memories, and dream-enacting behaviors – and consider how these may be applied to non-human animal models. We suggest that while animals close in brain structure to humans (such as mammals and birds) may be optimal models for the first two of these measurements, cephalopods, especially octopuses, may be particularly good candidates for the third.
... 12 Nightmares are usually described by frequency, level of distress caused, and chronicity. 32,33 Research examining nightmares in children and adolescents is limited, 34 but existing work suggests that nightmares are common, especially in younger youth. Approximately 22% to 28% of children aged 5 through 11 years experience nightmares, with a prevalence up to 41% for children in psychiatric care, 35,36 whereas 8% of older adolescents (15-18 years old) experience frequent nightmares. ...
Sleep disturbances have been linked to suicidal ideation and behaviors in adolescents. Specifically, insomnia and nightmares are associated with current suicide risk and predict future ideation. Associations between hypersomnia, sleep apnea, and suicide remain inconclusive. Potential biological mechanisms underlying these relationships include executive functioning deficits and hyperarousal. Related psychological factors may include thwarted belongingness, perceived burdensomeness, and negative appraisals. Assessing suicide risk in patients with sleep disturbances, and vice versa, is needed. Therapeutic interventions such as cognitive behavior therapy for insomnia and imagery rehearsal treatment, as well as pharmacologic treatments, show promise in treating sleep disorders and suicidal behavior.
... 6 Sleep paralysis may sometimes be linked to false awakening, 1 a state characterized by the perception of waking up in a familiar place and starting a normal daytime routine, only to later discover of having been trapped in one's own dream or to realize of having dreamt. 9,10 This state may also be referred to as a "dreamed" awakening. Only one report describes the polysomnography features of a SOREMP hallucination without 6 sleep paralysis, 11 later referred to as a false awakening by other authors. ...
Study objectives:
To determine the polysomnography characteristics during sleep paralysis, false awakenings and lucid dreaming (which are states intermediate to REM sleep and wake but exceptionally observed in sleep laboratory).
Methods:
In 5 subjects, we captured 5 episodes of sleep paralysis (2 time-marked with the ocular left-right-left-right code normally used to signal lucid dreaming, 1 time-marked by an external noise and 2 retrospectively reported) and 2 episodes of false awakening. The sleep coding (using three seconds mini-epochs) and spectral EEG analysis were compared during these episodes and normal REM sleep as well as wakefulness in the same four among these five subjects, and vs. lucid REM sleep in four other patients with narcolepsy.
Results:
During episodes of sleep paralysis, 70.8 % of mini-epochs contained theta EEG rhythm, (vs. 89.7% in REM sleep and 21.2% in wakefulness), 93.8% contained chin muscle atonia (vs. 89.7% in REM sleep and 33.3% in wakefulness) and 6.9% contained rapid eye movements (vs. 11.9% in REM sleep and 8.1% in wakefulness). The EEG spectrum during sleep paralysis was intermediate between wakefulness and REM sleep in the alpha, theta and delta frequencies, whereas the beta frequencies were not different between sleep paralysis and normal REM sleep. The power spectrum during false awakening followed the same profile as in sleep paralysis.
Conclusions:
The predominant theta EEG rhythm during sleep paralysis and false awakenings (with rare and lower alpha rhythm) suggests that the brain during sleep paralysis is not in an awake but in a dreaming state.
... We limited the age group to 18-39 because previous studies have reported adults in their 20s and 30s experienced the most frequent nightmares. 43,44 There were no exclusion criteria, and specific psychiatric diagnoses were not excluded. The participants were asked to read a cover sheet informing them of the purpose of the study and their rights prior to completing the survey and were also required to complete the survey in a single sitting. ...
Study objectives:
This study aimed to examine psychometric properties of the Disturbing Dream and Nightmare Severity Index (DDNSI) in individuals aged between 18 and 39.
Methods:
All participants (n=674) were asked to complete the DDNSI, including the modified Nightmare Effects Survey (mNES). Additionally, 109 participants were tested for test-retest reliability after three months. Among our sample, 229 (33.9%) reported having at least one nightmare per month.
Results:
Internal consistency was evaluated for the total sample (Cronbach's α = .920) and separately for individuals reporting more than once per month (Cronbach's α = .755). Test-retest reliability after three months was .705. Convergent validity of the DDNSI with mNES was also satisfactory (r = .638, p < .001). Finally, exploratory factor analysis was conducted to explore the construct of the DDNSI, and results indicated that it consisted of two factors, nightmare frequency and nightmare distress [χ²(df) = 2.241(1) △χ² (△df) = 155.575(4), TLI = .980, RMSEA (90% CI) = .074 (0, .208), SRMR = .011].
Conclusions:
The DDNSI is a reliable measure of nightmare severity that can be used in various settings.
... Thirty percent of these hallucinations are reported as frightening [6]. Nielsen and Zadra [8] described terrifying hypnagogic hallucinations as frightening dreams similar to those occurring in REM sleep. However, in this description, the phenomenon is described as arising from sleep-onset REM sleep instead of regular REM periods and to have an immediate recollection of the disturbing content, neither of which appears to fit our case. ...
Complex nocturnal behaviors associated with sleep have many potential causes, including parasomnias and epilepsy. Although the type of event and description can frequently lead to a diagnosis, sometimes it is challenging clinically to determine the cause of the behaviors, requiring a more in-depth investigation. We report the case of a 29-year-old woman with a long history of complex abnormal behaviors and visual hallucinations at night. An extensive clinical evaluation failed to reveal a definitive cause of these episodes, prompting a 3-day epilepsy monitoring unit admission. During the stay, several events were captured on video electroencephalography, leading to a conclusive final diagnosis. This case highlights the challenging task of finding a definitive diagnosis in cases of complex nocturnal behaviors and the potential role of an admission to an epilepsy monitoring unit to help diagnose the cause of these behaviors.
... We also assessed several other affective symptoms in our NM group, which scored consistently higher in depression, state anxiety, NM-distress and poor sleep quality than did the CTL group, suggesting a significant level of pathology in the sample. These characteristics are congruent with several studies with similar NM cohorts (Nielsen and Zadra, 2011;Schredl, 2003). The fact that we found no correlations between any psychological characteristics and either fluency or perseveration supports the conclusion that there is a link between NM pathology and executive deficits that is independent of comorbid affective pathologies. ...
