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Nightmare frequency in patients with primary insomnia

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The present study investigated the nightmare frequency of patients with insomnia. Patients reported more often nightmares, especially when overall dream recall frequency was statistically controlled. Moreover, nightmare frequency was related to the severity of insomnia complaints. It would be interesting to study whether specific techniques for treating nightmares (imagery rehearsal therapy) are beneficial for insomnia patients with nightmares.
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Nightmare Frequency in Patients with Primary Insomnia
International Journal of Dream Research Volume 2, No. 2 (2009) 85
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Nightmares are dened as disturbing mental experiences
that generally occur during REM sleep and that often result in
awakening (ICSD-2, American Academy of Sleep Medicine,
2005). Nightmares are very common; up to 80 % of adults
reported that they had occasionally experienced night-
mares (Englehart & Hale, 1990; Schredl, Morlock & Bozzer,
1996). Representative studies indicate that about 5% of the
general population has a current problem with nightmares
(Bixler et al., 1979; Cirignotta et al., 1983, Stepansky et al.,
1998). The etiology of nightmare is modeled by a disposi-
tion-stress model. Research indicates that genetic factors,
(Hublin et al., 1999), as well as current stressors, (Schredl,
2003; Schredl et al., 2008), are related to nightmare frequen-
cy. Since stressors, for example negative live events, are
also of importance in the etiology of primary insomnia (e.g.,
Harvey, 2002), it seems logical to hypothesize that these pa-
tients should experience nightmares more often than per-
sons without insomnia. Where as the relationship between
insomnia symptoms like frequency of nocturnal awakenings
and nightmares have been shown in a large number of stud-
ies (e.g., Charney et al., 1977; Krakow et al., 1995; Ohayon,
Morselli & Guilleminault, 1997; Schredl, 2003), Ohayon et
al. (1997) stated that the prevalence of primary insomnia
were lower in the patients having nightmares compared to
the patients with insomniac complaints and no nightmares.
In this study, the occurrence of nightmares was related to
depression and anxiety disorders; both mental disorders
are often accompanied by sleep disorders. The result of el-
evated nightmare frequency in insomnia patients reported
by Hoffmann et al. (1996) can also be interpreted in that way
because their sample included patients with primary insom-
nia and patients with secondary insomnia due to a mental
disorder. On the other hand, several studies (Schredl, 1991;
Ermann, 1995; Schredl et al., 1998) demonstrated that pa-
tients with primary insomnia reported more negatively toned
dreams in comparison to healthy controls.
The aim of the present study was to compare the nightmare
frequency of patients with primary insomnia (diagnosed in a
sleep clinic in order to rule out other causes for the insomnia
symptoms) with persons without insomnia. The second aim
was to determine whether nightmare frequency was related
to severity of the insomnia complaints.
Method1.
Participants1.1.
Patients. 295 patients (178 women, 117 men) diagnosed for
primary insomnia both by polysomnographic recording of
their night sleep and by psychiatric interviews were included
in the study. Common diagnostic criteria (DSM IV, American
Psychiatric Association, 1996; ICD 10, Deutsches Institut
für Medizinische Dokumentation und Information, 1994;
ICSD-2, American Academy of Sleep Medicine, 2005) were
applied. Patients with diagnosis of mental disorders such
as major depression, dysthymia or anxiety disorder were
excluded. Sleep apnea and periodic leg movements were
ruled out by measuring nasal and oral airow, chest and ab-
domen movements, blood oxygen saturation and anterior
tibialis electromyogram in both legs. The patients mean age
was 45.8 ± 14.9 yrs.
Healthy controls. The sample included 444 persons whose
mean age was 23.5 ± 5.7 years. These 376 women and 68
men were mainly psychology students. The participants
were recruited at the Universities of Mannheim, Heidelberg,
and Landau for a study entitled “Sleep, dreams, and per-
sonality” (Schredl et al., 2003). Participants were paid for
participation.
Research instruments1.2.
