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Nightmares and oxygen desaturations: Is sleep apnea related to heightened nightmare frequency?
Abstract
In the 19th century, several authors held the view that nightmares are caused by oxygen shortage. The present study was designed to study nightmare frequency in patients with obstructive sleep apnea syndrome and its relationship to respiratory parameters. A brief questionnaire was administered to 323 patients with sleep apnea syndrome before their first laboratory night. The reduction in nightmare frequency in the sleep apnea group was explained by the reduced dream recall frequency. Despite some illustrative examples of a correlation between oxygen desaturation and dream content, the respiratory parameters as measures of sleep apnea syndrome severity did not correlate substantially with nightmare frequency. Psychiatric comorbidity and an intake of psychotropic medication were associated with heightened nightmare frequency in this sample. It must be concluded that the oxygen hypothesis did not play a major role in explaining the occurrence of nightmares. As this might be partly explained by adaptation to the nightly desaturation periods, it will be fruitful to apply experimental procedures that interrupt airflow during (rapid eye movement) REM sleep for short periods in a systematic way without the knowledge of the sleeper and to then study their effects on dream content. Some patients reported a correlation between daytime stressors and nightmares, which is in line with modern etiological models of nightmares.
... Though some researchers have reported less dreams in patients with OSA, others have described that patients with OSA have increased dreams with emotional content, mainly violent and hostile (14)(15)(16)(17). It has been postulated that obstructive events during REM sleep may activate the limbic system, which may increase dreams with high emotional contents (15). ...
... The majority of previous studies that have assessed the relationship between OSA and dream recall has been retrospective. Whereas, some investigators reported less dream recall in patients with OSA and improvement of dream recall after treatment with continuous positive airway pressure (CPAP), others have demonstrated that OSA patients have increased dream recall frequency and increased dreams with emotional content, particularly aggressive and violent content (14)(15)(16)(17). Table 1 presents an overview of studies that assessed dream recall in patients with sleep-disordered breathing Initial studies that assessed dream recall at home by retrospective questionnaire scales demonstrated lesser dream recall in patients with OSA than in healthy controls (14,30). ...
... Whereas, some investigators reported less dream recall in patients with OSA and improvement of dream recall after treatment with continuous positive airway pressure (CPAP), others have demonstrated that OSA patients have increased dream recall frequency and increased dreams with emotional content, particularly aggressive and violent content (14)(15)(16)(17). Table 1 presents an overview of studies that assessed dream recall in patients with sleep-disordered breathing Initial studies that assessed dream recall at home by retrospective questionnaire scales demonstrated lesser dream recall in patients with OSA than in healthy controls (14,30). A subsequent study of 1,243 patients with OSA demonstrated higher dream recall in OSA patients than in a representative sample from the general population (31). ...
Obstructive sleep apnea (OSA) can present with or provoke various psychological symptoms. In this article, we critically review studies that have examined dreams, dream recall, and dream contents in patients with OSA. Obstructive events induce recurrent sleep fragmentation and intermittent desaturations in patients with OSA, which may trigger different parasomnias, including nightmares. Contradictory results have been reported concerning dreams in patients with OSA; while some investigators have reported less dreams in OSA patients, others have described that patients with OSA have increased dreams with emotional content, mainly violent and hostile content. Although there are reports of respiratory-related dream contents in patients with OSA, most studies that have assessed the dream contents of patients with OSA revealed that respiratory-related dream contents were unusual. A clear association between post-traumatic stress disorders, comorbid OSA, and nightmares has been reported in several studies. Further, an improvement in nightmare frequency with continuous positive airway pressure (CPAP) treatment has been shown. An inverse relationship between the severity of OSA reflected by the apnea-hypopnea index and dream recall has been demonstrated in several studies. Future studies should differentiate between patients with non-stage specific OSA and patients with rapid eye movement (REM) predominant OSA.