A recent study reported that individuals recalling frequent idiopathic nightmares (NM) produced more perseveration errors on a verbal fluency task than did control participants (CTL), while not differing in overall verbal fluency. Elevated scores on perseveration errors, an index of executive dysfunction, suggest a cognitive inhibitory control deficit in NM participants. The present study sought to replicate these results using a French-speaking cohort and French language verbal fluency tasks. A phonetic verbal fluency task using three stimulus letters (P, R, V) and a semantic verbal fluency task using two stimulus categories (female and male French first names) were administered to 23 participants with frequent recall of NM (≥2 NM per week, mean age = 24.4 ± 4.0 years), and to 16 CTL participants with few recalled NM (≤ 1 NM per month, mean age = 24.5 ± 3.8 years). All participants were French-speaking since birth and self-declared to be in good mental and physical health apart from their NM. As expected, groups did not differ in overall verbal fluency, i.e. total number of correct words produced in response to stimulus letters or categories (P = 0.97). Furthermore, groups exhibited a difference in fluency perseveration errors, with the NM group having higher perseveration than the CTL group (P = 0.03, Cohen's d = 0.745). This replication suggests that frequent NM recallers have executive inhibitory dysfunction during a cognitive association task and supports a neurocognitive model which posits fronto-limbic impairment as a neural correlate of disturbed dreaming.
... Despite our findings, the limitations to this study should be noted. First, according to previous studies (Nielsen & Zadra, 2011), important factors that may have contributed to the relationship between nightmares and suicidal ideation such as nightmare chronicity and coping style were not considered. Future studies are needed to present a more complete model underlying nightmares and suicidality. ...
Previous studies investigating the relationship between nightmares and suicidal ideation have been equivocal. In this study, we investigated the role of nightmare distress in the relationship between nightmare frequency and suicidal ideation. Study participants were 280 undergraduate students (Mage = 21.84, ± 2.14 SD, 77.9% women), who answered "yes" to experiencing nightmares in the past year. All participants completed questionnaires on nightmare frequency (Nightmare Frequency Questionnaire), nightmare distress (Nightmare Distress Questionnaire), suicidal ideation (Depressive Symptom Inventory-Suicidality Subscale), and insomnia (Insomnia Severity Index). Mediation analyses determined that nightmare distress fully mediated the relationship between nightmare frequency and suicidal ideation after controlling for insomnia. Although the total effect on the relationship between nightmare frequency and suicidal ideation (B = .21, SE = .08, p = .009), the direct effects of nightmare frequency on suicidal ideation were not significant after accounting for the effects of nightmare distress and insomnia (B = .12, SE = .08, p = .16). Additionally, the indirect effect of nightmare distress on the relationship between nightmare frequency and suicidal ideation was significant bootstrapped 95% confidence interval (CI) [0.0306, 0.1946]. Finally, gender moderated the mediated effect of nightmare distress between nightmare frequency and suicidal ideation. Our results support that both nightmare frequency and nightmare distress should be evaluated in clinical and research settings, especially for women, in the context of suicidal risk assessment.
... Nightmares are categorized into two subgroups: Idiopathic Nightmares (I-NM) and Posttraumatic nightmares (PT-NM). I-NM are caused by unknown factors (American Psychiatric Association, 2013) and according to Nielsen and Zadra (2011) they are the most common form of disturbed dreaming. Though other researchers may argue that all nightmares do not necessarily disturb sleep, and the notion of "disturbed dreaming" presupposes that nightmares cannot be a functional form of dreaming (Revonsuo, 2000b). ...
Mood regulation theories, RAT, TST
... These assumptions are in line with earlier studies showing the association between alpha activity in REM sleep and vivid dream experiences (Robert, Harry, Tyson, Melodie, & Daniel, 1982;Tyson, Ogilvie, & Hunt, 1984). Furthermore, nightmares seem to belong to a wide domain of unusual dream experiences like sleep paralysis, vivid dreaming, lucid dreaming or terrifying hypnagogic hallucinations, which usually occur during sleep-wake transitions (Nielsen & Zadra, 2011). Nevertheless, the question how the valence of these vivid dream experiences in NMs shifts toward the negative domain remains unanswered. ...
Although a growing body of research indicates that frequent nightmares are related to impaired sleep regulation, the pathophysiology of nightmare disorder is far from being fully understood. We examined the relative spectral power values for NREM and REM sleep separately in 19 individuals with nightmare disorder and 21 healthy controls, based on polysomnographic recordings of the second nights' laboratory sleep. Nightmare subjects compared to controls exhibited increased relative high alpha (10-14.5Hz) and fronto-central increases in high delta (3-4Hz) power during REM sleep, and a trend of increased fronto-central low alpha (7.75-9Hz) power in NREM sleep. These differences were independent of the confounding effects of waking emotional distress. High REM alpha and low NREM alpha powers were strongly related in nightmare but not in control subjects. The topographical distribution and spectral components of REM alpha activity suggest that nightmare disordered subjects are characterized by wake-like electroencephalographic features during REM sleep.
... Idiopathic nightmare sufferers frequently -at least once a week -experience visually vivid, intense and disturbing dreams that involve fear, anxiety, anger, sadness, disgust or other unpleasant emotions (Nielsen & Zadra, 2010). According to the International Classification of Sleep Disorders, 2nd edition (ICSD-II, 2005) these dream disturbances end in abrupt awakenings. ...
Nightmare disorder is a prevalent parasomnia characterized by vivid and highly unpleasant dream experiences during night time sleep. The neural background of disturbed dreaming was proposed to be associated with impaired prefrontal and fronto-limbic functioning during REM sleep. We hypothesized that the impaired prefrontal and fronto-limbic functioning in subjects with frequent nightmares would be reflected at the behavioral level during waking tasks as well. 35-35 Subjects with frequent nightmares and matched controls participated in Study 1, involving an Emotional Go/NoGo, an Emotional Stroop task, and a Verbal Fluency task. Nightmare subjects exhibited longer reaction times in the Emotional Go/NoGo and Emotional Stroop tasks. Moreover, they committed more perseveration errors and showed less fluent word generation in the Verbal Fluency task. Nightmare subjects showed an overall slowing irrespective of the valence of the stimuli. While the effects of sleep quality and waking anxiety were associated to these deficits in some cases, these factors could not solely explain the difference between the two groups. In Study 2, 17 subjects with frequent nightmares and 18 controls were compared by a Color-word and an Emotional, block design Stroop task in order to avoid the slow effects of emotional interference potentially caused by previous items. Nightmare subjects were characterized by an overall slowing in the Emotional Stroop task, irrespective of the valence of the stimuli. In the Color-word Stroop task, nightmare subjects were not significantly slower in comparison with controls. Our results suggest that individuals with frequent nightmares are impaired in executive tasks involving the suppression of task-irrelevant semantic representations.