The LISST sleep questionnaire (Landecker Inventar zur Er-
fassung von Schlafstörungen; Schürmann et al., 2001) is
comprised of 75 items and was constructed as a screening
instrument to detect different sleep disorders. Sum scores
Nightmare Frequency in Patients with Primary
Insomnia
Michael Schredl
Central Institute of Mental Health, Mannheim, Germany
Coresponding address:
Prof. Dr. Michael Schredl, Sleep laboratory, Central Institute of
Mental Health, PO Box 122120, 68072 Mannheim, Germany.
Email: Michael.Schredl@zi-mannheim.de
Submitted for publication: February 2009
Accepted for publication: March 2009
Summary. The present study investigated the nightmare frequency of patients with insomnia. Patients reported night-
mares more often, especially when overall dream recall frequency was statistically controlled. Moreover, nightmare fre-
quency was related to the severity of insomnia. It would be interesting to study whether specic techniques for treating
nightmares (for example; imagery rehearsal therapy) are benecial for insomnia patients with nightmares.
Keywords: Nightmare; Insomnia
Nightmare Frequency in Patients with Primary Insomnia
International Journal of Dream Research Volume 2, No. 2 (2009)86
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were computed for self-reported symptoms of insomnia (6
items), nocturnal breathing disorders (4 items), restless legs
syndrome (5 items), daytime tiredness (5 items), sleep qual-
ity (8 items) and disturbances of the sleep/wake rhythm.
The single scales followed a six-point Likert scale format
(1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = very
often, 6 = always). The item measuring nightmare frequency
was also of this six-point scale format. Sufcient internal
consistencies as well as accurate discrimination of patients
with sleep disorders (diagnosed in sleep medicine centers
including two polysomnographic procedures) have been
demonstrated (Schürmann et al., 2001). For eliciting dream
recall, a seven-point dream recall frequency scale (coded
from 0 = never, 1 = less than once a month, 2 = about once
a month, 3 = two or three times a month, 4 = about once a
week, 5 = several times a week, and 6 = almost every morn-
ing) was included in the sleep questionnaire. The dream
recall frequency scale has a high retest reliability (r = .85;
Schredl, 2004).
Procedure1.3.
The patients completed the LISST sleep questionnaire prior
to their rst diagnostic interview in the outpatient sleep cen-
ter. Subsequently, they spent two consecutive nights with
standard polysomnographic recordings (EEG, EOG, EMG,
ECG, respiratory parameters, blood oxygen saturation and
anterior tibialis EMG) in the sleep laboratory.
Statistical analyses included ANCOVAs and regression
models in order to control for age and gender (because age
and gender distributions differed between the patient group
and the healthy controls).
Results2.
Nightmare frequency2.1.
The comparison between patients with insomnia and
healthy controls in terms of nightmare frequency is depicted
in Table 1. Although the mean difference is not large, the
statistical analysis (ANCOVA with the factors diagnosis and
gender and the covariate age) yielded a signicant differ-
ence between insomnia patients and controls (F = 7.3, p =
.0070) after controlling for gender (F = 4.5, p = .0341) and
age (F = 2.8, p = .0958). The mean difference is larger for
men (see Table 1) but the interaction term of the ANCOVA
did not reach signicance (F = 2.2, p = .1361). Interestingly,
the statistical analysis showed that the difference between
insomnia patients and healthy controls regarding nightmare
frequency is even more pronounced (F = 17.8, p < .0001) if
dream recall frequency is statistically controlled (added as
second covariate).
Factors related to nightmare frequency2.2.
Nightmare frequency was not related to age, gender and
sleep quality. On the other hand, complaints regarding in-
somnia symptoms, restless legs symptoms, apnea symp-
toms, sleep/wake rhythm disturbances and daytime tired-
ness were positively correlated with nightmare frequency.
As expected, the correlation between nightmare frequency
and dream recall frequency was quite high. The regression
analysis explained 24.5 % of the variance (F = 10.4, p <
.0001) and indicated that insomnia symptoms as well as
apnea symptoms were the factors most closely associated
with nightmare frequency (in addition to dream recall fre-
quency which was introduced as a control variable).