... When the effect of current stress (subjective stress measured via questionnaire) was controlled statistically, the difference in DRF between sleep apnea patients and healthy controls was no longer significant, indicating that psychological factors might explain the findings since there was no significant correlation with symptom severity [respiratory disturbance index (RDI), oxygen saturation nadir]. Whereas Schredl et al. [23] also reported heightened DRF in OSAS patients, Schredl et al. [25], in a large sample (N=309), found a reduction in DRF. Interestingly, Carrasco et al. [2] reported a decrease in dream recall percentage after induced REM awakenings during continuous positive airway pressure (CPAP) treatment nights in comparison to the REM awakening nights prior to therapy, despite the well-known REM rebound effect. ...
... In a student sample, snoring was not related to nightmare frequency [7]. Schredl et al. [25], on the other hand, found a decreased nightmare frequency in OSAS patients compared with healthy controls, a finding that is likely explained by the lower DRF in this sample. ...
... A total of 1,706 patients (452 women, 1,254 men) diagnosed with OSAS (N=1,583), obstructive snoring (N=92), UARS (N=30), or Cheyne-Stokes breathing pattern (N=1), both by polysomnographic recording of their night sleep and by clinical interviews, were included in the study. The data of 246 patients were reported in Schredl et al. [25]. The patients' mean age was 55.3±12.5 years. ...
Question of the study
There are conflicting findings regarding dream recall frequency (DRF) in patients with sleep-disordered breathing: Various studies have reported less, equal, or higher DRF in comparison with healthy controls. Although more negatively toned dreams were found in these patients, nightmare frequency had not been found to be increased in a previous study. This study concerned whether DRF or nightmare frequency was altered in patients with sleep-disordered breathing without other comorbid diagnoses and whether disorder-related parameters, comorbidity, or drug intake was associated with DRF and nightmare frequency.
Patients and methods
The present study assessed home DRF and nightmare frequency via two rating scales in 1,706 patients with sleep-disordered breathing. These data were compared with those of healthy control samples from other studies.
Results
In comparison with the control group, a reduced DRF was found that was not associated with respiratory parameters or comorbidity. Similarly, nightmare frequency was reduced, and one might speculate whether these findings can be explained by cognitive dysfunction, which is often found in patients with sleep-disordered breathing. Use of antidepressants and psychiatric comorbidity were associated with heightened nightmare frequency.
Conclusions
Future studies should include current medication intake, measures of cognitive functioning, and sleep parameters in order to explain reduced DRF and reduced nightmare frequency in patients with sleep-disordered breathing.
... Lucid dreaming is a non-pathological variant of normal REM dreaming, in which one is aware of dreaming while continuing to sleep. 45 [59][60][61] However, among patients with obstructive sleep apnoea, those with a higher apnoea-hypopnea index specifically in REM sleep tend to have more nightmares, 62 and patients who have both nightmares and sleep apnoea report a reduction in nightmares after starting positive airway pressure therapy. 62 Notably, the dramatic REM sleep rebound observed when starting positive airway pressure therapy in patients with severe obstructive sleep apnoea is not associated with increased dreaming, and the ventilator is not featured in patients' dreams. ...
... 62 Notably, the dramatic REM sleep rebound observed when starting positive airway pressure therapy in patients with severe obstructive sleep apnoea is not associated with increased dreaming, and the ventilator is not featured in patients' dreams. 58 Studies assessing dream recall have reported inconsistent results, including higher, 63,64 lower, 61 or similar 58 dream recall in patients with obstructive sleep apnoea compared with control participants. Additionally, individual dreams of such patients appear to have more anxiety-filled, violent, unpleasant, and realistic content than those of controls. ...
Dreams are experiences that occur during sleep, while we are disconnected from the environment. Thanks to recent progress in neuroimaging techniques, it is now becoming possible to relate dream features to specific patterns of brain activity. Some conditions occurring in patients with neurological disorders, such as lucid dreams and parasomnias, not only have diagnostic value, but also offer a window into the dream process. They show that dreaming is reflected in physiological signals, behaviours, and brain activity patterns, and that the body can enact dream content. Yet, the dream body can also be distinct from the real body; in their dreams, patients with congenital paraplegia can walk, those with sleep apnoea rarely suffocate, and phantom limb pain can disappear. These conditions provide valuable models for future studies investigating the mechanisms that underlie oneiric experiences.