Background: Posttraumatic stress disorder (PTSD), sleep disturbances, and problematic alcohol use are frequently comorbid. Research shows that individuals with more PTSD symptom severity and poorer sleep are highly susceptible to drinking alcohol to cope with negative affect. The current study examined the number and nature of different subgroups of trauma-exposed college students based on endorsed PTSD symptoms and sleep disturbances; and how such subgroups relate to drinking to cope motives. Method: The sample included 474 trauma-exposed college students (Mage = 20.69 years; 75.50% female) who completed self-report surveys. Results: Latent profile analyses revealed three subgroups: High PTSD-Sleep Disturbances (n = 71), Moderate PTSD-Sleep Disturbances (n = 135), and Low PTSD-Sleep Disturbances (n = 268). Results indicated that college students in the Low PTSD-Sleep Disturbances group endorsed the lowest amount of coping-related drinking motives; however, college students in the Moderate PTSD-Sleep Disturbances group did not endorse significantly different levels of coping-related drinking motives than college students in the High PTSD-Sleep Disturbances group. Conclusions: College students with subclinical presentations of psychopathology are at risk for endorsing risky drinking motives. As they adjust to a stressful environment with a culture of heavy drinking, providing context-relevant intervention efforts such as adaptive coping strategies, relaxation skills designed to facilitate restful sleep, and trauma-informed care may be highly beneficial for college students.
Parasomnias are defined as “undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousal from sleep.” They occur during the night, without altering the normal structure of sleep, the evolution is usually benign, with spontaneous resolution at puberty. The prevalence is variable depending on the type of parasomnia and the age of occurrence. They are classified as NREM and REM parasomnias and other parasomnias. NREM-related parasomnias are defined as recurrent episodes of incomplete awakening from NREM sleep, characterized by abnormal sleep-related complex movements and behaviors associated with various degrees of autonomic nervous system activation, inappropriate or scarce responsiveness to the external environment that are difficult to differentiate from other episodes occurring during sleep like seizures. REM-related parasomnias are an admixture of the elements of REM sleep together with wakefulness. They comprise REM behavior disorder, nightmare disorders, and sleep paralysis. REM-related parasomnias are more likely to occur later in the night. Other parasomnias include sleep enuresis that is common in childhood and associated with daytime dysfunction and psychological consequences. The management of parasomnias is different for each single disorder, but NREM parasomnias have similar pathophysiology and similar treatment, either pharmacological or non-pharmacological.
Objectives
Nightmares are extremely unpleasant and vivid recurring dreams that are accompanied with awakening during sleep. However, earlier studies were mostly conducted with children and adults, with very few studies on nightmares in older adults. This population-based study aims to investigate the prevalence of nightmares and its associated factors nightmares in the elderly.
Methods
This study utilized a subsample from the Korean Genome and Epidemiology Study (KoGES). Participants (n=2,940; mean age 63.71 ± 6.73) completed the questionnaires on nightmares(Disturbing Dream and Nightmare Severity Index; DDNSI), depression, suicidal ideation, sleep quality and stress.
Results
Among the sample, 2.7%(n=79) were classified into the nightmare group(NG), which was classified with DDNSI scores. In the age group over 70, prevalence of nightmares was 6.3%(n=37), which was significantly higher than other age groups. Marital status, employment status and family income were associated with nightmares. Additionally, NG reported significantly more sleep problems, higher suicidal ideation, depression and stress compared to the non-nightmare group(N-NG). Logistic regression analyses results indicated that the NG was 4.35 times at higher risk for depression, and 3.16 higher risk for stress, and 3.45 higher risk for suicidal ideation compared to the N-NG after controlling for covariates.
Conclusions
Our results indicate that psychological and demographic factors are associated with nightmares in the elderly. Furthermore, this population-based cohort study showed the prevalence of nightmares increased after age 70, which suggests the need for further studies of nightmares in older populations.
Approximately 5–8 % of the general population report problems with nightmares, and a sizeable proportion of individuals exposed to a traumatic event will experience frequent nightmares. Chronic nightmares can accompany a broad range of clinical conditions but may also occur in otherwise well-functioning individuals. Targeting nightmares directly can be a practical and valuable way of approaching the problem. A range of cognitive-behavioral techniques have been shown to be effective at alleviating nightmares and improvements can be achieved rather rapidly and maintained over time. Pharmacological options also exist, particularly in regards to posttraumatic stress disorder-related nightmares. A clinical vignette is presented to highlight assessment and treatment considerations.
To conduct a comprehensive and comparative study of prospectively collected bad dream and nightmare reports using a broad range of dream content variables.
Correlational and descriptive.
Participants' homes.
Three hundred thirty-one adult volunteers (55 men, 275 women, 1 not specified; mean age = 32.4 ± 14.8 y).
N/A.
Five hundred seventy-two participants kept a written record of all of their remembered dreams in a log for 2 to 5 consecutive weeks. A total of 9,796 dream reports were collected and the content of 253 nightmares and 431 bad dreams reported by 331 participants was investigated. Physical aggression was the most frequently reported theme in nightmares, whereas interpersonal conflicts predominated in bad dreams. Nightmares were rated by participants as being substantially more emotionally intense than were bad dreams. Thirty-five percent of nightmares and 55% of bad dreams contained primary emotions other than fear. When compared to bad dreams, nightmares were more bizarre and contained substantially more aggressions, failures, and unfortunate endings.
The results have important implications on how nightmares are conceptualized and defined and support the view that when compared to bad dreams, nightmares represent a somewhat rarer-and more severe-expression of the same basic phenomenon.
Robert G; Zadra A. Thematic and content analysis of idiopathic nightmares and bad dreams. SLEEP 2014;37(2):409-417.