Discussion3.
The results indicate that, as predicted, insomnia patients
report nightmares more often than controls, conrming the
ndings of more negatively toned dreams in these patients
(e.g., Schredl et al., 1998). This difference is even more
pronounced if dream recall frequency was statistically con-
trolled, i.e. the percentage of negatively toned dreams in re-
lation to the total number of recalled dreams is larger in the
patient group. In addition, nightmare frequency was related
to the severity of insomnia symptoms. To carry on this line
of research, it would be interesting to study whether the oc-
currence of current stressors solely explain the heightened
nightmare frequency in insomnia patients. Schredl (2003)
reported that although stress reduced the correlation coef-
cients between sleep quality and nightmare frequency the
correlation coefcient was still signicant. The interaction
between nightmares and insomnia symptoms can be two-
fold. First, the nightmare is, by denition, interrupting sleep
and thus increases insomnia symptoms (nocturnal awak-
enings). Second, fears that nightmares might occur during
the night impairs sleep onset and may lead to light sleep. It
would be interesting to study insomnia patients with night-
mares in the sleep laboratory in order to determine whether
the increased number of insomnia complaints is reected in
altered sleep physiology, i.e. number of brief awakenings or
arousal indices.
The signicant relationship between nightmare frequen-
cy and apnea symptoms is in line with previous research
(Hicks & Bautista, 2003; Schredl, 2008).It should be kept in
mind that sleep apnea as possible co-morbid sleep disor-
der was ruled out in this patient group. Moreover, two stud-
ies (Schredl et al., 2006; Schredl & Schmitt, 2009) clearly
demonstrated that sleep apnea patient do not report night-
mares more often than healthy controls. The hypothesis put
forward by Boerner (1855) that breathing pauses accom-
panied by oxygen desaturations cause nightmares is very
Table 1. Nightmare frequency and dream recall frequency of patients with insomnia and healthy controls (Means ± SD)
Variable Insomnia patients Healthy Controls
Nightmare frequency (Total sample) 2.39 ± 1.36 2.30 ± 1.10
Nightmare frequency (women) 2.41 ± 1.33 2.36 ± 1.10
Nightmare frequency (men) 2.36 ± 1.41 1.94 ± 1.01
Dream recall frequency (Total) 2.99 ± 1.91 4.31 ± 1.21
Nightmare Frequency in Patients with Primary Insomnia
International Journal of Dream Research Volume 2, No. 2 (2009) 87
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unlikely to be valid. So, future research has to investigate
whether breathing pauses, measured by polygraphy (am-
bulatory measurement unit) or polysomnography (sleep
laboratory), occur more often in persons with nightmares;as
a link between dream content and sleep physiology (body-
mind interaction, see Erlacher & Schredl, 2008),or whether
the subjective reporting of apnea symptoms are related to
the nightmares directly, i.e. waking up from a nightmare and
having the impression of gasping for air.
The correlation between nightmare frequency and day-
time tiredness reects the negative effects nightmares exert
on the next day (e.g., Köthe & Piotrowski, 2001). Also war-
ranting further investigation, is why restless legs symptoms,
as well as complaints regarding the sleep/wake rhythm, are
related to nightmare frequency (at least in the correlation
analyses)..
To summarize, nightmare frequency was elevated in in-
somnia patients and related to the severity of insomnia
symptoms within the patient group. From a clinical view-
point, it would be very interesting to study whether imagery
rehearsal therapy (Krakow & Zadra, 2006) which has been
shown to reduce nightmare frequency effectively is also
benecial for insomnia patients with additional nightmare
complaints. The brief intervention can easily t into the stan-
dard cognitive-behavioral therapy for insomnia.