... The findings in this study suggest that nightmares may be triggered by awakenings during sleep caused by breathing irregularities, aberrant movements or hyperarousal and that the more frequent the arousals, the more likely a dream recall. However, Schredl et al., [44] found no significant correlation between the respiratory disturbance index or the periodic limb movements index and nightmare frequency. Phelps [42] and Schredl [44] agree that arousal alone is insufficient and that pre-existing stress is required for nightmares but their work suggests that terrifying dreams at night and flashbacks during the day may be related waking phenomena. ...
... However, Schredl et al., [44] found no significant correlation between the respiratory disturbance index or the periodic limb movements index and nightmare frequency. Phelps [42] and Schredl [44] agree that arousal alone is insufficient and that pre-existing stress is required for nightmares but their work suggests that terrifying dreams at night and flashbacks during the day may be related waking phenomena. Both are susceptible to suppression by cannabinoids [2,45]. ...
The cannabinoids, Δ9 tetrahydrocannabinol and its analogue, nabilone, have been found to reliably attenuate the intensity and frequency of post-traumatic nightmares. This essay examines how a traumatic event is captured in the mind after just a single exposure and repeatedly replicated during the nights that follow. The adaptive neurophysiological, endocrine and inflammatory changes that are triggered by the trauma and that alter personality and behavior are surveyed. These adaptive changes, once established, can be difficult to reverse. But cannabinoids, uniquely, have been shown to interfere with all of these post-traumatic somatic adaptations. While cannabinoids can suppress nightmares and other symptoms of the post-traumatic stress disorder, they are not a cure. There may be no cure. The cannabinoids may best be employed, alone, but more likely in conjunction with other agents, in the immediate aftermath of a trauma to mitigate or even abort the metabolic changes which are set in motion by the trauma and which may permanently alter the reactivity of the nervous system. Steps in this direction have already been taken.
... Obstructive Sleep Apnea Syndrome (OSAS) is one of the most common and important disorders of sleep and diagnosed by demonstrating a sufficient number of obstructive apneas or obstructive hypopneas [4]. There are a number of studies about nightmare frequencies and bad dreams in OSAS patients but results do not reveal any clear evidence about relationship between OSAS severity and emotional content of dreams [5][6][7]. ...
... Whereas there were no differences found between the groups in terms of length, weight, body mass index and waist circumference measurements it was determined that the measurements of neck circumference had been higher in COSAS group compared to ROSAS. It was determined that REM dependent OSAS patients had been more obese [6,13]. In the corresponding literature no studies that contain only the difference of neck circumference just as in the case of our study hold place. ...
... The Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) is characterized by the deposition of the tongue in the side walls of the oropharynx and soft palate, which promotes a collapse of these structures and reduction or absence decreased oxygenation would have an increased prevalence of nightmares, but respiratory parameters in patients with OSAHS showed that they did not correlate significantly with the frequency of nightmares 12 . ...
... A detailed study of the relationship between arousals and REM sleep parameter was not performed, and the automatic analysis of routine diagnostic procedures are not valid. In addition, the AHI and oxygen saturation are a rough measure for the number of relevant desaturations per night 12 . ...
Purpose
: to evaluate some polysomnographic parameters of patients that were referred to use mandibular protusion device (MPD).
Methods
: we studied, retrospectively, data from medical records with items that made up polysomnography of 124 patients aged between 25-77 years, that were not having any treatment for OSAHS. The study was approved by the Ethics Committee of origin institution (CAE number 0378.0.133.000-10).
Results
: 46.8% of respondents had mild apnea, snoring and most had poor sleep efficiency. Almost all of these patients had OSAHS. The lower oxygen saturation during the test ranged from 60% to 97%, with more than four fifths of the sample rates below 90%.