Goal of this series of cases was to investigate lucid dreaming treatment for nightmares. Hypotheses were that lucid dreaming treatment would decrease nightmare frequency and state/trait anxiety, and improve the quality of sleep. Eight participants received a one-hour individual session, which consisted of lucid dreaming exercises and discussing possible constructive solutions for the nightmare. Nightmare frequency and sleep quality were measured by a sleep questionnaire, anxiety was measured by the Spielberger State and Trait Anxiety Inventory. At the follow-up two months later the nightmare frequency had decreased, while the sleep quality had increased slighty. There were no changes on state and trait anxiety. Lucid dreaming treatment seems to be effective in reducing nightmare frequency, although the effective factor remains unclear.
Describes strategies, techniques, and implementation of nightmare therapy for psychotherapy clients with posttraumatic stress disorder. Case examples of combat veteran trauma survivors are included. Approaches discussed include dream group, storyline alteration, story title conversion, sandplay, and face and conquer techniques. Based on a posttreatment survey administered to 25 clients, 65% of Ss reported the elimination of nightmares while the remaining 35% reported diminished distress. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Sensed presence (PRES), the illusory, often fearful impression of someone being present, is the most frequent type of imagery accompanying isolated sleep paralysis (ISP). Because of numerous similarities between PRES and social anxiety, the authors hypothesized that individuals who reported having had PRES during ISP would have higher levels of social anxiety than would either subjects who reported ISP without PRES or controls with neither experience. Forty-five university students (16 ISP + PRES, 10 ISP, 19 controls) were administered validated questionnaires measuring social anxiety, depression, and specific phobias. A one-way analysis of variance revealed that ISP + PRES subjects had higher social anxiety than ISP subjects ( p = .013). The effect size for this analysis was large (.598). However, an analysis of covariance controlling for depression and specific phobias revealed a smaller intergroup difference (effect size = .464), a finding apparently due to elevated depression scores among ISP + PRES subjects (p < .001) rather than to differences in severity of phobias (ns). (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A multivariate comparison was made among 52 recurrent, past-recurrent, and nonrecurrent dreamers aged 18–21 yrs. The participants completed measures of well-being and collected a 14-day sample of their own remembered dreams. Multivariate analysis showed that recurrent dreamers scored low on psychological well-being and reported more negative dream content. As was true in an earlier study, a single psychometric dimension, which the authors call psychological well-being, discriminated between the recurrent dream group and the other two groups over the entire set of well-being and dream content variables. As was true in two previous studies, dream archetypality was negatively correlated with a measure of neuroticism. It is concluded that in both late teenagers and older adults, recurrent dreams occur in times of stress, are accompanied by negative dream content, and are associated with a deficit in psychological well-being. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Explored the relationship of the personality measure of thin and thick boundaries to dream recall frequency and to dream content among 757 graduates and undergraduates and patients with sleep problems (aged 18–60 yrs). There was a highly significant positive correlation between thinness of boundaries, measured on the Boundary Questionnaire by R. Harrison et al (unpublished manuscript), and frequency of dream recall. A subsample of 64 frequent dreamers (7 or more dreams per week) scored significantly thinner than a group of 69 nondreamers on the Boundary Questionnaire and on each 1 of the 12 content categories of the questionnaire. Dream content was examined in smaller samples of Ss who scored either very thick or very thin. Dreams of "thin" Ss were rated significantly more vivid, more emotional, and with more interaction between characters, compared with dreams of "thick" Ss. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Retrospective estimates of nightmare frequency for a sample of 23,990 respondents to an Internet questionnaire (female: N = 19,367, mean age = 24.9 ± 10.14 years; male: N = 4,623; mean age = 25.5 ± 10.81) were evaluated as a function of age, gender, and pre- versus post-September 11, 2001. Female respondents reported more frequent monthly nightmares (4.44 ± 6.71) than did male respondents (3.39 ± 6.07), and this result was seen for all age strata younger than 60. Also, for female respondents, nightmare frequency increased from ages 10-19 to 20-39 then decreased monotonically to ages 50-59. For male respondents, nightmare frequency was stable from ages 10-19 to 30-39 then decreased to ages 50-59. An increase in nightmare frequency was observed post-September 11 only for male respondents-particularly for 10- to 29-year-olds. This increase was sustained 2 years later. These effects were maintained when dream recall was held constant. Results replicate, in a single sample, previously published gender and age effects and provide new evidence that the nightmares of males may be differentially sensitive to traumatic events for which victims and/or perpetrators are primarily male. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A multivariate comparison was made among 67 recurrent, past-recurrent, and nonrecurrent dreamers (aged 18–88 yrs). Ss collected a 14-day sample of their remembered dreams and on 2 occasions completed measures including the Eysenck Personality Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory. Multivariate and discriminant analyses show that recurrent dreamers scored low on psychological well-being (PWB) and reported more anxious, aggressive, and dysphoric dream content. Past-recurrent dreamers scored high on PWB and reported more positive dream content. A single psychometric dimension of PWB discriminated among the 3 groups over the entire set of PWB and dream content variables. Results support analytical psychology theory's assertion of the relation between dreaming and psychological adaptation. The function of dreams is discussed in relation to both their recurrence and archetypicality. (92 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In an attempt to replicate a classificatory study reported by D. Kuiken and S. Sikora (1993), 36 volunteers (aged 18–45 yrs) reported a dream that was as impactful as their most impactful dream during the preceding month and then the 1st dream that they recalled at least 4 days later. Cluster analysis revealed 5 classes of dreams, each with a characteristic profile of emotions, goals, concerns, movement styles, sensory phenomena, self-reflectiveness, and dream endings. Four of these classes substantially correspond to the dream types identified in the original study: existential dreams (distressing dreams concerned with separation and personal integrity), anxiety dreams (frightening dreams concerned with threats to physical well-being), transcendent dreams (ecstatic dreams concerned with magical accomplishments), and mundane (unimpactful) dreams. A 5th class of moderately impactful dreams, new to this study and referred to as alienation dreams, expressed emotional agitation and concerns about interpersonal efficacy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study analyzes the relationships among nightmare frequency, nightmare distress, and interference due to nightmares, sleep quality, psychopathology (anxiety and depression), and personality (neuroticism, psychoticism, and boundaries). The nightmare parameters were evaluated with the Nightmare Frequency Questionnaire (B. Krakow et al., 2000; see also record
2000-16731-002), the Nightmare Distress Questionnaire (K. Belicki, 1992b; see also record
1993-08389-001), and the Nightmare Effects Survey (Krakow et al., 2000). The sample was composed of 147 healthy students. The results demonstrated that the 2 measurements of distress (subjective distress associated with nightmares and, especially, deterioration of psychosocial functioning) were the dimensions that best related to the variables studied, although the relationships were modulated by nightmare frequency. The parameter of nightmare frequency was found to be useful as an indicator of certain personality characteristics rather than psychological perturbation. Having nightmares on a weekly basis was strongly associated with depressed mood. The knowledge about these relations is relevant not only theoretically but also as a practical guide. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Twenty participants hand-wrote reports of their dreams and waking life events and used an extensive lexicon of emotion words and types to rate the emotions experienced in each scene of each report. From these ratings, the incidence and intensity of 22 different emotion types in the two kinds of report were assessed. The incidence of emotion categories specified by a cognitive model of emotions was also assessed. Emotions were found to be present in virtually all scenes of all dream reports and only one of the 22 emotion types was never used in the ratings. The incidence of most of the emotion types was similar to that of reports of important life events. There was also evidence that the incidence of positive emotions was lower in dream reports than event reports, while the incidence of fear was higher. Specifically, the mean number of positive emotions per scene was lower and the proportion of fear was higher in dream reports than in event reports.