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Variable Correlation coefcient Standardized Regression coef-
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Age -.093 .047
Gender (1 = female, 0 = male) .039 .014
Restless legs symptoms .155 ** .025
Insomnia symptoms .285 *** .250 ***
Apnea symptoms .156 ** .167 **
Sleep/wake rhythm disturbances .190 ** .013
Sleep quality .023 -.167
Daytime tiredness .206 *** .102
Dream recall frequency .428 *** .379 ***
Note. * p < .05, ** p < .01, *** p < .001
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... Auch Alpträume, die eine besonders starke Ausprägung negativer Traumemotionen aufweisen, kommen bei Insomniepatienten häufiger vor als unter gesunden Personen (J. Pagel & S. Shocknesse, 2007;Schredl, 2009c). Zudem korreliert die ...
... Häufigkeit von Alpträumen mit der Intensität der Insomniebeschwerden (Schredl, 2009c). ...
... In diesen SOREMPs war der stärkste Anstieg der Traumemotionen in Angst/Furcht, gefolgt von Freude und Begeisterung zu verzeichnen. Verglich man die späteren, nächtlichen REM-Träume bei Restless Legs Syndrom und PLMD Zur Traumerinnerung und Trauminhalten von Patienten mit Restless Legs Syndrom oder dem PLMD gibt es gegenwärtig nur wenige Untersuchungen.Schlafstörungen wie der Insomnie zusammenhängen und beispielsweise zu vermehrt negativen Traumemotionen(Ermann et al., 1993; Schredl et al., 1998) und Alpträumen(Schredl, 2009c) führen, ist es wahrscheinlich dass es solche Unterschiede auch bei RLS/PLMD-Patienten gibt. Bisher fehlen jedoch Studien, die ...
Thesis
Die vorliegende Studie verglich 447 Patienten (318 mit Restless Legs Syndrom (RLS); 129 mit Periodic Limb Movement Disorder (PLMD)) mit 208 gesunden Kontrollen bezüglich Schlafverhalten, Traumerinnerungshäufigkeit, Traumgefühlen und Trauminhalt. Die Patientengruppe zeigte in allen Parametern, die zur Evaluierung des Schlafes benutzt wurden, signifikant schlechtere Ergebnisse. Diese Erkenntnis ist stimmig mit bisher veröffentlichten Studien, die den Einfluss des Restless Legs Syndrom auf den Schlaf untersucht haben. Bezüglich der Traumerinnerungshäufigkeit konnten, trotz signifikant häufigerem nächtlichem Erwachen unter RLS/PLMD, keine Unterschiede zwischen Patientengruppe und gesunden Kontrollen ermittelt werden. Diese Erkenntnis stellt das Arousal-RetrievalModell, das häufigeres nächtliches Erwachen mit erhöhter Traumerinnerungshäufigkeit verknüpft, zumindest für die Schlafstörungen RLS und PLMD in Frage. Dieses Ergebnis bestätigt die Resultate vorrausgegangener Studien, die für Patienten mit dem Restless Legs Syndrom ebenfalls keine erhöhte Traumerinnerungshäufigkeit finden konnten. Eine Untersuchung der Traumerinnerungshäufigkeit mit Weckungen während der Rapid-Eye-MovementPhasen (REM) könnte möglicherweise andere Ergebnisse erbringen und bedarf somit weiterer Untersuchungen. Die Traumgefühle der Patientengruppe fielen in der externen Einschätzung weniger positiv und in der Selbsteinschätzung signifikant negativer aus. Auch Alpträume, die signifikant mit der RLS/PLMD-bezogenen Belastung assoziiert waren, kamen in der Patientengruppe häufiger vor. Diese Ergebnisse sind möglicherweise die Folge der unangenehmen Empfindungen des RLS, des beeinträchtigten Schlafes und der daraus resultierenden psychischen Belastung der beiden Krankheitsbilder. Demnach finden sich die Beschwerden des Tages während des Schlafes im Traumerleben wieder und würden die Kontinuitätshypothese bekräftigen. Der Trauminhalt wird von