Conclusion
: there was no significant relationship between rates of apnea and the levels of oxyhemoglobin saturation. Sleep efficiency was directly related to the severity of OSA, with statistical evidence; oximetry can be a valuable tool for the diagnosis of OSA, but cannot be sole source to refer to the severity of the syndrome, REM sleep was poor in most investigated, and this was significantly related to sleep efficiency.
... Researchers have investigated correlations between nightmares and anxiety (Hersen, 1971, Wood & Bootzin, 1990, post-traumatic stress disorder (PTSD) (Mellman, David, Bustamante, Torres, & Fins, 2001), major depression (Agargun, et al., 1998), bipolar disorder (Beauchemin & Hays, 1995), dissociative disorders , schizotypy (Claridge, Clark & Davis, 1997;Levin, 1998), borderline personality (Clarigde, Davis, Bellhouse & Kaptein, 1998;Levin & Raulin, 1991), neurotic psychopathology (Berquier & Ashton, 1992) and psychosis (Hartmann, 1984;Fenning, Salganik & Chayat, 1992). Considerable work has also been conducted on investigating nightmare incidents and pathological correlates such as sleep disordered breathing SDB and snoring (Krakow , Haynes , Warner et al., 2004), obstructive sleep apnoea OSA (Krakow, Lowry, Germain et al., 2000); Parkinson's disease (Kumar, Bhatia & Behari, 2002), epilepsy (Silvestri, DeDomenico, Mento et al., 1995), and asthma ( Schredl, Schmitt, Hein, Schmoll, Eller & Haaf, 2006). ...
... Several researchers have proposed that nightmares arise due to the lack of oxygen (Janson, Gislason, Boman, Hetta & Roos, 1990;Klink & Quan, 1987;Wood, Bootzin, Quan & Klink, 1993). However, Schredl (2006) investigated nightmare frequency in patients with OSA. He administered a brief questionnaire to 323 patients with OSA and found that the mean monthly nightmare frequency was 1.34 (SD = 4.04) which was less than healthy controls who reported a mean monthly nightmare frequency of 1.61 (SD = 3.02). ...
... Questionnaire studies that applied a retrospective dream frequency scale with high retest reliability 45 have yielded mixed results. Whereas Schredl and colleagues 46 reported increased dream recall frequency in a sample of 44 sleep apnea patients, a second study 47 found lower dream recall frequency in patients (N 5 309) than in healthy controls. A third study 10 found no differences at all. ...
... The first systematic study of nightmare frequency in sleep apnea patients (N 5 309) found that, on average, nightmares occurred about once per month in the patient group, which was comparable with the mean of the healthy controls after correcting for age, gender, and overall dream recall frequency. 47 Moreover, nightmare frequency was not related to a RDI or the oxygen saturation nadir. Solely the presence of a psychiatric comorbidity, such as depression or anxiety disorder, was associated with heightened nightmare frequency in this patient group, 47 a finding that is in line with studies of psychiatric patients. ...
Dreaming is defined as mental activity that occurs during sleep. This article reviews the major findings of dream studies performed in patients with sleep disorders. Dream recall is heightened in patients who have insomnia and their dreams reflect current stressors. Although breathing-related dreams in sleep apnea patients are rare, deregulation of the rapid eye movement sleep system in narcolepsy also manifests in dreams, which are more bizarre and more negatively toned than in healthy persons. The number of studies in this young and growing field is small, however, and further research is needed to confirm and expand the reviewed findings.
... Most of the previous studies that have examined the effect of OSA on dream recall have been retrospective in nature and have reported contradictory results. Although some investigators have reported less dream recall in OSA patients and normalization of dream recall occurred following continuous positive airway pressure (CPAP) therapy, others have reported that OSA patients have more dreams with emotional content, particularly violent and aggressive content [5][6][7][8]. Only a limited number of studies have assessed nightmares in OSA patients, and the results have been contradictory [7,[9][10][11]. ...