Prazosin is recommended for treatment of Posttraumatic Stress Disorder (PTSD)-associated nightmares. Level A. Image Rehearsal Therapy (IRT) is recommended for treatment of nightmare disorder. Level A. Systematic Desensitization and Progressive Deep Muscle Relaxation training are suggested for treatment of idiopathic nightmares. Level B. Venlafaxine is not suggested for treatment of PTSD-associated nightmares. Level B. Clonidine may be considered for treatment of PTSD-associated nightmares. Level C. The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Nefazodone is not recommended as first line therapy for nightmare disorder because of the increased risk of hepatotoxicity. Level C. The following behavioral therapies may be considered for treatment of PTSD-associated nightmares based on low-grade evidence: Exposure, Relaxation, and Rescripting Therapy (ERRT); Sleep Dynamic Therapy; Hypnosis; Eye-Movement Desensitization and Reprocessing (EMDR); and the Testimony Method. Level C. The following behavioral therapies may be considered for treatment of nightmare disorder based on low-grade evidence: Lucid Dreaming Therapy and Self-Exposure Therapy. Level C No recommendation is made regarding clonazepam and individual psychotherapy because of sparse data.
The present study investigated the prevalence and heritability of nightmares and their comorbidity with psychopathology in a sample (N = 1,318) of children, adolescents, and child and adolescent twins ranging in age from 4 to 17 years old. The prevalence of terrible nightmares was estimated to be 6.4%, which is similar to previous studies. There were marginal gender differences in this rate (7.7% for boys; 5.1% in girls), contrary to previous studies that purport higher rates for girls. There was little evidence for prevalence changes across age. Nightmares were highly heritable and attributed to an additive genetic influence (51%) and nonshared environmental effects (49%). There was little evidence for a shared genetic correlation for nightmares and generalized waking anxiety (Overanxious Disorder of Childhood). There was also a substantial and pervasive comorbid psychopathology for those parents who reported Strongly True on Item 59: My child has terrible nightmares on the 200-item parent-as-respondent, Coolidge Personality and Neuropsychological Inventory. Issues in estimating prevalence rates of nightmares were identified.
Children's role play activities are included in symptom checklists of dissociative disorders, yet little is known about the potential relation between individual differences in role play and dissociative behaviors in normative development. This issue was examined in a study of 147 children aged 3 and 4 from a nonclinical population. Parents completed the Child Dissociative Checklist (CDC; F. W. Putnam, K. Helmers, & P. K. Trickett, 1993) and a questionnaire about their child's role play, fears, behavior problems, and dreams. Children were also interviewed about these same items. Dissociation was significantly related to parent report of fears, problem behaviors, and nightmares. These results are consistent with the view that CDC scores reflect some degree of difficulty in children's lives. Children who engaged in role play, particularly children with imaginary companions, scored higher on the CDC than other children. However, role play was not related to the measures of fears or problem behaviors. The results suggest that a distinction between pathological and nonpathological dissociation is warranted, with role play activities being more closely linked to the latter. Measurement of dissociation in preschoolers is discussed.
There is an extensive range of EEG patterns associated with drowsiness. The occurrence of burst patterns with a sharp configuration or containing sharp transients was evaluated in 700 consecutive clinical EEGs of adults and children. All recordings included 16 channels of EEG and two channels of eye movements. Recordings included mostly bipolar but also referential montages. Patterns were classified by consensus and regarded as normal variants or of uncertain significance. The main reasons for referral were epilepsy or psychiatric disorders. One or more of 16 different patterns were found in 39% of all subjects. Vertex sharp waves were the most common (n=178) and were initially asymmetrical in 17 cases. Hypnagogic paroxysmal spike-wave bursts were seen in 21/165 children. Sharp transients were also prominent in generalized sharp bursts (n=21), frontocentral sharp bursts (n=3), temporal or vertex sharp waves with alpha (n=6), and beta bursts (n=11). Some drowsiness patterns containing spikes included benign sporadic sleep spikes (n=13), 6/sec spike and wave (n=2), and 14 and 6/sec positive spikes (n=10). Arch-shaped series of waves included the midline theta rhythm (n=19), rhythmical temporal discharge (n=3), and wicket spikes (n=1). Subclinical rhythmical epileptiform discharges of adults (SREDA) were found in two subjects. Burst patterns during drowsiness occur sufficiently often in routine clinical EEG recordings to warrant their careful analysis.
It was Aristotle [1] who first proposed the hypothesis that the hallucinations of madness result from aberrant functioning of those mechanisms which normally produce hallucinations during sleep, i.e. the mechanisms of dreaming. With the 1952 discovery by Aserinski and Kleitman [2,3] of REM sleep and its relationship to dreaming, it became possible to put Aristotle’s, by now somewhat hoary, hypothesis to experimental (although indirect) tests. The first such experimental study was begun by Koresko, Snyder and Feinberg [4] just 10 years ago. While the data produced by this and the subsequent investigations of the past decade can hardly be considered definitive, I think that our knowledge nevertheless has advanced significantly and that it is worthwhile here to review those studies most pertinent to possible dream-hallucination relations.