RLS/PLMD nach den Erkenntnissen dieser Arbeit nur geringfügig beeinflusst. Bei Auswertung des Trauminhaltes mithilfe eines Traummanuals konnte gezeigt werden, dass die Patientengruppe signifikant häufiger von Problemen träumte, was unter Berücksichtigung des krankheitsbedingten Leidensdrucks, mit der Zusammenfassung 87 Kontinuitätshypothese vereinbar ist. Bei der Trauminhaltsanalyse bezüglich der Bewegungen von Beinen/Armen bzw. der konkreten Nennung von Bein/Arm konnte meine Hypothese eines häufigeren Auftretens dieser in der Patientengruppe nicht bestätigt werden. Paradoxerweise kamen Bewegungen, die mit Armen assoziiert waren in der RLS/PLMD-Gruppe sogar signifikant seltener vor als in der Kontrollgruppe. Dieser signifikante Unterschied verschwand allerdings bei der Subanalyse, die ausschließlich RLS-Patienten berücksichtigte. Zur weiteren Untersuchung potentieller Unterschiede im Trauminhalt könnten in Zukunft Träume nach REM-Weckungen verglichen werden. Außerdem wäre ein interessanter Ansatz Patienten direkt nach periodischen Beinbewegungen, die für RLS und PLMD charakteristisch sind, zu wecken und zu untersuchen inwiefern diese in den Trauminhalt inkorporiert werden.
... However, studies directly linking sleep-related metacognitions with dreaming have not yet been carried out. Indirect evidence is provided by studies showing that patients with insomnia experience more negatively toned dreams [7][8][9] and more nightmares [10], as these patients more often report dysfunctional sleep-related metacognitions [2][3][4]. This might, however, also be explained by heightened stress levels in the patient group affecting metacognitions and dreaming, especially nightmares [11]. ...
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Sleep-related metacognitions play a role in the etiology of insomnia and are distressing while falling asleep. Although similar concepts, such as thought suppression, have been studied in the context of dreaming, the relationship between sleep-related metacognitions and more negatively toned dreaming due to stressful pre-sleep experiences has yet to be studied. Overall, 919 patients with various sleep disorders completed the Metacognitions Questionnaire-Insomnia (MCQ-I20), Arousal Disposition Scale (APS), and Pre-Sleep Arousal Scale (PSAS) and kept a sleep diary over seven days eliciting dream recall, nightmare frequency, and the emotional tone of their dreams. The regression analysis showed that the MCQ-I20 (small effect size) and the APS (medium effect size) were associated with nightmare frequency and negatively toned dream emotions. These findings suggest that dysfunctional sleep-related metacognitions that are active prior to sleep are also associated with more negatively toned dreaming and more nightmares—even after controlling for trait arousability. It would be very interesting to study where therapeutic strategies, such as metacognitive therapy explicitly targeting sleep-related metacognition, could also be beneficial with regard to dreams (more positive dreams and fewer nightmares).
... The results on insomnia and depression are in line with former research. 22,24,63,69 The prevalence of nightmares is significantly increased in patients with insomnia with awakenings, daytime anxiety and female gender strongly related to nightmares in insomniacs 22 and also to NMF in the present study. Scarpelli et al 2 found people that had COVID-19 differed from people that did not have COVID-19 in NMF but not in DRF. ...