... Although the REM duration was not different between the OSA patients with and without nightmares, the OSA patients with nightmares had a significantly higher AHI during REM sleep compared with the OSA patients without nightmares. Previous studies have shown that OSA patients with a higher AHI report a significantly lower frequency of nightmares [5,22]. Because nightmares are an REM-related parasomnia [18], they are likely to occur during REM sleep, which is usually suppressed in patients with severe OSA. ...
Objective:
To assess the characteristics of obstructive sleep apnea (OSA) patients with nightmares and the effects of continuous positive airway pressure (CPAP) therapy on nightmares.
Methods:
Consecutive patients referred with a clinical suspicion of OSA underwent attended overnight sleep studies. OSA and nightmares were diagnosed according to the American Academy of Sleep Medicine (AASM) criteria, and CPAP titration was performed in accordance with the AASM guidelines. A follow-up visit was performed 3months later, and the patients with nightmares were divided into two groups: group 1 used CPAP with good compliance, whereas group 2 refused CPAP treatment and did not use other alternative treatments for OSA.
Results:
The study included 99 patients who had been diagnosed with OSA with nightmares. Their mean age was 47.2±11.2years, and they had a mean apnea-hypopnea index (AHI) of 36.5±34.3/h. Also included were 124 patients with OSA without nightmares. The mean age of these patients was 45.4±13.9years, and they had a mean AHI of 40.2±35/h. The patients with nightmares had a significantly higher AHI during rapid eye movement sleep (REM) compared with the patients without nightmares (51.7±28.1 vs 39.8±31.9/h). Logistic regression analysis revealed that the REM-AHI and interrupted sleep at night were independent predictors of nightmares in the OSA patients. Nightmares disappeared in 91% of the patients who used CPAP compared with 36% of patients who refused to use CPAP (p<0.001).
Conclusion:
Nightmares in OSA patients are associated with a higher REM-AHI. CPAP therapy results in a significant improvement in nightmare occurrence.
... US$1.00 = HK$7.80 the association between nightmares and sleep apnea in adult populations were conflicting. [57][58][59][60][61] Some studies reported that nightmare frequency was not related to snoring 57,58 and objective measures of sleep apnea syndrome severity, 59 whereas other studies on patients with PTSD suggested that successful treatment of sleep apnea was associated with a significant reduction in nightmares. 60,61 Furthermore, in our study, frequent nightmares were found to be significantly associated with several indexes of impaired sleep quality, including morning unrefreshness and daytime fatigue. ...
... US$1.00 = HK$7.80 the association between nightmares and sleep apnea in adult populations were conflicting. [57][58][59][60][61] Some studies reported that nightmare frequency was not related to snoring 57,58 and objective measures of sleep apnea syndrome severity, 59 whereas other studies on patients with PTSD suggested that successful treatment of sleep apnea was associated with a significant reduction in nightmares. 60,61 Furthermore, in our study, frequent nightmares were found to be significantly associated with several indexes of impaired sleep quality, including morning unrefreshness and daytime fatigue. ...
To determine the prevalence of frequent nightmares and their correlates in a large community-based cohort of middle-aged Hong Kong Chinese.
A 2-phase design involving a cross-sectional survey of 8558 subjects (men, 47.6%) with a mean age of 40.9 years (SD 5.5, range 20-78) and subsequently followed by a detailed clinical evaluation of the psychopathology and personality profile of 252 subjects.
Community.
N/A.
The prevalence of frequent nightmares, as defined by at least once per week, was 5.1%. Female sex, low monthly family income, insomnia symptoms, sleep-disordered breathing symptoms, and sleep-related daytime consequences were significantly associated with nightmare frequency. The risk of having a psychiatric disorder was 5.74 times greater for subjects with frequent nightmares (95% confidence interval 2.03-16.26), especially mood disorders (odds ratio = 15.57, 95% confidence interval 3.77-64.37). After exclusion of concomitant psychiatric morbidities, subjects with frequent nightmares still scored significantly higher on neuroticism in the personality scale (p < 0.05).
Frequent nightmares were not uncommon in the general population and were associated with a constellation of factors, including sociodemographic characteristics and comorbid sleep and psychiatric disorders. Moreover, frequent nightmares were independently related to the neuroticism personality trait, irrespective of psychiatric diagnosis. Prospective studies should be conducted to investigate various predisposing, precipitating, and perpetuating factors and the associated repercussions of nightmares.