Dream disturbance sufferers are more psychologically troubled, recall fewer normal dreams, and are more responsive to their dreams than are vivid dreamers. The increased responsivity suggests an integrative failure that may be affected by the altered emotional state (increased psychopathology) of disturbed dreamers. There is reason to believe that the sleep process is related to alterations in subjective state, particularly affect, mood, or feelings. If the sleep process has been successful, it is generally agreed that one feels down, tired, and sleepy before sleep and feels refreshed after sleep. This view of sleep relates, in a general way, to the theory that dreaming is related to emotional alterations during sleep and that bad dreams are related to (and often the consequence of) altered feeling states during the day. This chapter explores the patterns and functions of nightmares in Vietnam veterans suffering from posttraumatic stress disorder. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
construct a theory of the function of psychological dreaming [the Selective Mood Regulatory Theory of Dreaming]
the theory of dream function / the core observation [the contribution of REM physiology] / mood before and after sleep / mental content before, after and during sleep / the dream's responsiveness to the emotional state of the dreamer / the relationship between mood and dreams / the relationship between mood and the physiology of sleep / problem solving: the dream mechanism for mood change (PsycINFO Database Record (c) 2012 APA, all rights reserved)
suggest that certain features of dream content might be a possible clue to at least one function of dreams / [argues] that the intensity of a preoccupation can be inferred from the frequency with which a particular dream character or dream activity appears / look at the function of dreams by constructing a continuum that I call the repetition dimension / it runs from repeated dreams to repeated themes and elements in dreams
examine what we know about traumatic dreams, recurrent dreams, repeated themes, and frequent dream elements / argue . . . that dreams are an attempt at resolving emotional preoccupations (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents a history and critical examination of sleep mentation research since the onset of electrographic laboratory methods. New, empirical sleep studies are included. Although the focus is on data, several chapters relate new research to clinical utilization of dreams and to the field of cognitive psychology. Topics explored include methodological techniques, models of sleep mentation in relation to physiological events, and the influence of several experimental variables (e.g., external stimuli, drugs, REM deprivation). (43 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The theory that psychosis and dreaming share some common underlying mechanism finds support in the observation that chronic nightmare sufferers are at increased risk for psychopathology. This connection was examined in 204 participants (aged 14–51 yrs). Ss were administered a battery of psychosis proneness and other personality scales, together with a nightmare distress scale; they also answered a single question on pleasurable mood associated with dreaming. In addition, Ss completed the Bem Sex Role Inventory, to reinvestigate previously observed gender differences in nightmare susceptibility. It was found that, among the psychosis proneness scales, the best predictor of nightmare distress was Schizotypal Personality, a mostly cognitive measure of schizotypy; this was true even after allowing for a strong influence in the data of general neuroticism. Other aspects of psychosis proneness were unrelated to nightmares. However, sex and sex role differences did make a significant contribution, with self-confessed feminine females and masculine males reporting, respectively, the highest and lowest nightmare distress. It is concluded that a unifying theme explaining the data is the schizotype's greater imaginativeness. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Study Objective: To estimate the prevalence rates of self-reported nightmares among Kuwaiti children and adolescents aged 10 to 18 years, and to examine the age and gender differences. Methods: A sample of 6, 727 school students was recruited. A self-rating scale item was used to assess nightmares' frequency. It was answered on a 5-point intensity scale, anchored by 0: No and 4: Very much. This scale had acceptable temporal stability. Point prevalence rate was computed as the summation of the percentages of responses in the two options: "Much" and Very much" during the most recent month. Results: The prevalence rates among males ranged between 6.1% (age 18) and 17.6% (age 13). The ages 13, 12, and 11 had, respectively, the highest rates. From the age 10 to 13 years, the prevalence rates were increasing steadily, but from the age 14 to 18 years, the prevalence rates were decreasing consistently. As for females, the prevalence rates ranged from 9.5% (age 11) to 17.9% (age 18). The younger groups (10-14 yrs) had a lower prevalence than the older ones (15-18 yrs). Gender differences in the mean scores on the self-reported nightmares were significant in the ages 15 to 18, in which females had significantly higher mean scores than their male counterparts. Conclusions: In a non-Western large Kuwaiti sample, self-reported nightmares are common. There is a need for comprehensive programs of guidance, counseling, or intervention. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This new edition of the book published in 1931 under the title of "Nightmare, witches, and devils," (see
6: 658) contains a new preface by the author. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In clinical practice, parasomnias are often found to run in families and to co-occur. Several studies have indicated a role of genetic factors in them. In 1990, a questionnaire (response rate, 77%) sent to the Finnish Twin Cohort, a representative population sample aged 33-60 years, surveyed the frequency of five parasomnias (sleepwalking, sleeptalking, enuresis, bruxism, and nightmares) in childhood and as adults. In assessing the phenotypic covariation and shared genetic effects between the parasomnias, we used polychoric correlations and structural equation modelling. In childhood (n = 5856 individuals), co-occurrence is highest in sleeptalking with sleepwalking (R = 0.73), nightmares (R = 0.50), and bruxism (R = 0.43). As adults (n = 8567), the results are similar (R = 0.56, 0.43, and 0.39, respectively). The analyses of shared genetic effects included 815 monozygotic and 1442 dizygotic twin pairs with complete responses on four parasomnias as adults. The strongest genetic covariation was found in sleeptalking with sleepwalking, sleeptalking with bruxism, and in sleeptalking with nightmares. The estimated proportions of shared genetic effects were 50, 30, and 26%, respectively. The present results indicate that parasomnias share some common genetic background.
Riassunto La scomparsa di riflesi spinali mono- e polisinaptici nel corso del sonno desincronizzato è legata a meccanismi inibitori esercitantesi sugli archi riflessi spinali. Questa azione di controllo viene trasmessa da centri sopraspinali al midollo spinale attraverso vie che decorrono principalmente, per quanto non esclusivamente, nei funicoli ventro-laterali.