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Purpose: The COVID-19 pandemic affects mental health and sleep, resulting in frequent nightmares. Therefore, identifying factors associated with nightmare frequency is important, as it can indicate mental health issues. The study aimed to investigate increases in nightmare frequency comparing the pre-pandemic and pandemic period, and identify its risk factors. Further, the mediating role of post-traumatic stress disorder symptoms between the pandemic and nightmares is explored. Patients and methods: For this cross-sectional survey data were obtained via self-rating online survey (ICOSS: details in Partinen et al, 2021), which was open to anyone older than 18 years. The final volunteer sample consisted of 15,292 participants, divided according to their nightmare frequency (high: ≥1-2 nights/week; low: <1-2 nights/week). A total of 9100 participants were excluded if answers on variables of interest were missing or receiving rewards for participation. Chi-square tests identified changes of nightmare frequency. Predictors of high nightmare frequency were assessed using logistic regression and presented as Odds Ratios. Post-hoc mediation models were used to investigate the role of post-traumatic stress symptoms (PTSS). Results: The mean age was 41.63 (SD=16.55) with 64.05% females. High nightmare frequency increased significantly from 13.24% to 22.35% during the pandemic. Factors associated with it included self-reported PTSS (OR=2.11), other mental disorders and various sleep disorders or problems. Financial burden due to the pandemic, confinement, having had COVID-19, and work situation during the pandemic were associated with nightmare frequency, those relations were partly mediated through PTSS. Conclusion: Our results display the pandemic influence on nightmare frequency, which in turn connects to multiple mental health and sleep factors. These relations were partly mediated through PTSS. The COVID-19 pandemic appears to have caused traumatization of a substantial proportion of society. Health care workers should consider nightmares in their screening routines, as it might indicate PTSS and/or other mental and sleep disorders.
... During the early stages of the pandemic, individuals with insomnia reported higher dream recall frequency, bizarreness, negative emotional tone and more frightening nightmare content compared with good sleepers (Fränkl et al., 2021;Gorgoni et al., 2021;Kennedy et al., 2021). Pre-pandemic literature suggests that individuals with insomnia experience more nightmares, with more negatively toned, bizarre and health-related dreams than good sleepers (Feige et al., 2018;Ohayon, Morselli, & Guilleminault, 1997;Sandman et al., 2015, & Schredl, 2009Schredl, Schäfer, Weber, & Heuser, 2015). Individuals with insomnia experience more dreams related to waking life stressors than good sleepers, likely reflecting their increased perception of, and rumination about, daily stressors (Fernández-Mendoza et al., 2010;Schredl et al., 1998). ...
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Dreaming and insomnia are important markers of distress in times of crisis. Here, we present a longitudinal, mixed‐methods study examining changes in dreaming between individuals with and without insomnia symptoms and their relationship to mental health during the COVID‐19 pandemic. A global survey examining insomnia symptoms, dreams and mental health was launched in April 2020 and followed participants over 12 months. Of 2214 participants, 1009 (45%) reported dream changes at baseline. A higher proportion of participants with new‐onset insomnia reported dream changes (55%) than those with pre‐existing insomnia (45%) or good sleepers (36%). Overall, thematic analysis identified key dream change themes of increased dream activity, with participants dreaming vividly, in high‐definition, and with a strong negative charge. Themes around survival, adjusting to pandemic life, meaning‐making and poor sleep quality were also noted. Linguistic Inquiry Word Count showed that individuals with insomnia used more negative words to describe their dream changes than good sleepers. Specifically, the new‐onset insomnia group used more anxious and death‐related words than those who slept well. Notably, all groups experienced a significant reduction in dream activity by 3‐month follow‐up. Lastly, dream changes were associated with worse mental health symptoms over time, and this effect was more pronounced in individuals with insomnia. Our results highlight that insomnia symptoms, especially new‐onset insomnia, are associated with more negative dream changes during collective stressful events, potentially compounding daytime distress and mental health symptoms over time. During times of crisis, dreaming and insomnia may reveal an important target for mental health interventions.
... Recently, the importance of dream research has been emphasized since dreams are believed to have crucial clinical significance. For example, research has indicated that nightmares are correlated with several mental illnesses, including depression [1], attempted suicide [2,3], insomnia [4], and (post-traumatic stress disorder (PTSD) [5]. Moreover, Siclari et al. [6] suggested that dreams could be defined as consciousness occurring despite being immobile, unresponsive, and largely disconnected from the environment, which might give cues to understanding conscious experiences. ...
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... Several studies have demonstrated that nightmares are related to suicide attempts, depression [1e4], and/or insomnia [4,5]. Therefore, the clinical significance of studying dreams is now growing in importance. ...