Clinical lore and a small number of published studies report that the selective serotonin reuptake inhibitors (SSRIs) intensify dreaming. This study examines the dream effects of paroxetine and fluvoxamine in order to both increase clinical knowledge of these agents and to test an important potential method for probing the relationship between REM sleep neurobiology and dreaming in humans. Fourteen normal, paid volunteers (4 males, 10 females; mean age 27.4 year, range 22–39) free of medical or neuropsychiatric symptoms as well as of psychotropic or sleep affecting drugs completed a 31-day home-based study consisting of: 7 days drug-free baseline; 19 days on either 100 mg fluvoxamine (7 Ss) or 20 mg paroxetine (7 Ss) in divided morning and evening doses; and 5 days acute discontinuation. Upon awakening, subjects wrote dream reports, self-scored specific emotions in their reports and rated seven general dream characteristics using 5-point Likert scales. Dream reports were independently scored for bizarreness, movement and number of visual nouns by three judges. REM sleep-related measures were obtained using the Nightcap ambulatory sleep monitor. Mean dream recall frequency decreased during treatment compared with baseline. Dream report length and judge-rated bizarreness were greater during acute discontinuation compared with both baseline and treatment and this effect was a result of the fluvoxamine-treated subjects. The subjective intensity of dreaming increased during both treatment and acute discontinuation compared with baseline. Propensity to enter REM sleep was decreased during treatment compared with baseline and acute discontinuation and the intensity of REM sleep increased during acute discontinuation compared with baseline and treatment. The decrease in dream frequency during SSRI treatment may reflect serotonergic REM suppression while the augmented report length and bizarreness during acute SSRI discontinuation may reflect cholinergic rebound from serotonergic suppression.
In a sample of 1798 university undergraduates (females, n = 976; males, n = 822) 21% reported one or more episodes of sleep paralysis, and there was no significant sex difference in this regard. Most (98.4%) sleep paralysis sufferers reported at least one psychological symptom (e.g., hallucinations) accompanying their last (or only) episode. A total of 190 sleep paralysis reporters and 221 controls who did not report sleep paralysis were further tested on a battery of instruments that assessed other sleep phenomena (e.g., nightmares), psychopathology, reported physical and sexual abuse, and imaginativeness. A composite index of imaginativeness predicted both the occurrence and frequency of sleep paralysis and also the intensity of sleep paralysis symptomatology. A salience hypothesis of sleep paralysis occurrence was developed to account for these findings.
Following an historical and theoretical overview and introduction, reports on the direct psychological treatments of nightmares are reviewed. The majority of the reviewed reports are case studies, although there are several controlled and group studies. Many techniques, including desensitization, operant procedures, hypnosis, analysis, story line alteration, and “face and conquer” approaches were all noted as helpful for some subjects. Advantages and limitations of the different methods, as well as the ways the therapies impact on the anxiety, uncontrollability, perceived importance, or realism of the nightmares, are discussed. The article concludes with suggestions far both the clearer reporting of case studies are for further research.
The current study investigated the relationship between nightmare experience, psychopathology and personality in a sample of 148 Australian school students aged between 12 and 18 years. In this sample, adolescents who experienced high levels of nightmare sleeping distress also tended to experience high levels of nightmare waking distress. Adolescents who experienced higher frequency of nightmares also tended to experience higher levels of nightmare waking distress. Frequency of nightmares was not associated with nightmare sleeping distress. No significant difference for gender was found on any of the nightmare measures. All psychopathology scores intercorrelated strongly and psychopathology was associated with all three nightmare measures. Anxiety was the most commonly reported correlate of all three nightmare measures. The hypothesis that nightmare sleeping distress was predicted by personality and psychopathology was partially supported. Nightmare sleeping distress was more likely to be associated with high levels of neuroticism and with lower levels of psychoticism, but not with extraversion. However, other hypotheses predicting a mediational model for personality and psychopathology with nightmare frequency and nightmare waking distress were not supported.
The clinical relevance of marijuana withdrawal has not been established. This study is the first to document the incidence and severity of perceived marijuana withdrawal symptoms in a clinical sample of marijuana-dependent adults.
Fifty-four people seeking outpatient treatment for marijuana dependence completed a 22-item Marijuana Withdrawal Symptom checklist based on their most recent period of marijuana abstinence.
The majority (57%) indicated that they had experienced > or = six symptoms of at least moderate severity and 47% experienced > or = four symptoms rated as severe. Withdrawal severity was greater in those with psychiatric symptomatology and more frequent marijuana use.
This study provides further support for a cluster of withdrawal symptoms experienced following cessation of regular marijuana use. The affective and behavioral symptoms reported were consistent with those observed in previous laboratory and interview studies. Since withdrawal symptoms are frequently a target for clinical intervention with other substances of abuse, this may also be appropriate for marijuana.
To examine whether disrupted regulation of REM sleep propensity is implicated in nightmare (NM) pathophysiology.
Heightened REM propensity induced by REM sleep deprivation is belied by increases in REM %, REM density and the dream-like quality of dream mentation during post-deprivation recovery sleep. Compromised regulation of REM sleep propensity may be a contributing factor in the pathophysiology of frequent NMs.
A preliminary study of 14 subjects with frequent NMs (> or = 1 NM/week; 27.6+/-9.9 years) and 11 healthy control subjects (<1 NM/month; 24.3+/-5.3 years) was undertaken. Subjects completed home sleep/dream logs and underwent three nights of polysomnographic recording with REM sleep deprivation on night 2. Group differences were assessed for a battery of REM sleep and dream measures on nights 1 and 3.
Several measures, including #skipped early-night REM periods, REM latency, REM/NREM cycle length, early/late REM density, REM rebound, late-night REM% and dream vividness, suggested that REM sleep propensity was abnormally low for the frequent NM group throughout the 3-day study.
Findings raise the possibility that REM anomalies recorded from NM sufferers sleeping in the laboratory environment reflect a disruption of one or more endogenous regulators of REM sleep propensity.
Es la primera obra sistemática y clínica detallada de análisis de sueños desde umn punto de vista no-freudiano. Se toman como punto de partida dos movimientos contemporáneos para llevar a cabo el conocimiento: uno experimental, psicológico e inmiscuido con el proceso mismo del sueño; el otro, psicológico, teórico, clínico e inmiscuido primordialmente con el significado del sueño.