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Objective As connections between nightmares and various psychiatric disorders have been reported, the clinical significance of studying dream emotionality is now growing in importance. Odor presentation may be a crucial tool to study dream emotions because the olfactory bulb connects directly to the amygdala. Previous studies have demonstrated that presentation of positive/negative odors during rapid eye movement (REM) sleep affects various aspects of dreaming. Although olfactory perception can be influenced by personal experiences, the role of individual preferences in the effects of olfactory stimuli on dreaming has not yet been clarified. The purpose of the current study was to clarify the effects of odor on dreaming during REM sleep, taking individual preferences into account. Methods Phenyl ethyl alcohol (rose-like smell) airflow was presented as an experimental stimulus, and odorless airflow was presented as the control. Participants who like (n = 7) and dislike (n = 8) the odor of phenyl ethyl alcohol were presented air with and without the odor of phenyl ethyl alcohol, respectively, during REM sleep and then awakened to report and rate their dream contents. Thereafter, the transcribed dream reports were rated by independent raters. Results and Conclusion s: Participants who liked the odor of phenyl ethyl alcohol reported more emotionally negative dreams when they were presented with phenyl ethyl alcohol airflow than that with odorless airflow. In other words, the participant’s favorite odor was associated with emotionally negative dreams. These findings could be attributed to the nature of odor perception and the characteristics of brain activities during REM sleep.
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Is the dreamer with his or her bizarre dream worlds a “normal” madman at night? On the other hand, how is dreaming affected by the presence of a mental disorder like depression or schizophrenia? The findings clearly indicate that the waking-life symptoms of the patients show up in their dreams like negatively toned dream in depressed patients or bizarre dreams in patients with schizophrenia. Also in patients with sleep disorders (insomnia, narcolepsy) dreaming is altered.
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Factors affecting or inducing nightmares have been investigated repeatedly. However, little research is carried out on the behavioral consequences of nightmares. The present study thus served to investigate behavioral effects of nightmares in correlation to personality variables. 41 non-clinical participants, who suffer from about 2 nightmares per month recorded their dreams and nightmares over a 4-week period. A nightmare was defined as a dream that frightens the dreamer and could be recalled in detail on awakening. Anxiety and mood were monitored every morning. All nightmares and their behavioral consequences were noted on a questionnaire. Personality traits and life events were assessed at the beginning of the investigation. 100 nightmares were reported by the subjects over the 4-week period (range: 0–8). Following a nightmare, the subjects were significantly more anxious and were of a less stable mental condition compared to nights without nightmares. Additionally, nightmares induced physical complaints. This was considered to be an indicator that something was wrong in their lives and induced them to solve personal problems. The behavioral effects were most pronounced in subjects scoring high on neuroticism and on the number of physical complaints and low on achievement orientation and openness. The results suggest that sufferers of nightmares intend to change their lives, especially those with a neurotic-like personality.
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This study was based on a survey of a representative sample of 1000 Austrians who were questioned about their sleep and dream behavior. About two-thirds of the respondents reported that they generally recalled at least one dream per month. Dream recall frequency decreased with advancing age, but did not differ between men and women. Fifty-five percent of the respondents characterized the affective content of their dreams: 29% reported neutral, 20% positive, and 6% negative dreams. Four percent of the sample reported suffering from nightmares. These respondents more frequently reported snoring, interrupted sleep, daytime somnolence, anxiety and nervousness, depression, high dream recall, recurrent dreams, and dreaming in color. Twenty-six percent of the total sample reported that sometimes they realized during their dreams that they were dreaming. These respondents more frequently reported family problems, high dream recall, positive dream content, recurrent dreams, dreaming in color, and nightmares.
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The present study investigated the correlations among snoring, breathing pauses during sleep, and nightmare frequency in a sample of 444 healthy individuals. Breathing pauses, but not snoring, were associated with heightened nightmare frequency. Whereas the hypothesis that shortage of oxygen directly causes nightmares is not supported by the literature, novel internal stimuli might affect dream content.