Rapid eye movement (REM) sleep and dreaming may be implicated in cross-night adaptation to emotionally negative events. To evaluate the impact of REM sleep deprivation (REMD) and the presence of dream emotions on a possible emotional adaptation (EA) function, 35 healthy subjects randomly assigned to REMD (n = 17; mean age 26.4 +/- 4.3 years) and control (n = 18; mean age 23.7 +/- 4.4 years) groups underwent a partial REMD and control nights in the laboratory, respectively. In the evening preceding and morning following REMD, subjects rated neutral and negative pictures on scales of valence and arousal and EA scores were calculated. Subjects also rated dream emotions using the same scales and a 10-item emotions list. REMD was relatively successful in decreasing REM% on the experimental night, although a mean split procedure was applied to better differentiate subjects high and low in REM%. High and low groups differed - but in a direction contrary to expectations. Subjects high in REMD% showed greater adaptation to negative pictures on arousal ratings than did those low in REMD% (P < 0.05), even after statistically controlling sleep efficiency and awakening times. Subjects above the median on EA(valence) had less intense overall dream negativity (P < 0.005) and dream sadness (P < 0.004) than subjects below the median. A correlation between the emotional intensities of the morning dream and the morning picture ratings supports a possible emotional carry-over effect. REM sleep may enhance morning reactivity to negative emotional stimuli. Further, REM sleep and dreaming may be implicated in different dimensions of cross-night adaptation to negative emotions.
One previous study reported that psychiatric inpatients on bedtime-only doses of tricyclic or neuroleptic drugs reported more frequent frightening dreams than did those on divided daily doses. As a further test of this hypothesis, and in order to see whether differences in frequency of frightening dreams were a function of differences in total dream recall, we administered a questionnaire to outpatients in a Veterans Administration Hospital Mental Hygiene Clinic, asking about frequency of dream recall, frequency of frightening dream recall, and doses and times of any medications taken. Questionnaire reports of medications were checked with the medical record of the patient; for 48 patients on tricyclic or neuroleptic drugs the reports agreed, and the data of these patients were analyzed. Our findings corroborated the previous report of more frequent frightening dreams in patients on bedtime-only dosage schedules (p less than .01). In addition, we found no significant difference between the two groups with respect to frequency of dream recall; thus a difference in the affect of dreams, rather than a difference in quantity of dream recall, constituted the difference between the two groups. When a patient on bedtime doses of tricyclic or neuroleptic drugs has undesirable frightening dreams, the clinician should consider a change to divided daily doses.
Twenty-seven of eighty-eight (30.7%) Parkinsonian patients on chronic levodopa or levodopa/carbidopa therapy developed drug related dream phenomena. The patients reported three separate types of new dreams which we have classified as vivid dreams, night terrors and nightmares. These dreams are correlated to the duration of levodopa therapy although the mechanism of their production is unclear.
It has been suggested by many writers that the mental activity of dreaming and waking has lawful interactions. Most often it is proposed that the four or five dreams of the night represent a continuation of the cognitive processing of affective material made salient during the previous waking period. This proposition has proved difficult to test in any formal way. Which of all the emotional stimuli of the day are likely to carry over into the dreams, and how is one to recognize them if they do? The problem of establishing the validity of the idea that a dream element is the equivalent of a waking experience has been troublesome. Dream images are so unique that unless some repetitive elements or themes can be established to exist and to have the same meaning whenever they occur, obtaining agreement on what a dream represents will be hard to establish. Most often this problem has been approached by manipulating the presleep situation to induce some known specific affect, such as sexual or aggressive feelings, or by studying the dreams following some naturally occurring, highly arousing situation. Although these methods have produced examples of dreams in which the influence of the prior waking situation is undeniably clear, the data have either not been analyzed according to the usual statistical tests or the tests have not established the lawfulness of this relation.
Of 88 patients with idiopathic Parkinson's disease, without prior psychotic symptoms, and without significant dementia, nearly half had experienced vivid dreams, hallucinations, illusions, and nonconfusional as well as confusional psychoses as side effects of chronic levodopa therapy within the previous year of treatment. It was found that 61.3% of all hallucinations were associated with preexistent or concurrent vivid dream phenomena, that all psychotic states were associated with preexistent or concurrent vivid dreams and/or hallucinations, and that nonconfusional psychotic states tended to become confusional. These findings raise the possibility that chronic levodopa therapy may result in dopaminergic kindling and support the hypothesis that chronic dopaminergic agonism may, via such a kindling mechanism, play a role in the development of some types of psychoses.
This paper describes a syndrome of psychological and physical symptoms involving body paralysis and hallucinations traditionally interpreted in Newfoundland as an attack of 'Old Hag'. Folk theories of cause and treatment are outlined based on 13 months of field research in a community on the northeast coast of Newfoundland. Data derived from the responses of 69 adults to the Cornell Medical Index (CMI) indicate that there are no significant differences in psychological or physical illness complaints between adults who have experienced the Old Hag and adults who have not had this experience. The striking similarity between the Old Hag experience and a clinical condition called sleep paralysis is analyzed, and the implications of viewing the Old Hag as sleep paralysis are discussed within the context of current theoretical issues in transcultural psychiatry.
Among 100 men alcoholics, most of the symptoms of alcohol withdrawal were relieved by further drinking.
Four examples of catastrophic dreams in which the dream action progressed to include the total destruction of the dreamer's body image are presented. This feature of total destruction of the body image possesses a special heuristic significance because it is a variance with Freund's clinical experience which helped to shape his view of the factors responsible for the creation of traumatic neurosis. He felt that nothing resembling death can ever have been experienced and therefore he dismissed the idea that the traumatic neurosis could arise a direct result of the fear of death. Each of the dreams revived a real life traumatic event which had caused a registration in the mind of a shattering experience without causing the destruction of the actual body at the same time. When the same traumatic event was revived in the dream the ego functions available at that time were evidently insufficient either to modify the traumatic event or to awaken the dreamer prior to its denouement. The powerless ego of the dreamer seemed to have been derived from the powerless ego of the patient at the traumatic moment in waking life which was carried over into the dream as a part of the representation of the traumatic event. The destruction of the body image in these dreams apparently played a role in the production of symptoms characteristic of the dissociative syndromes. On the morning following the dream three of the patients awakened in a depersonalized state and the fourth in a catatonic state.