... Previously published data have described a considerably lower rate of nightmares in patients with OSA and a higher AHI [81,82]. Because nightmares appear during REMS [83], they are usually inhibited in individuals with severe OSA. ...
Purpose: This article focuses on recent evidence linking Rapid eye movement (REM) obstructive sleep apnea (OSA) (REMOSA) to neurocognitive dysfunction and mood changes, the proposed mechanisms for increased risk of neurocognitive dysfunction in REMOSA, and future research prospects.
Methods: PubMed and Google Scholar records were examined for articles utilizing pre-defined keywords. In this work, we mainly included studies published after 2017; nevertheless, critical studies published prior to 2017 were considered.
Results: REMOSA is an under-recognized stage-related sleep-disordered breathing in which obstructive respiratory events happen chiefly in stage REM. The disorder is commonly seen amongst younger patients and females and has recently been linked to cardiometabolic complications. Although less symptomatic than non-REMOSA and non-stage-specific OSA, current findings indicate that REMOSA may have neurocognitive repercussions and mood changes and could be linked to insomnia, increased dreams, and nightmares.
Conclusion: Currently available evidence indicates that REMOSA may present with insomnia and nightmares and could affect cognitive function and mood.
... Additionally, awakenings from obstructive events often occur with sympathetic nervous system activation, with associated symptoms of racing heart, shortness of breath, and anxiety, all of which could worsen the experience of a nightmare [47]. OSA has been associated with nightmares even in individuals without PTSD, often with content related to suffocation, choking, drowning, strangulation, burial, and death [48][49][50][51]. A study of patients with OSA who slept in a laboratory before and after starting continuous positive airway pressure (CPAP) were awakened after the beginning of every REM period for dream reports. ...
Obstructive sleep apnea (OSA) and post-traumatic stress disorder (PTSD) are often co-morbid with implications for disease severity and treatment outcomes. OSA prevalence is higher in PTSD sufferers than in the general population, with a likely bidirectional effect of the two illnesses. There is substantial evidence to support the role that disturbed sleep may play in the pathophysiology of PTSD. Sleep disturbance associated with OSA may interfere with normal rapid eye movement (REM) functioning and thus worsen nightmares and sleep-related movements. Conversely, hyperarousal and hypervigilance symptoms of PTSD may lower the arousal threshold and thus increase the frequency of sleep fragmentation related to obstructive events. Treating OSA not only improves OSA symptoms, but also nightmares and daytime symptoms of PTSD. Evidence suggests that positive airway pressure (PAP) therapy reduces PTSD symptoms in a dose-dependent fashion, but also presents challenges to tolerance in the PTSD population. Alternative OSA treatments may be better tolerated and effective for improving both OSA and PTSD. Further research avenues will be introduced as we seek a better understanding of this complex relationship.
... Previous studies have shown that OSA patients with a higher AHI report a significantly lower frequency of nightmares [67,68]. Because nightmares are a REM-related parasomnia [69], they are likely to occur during REM sleep, which is usually suppressed in patients with severe OSA. ...
Obstructive sleep apnea (OSA) is a breathing-related sleep disorder that is associated with substantial morbidity and disturbed quality of life. It is a systemic disorder that is associated with a wide range of comorbid abnormal behavioral symptomatology. OSA usually presents with snoring, daytime sleepiness, and choking attacks during sleep. However, the disorder may present with unusual presentations such as behavioral, psychiatric, and neurocognitive abnormalities, or abnormal movements disorders during sleep. Additionally, OSA may worsen comorbid psychiatric and behavioral disorders. Therefore, it is imperative for healthcare providers to have the knowledge and clinical skills to recognize the unusual presentation of OSA, particularly, changes in behavior, and to recognize the interaction between OSA and its comorbidities, which may affect behavior. This chapter discusses the association between OSA and psychiatric and behav- ioral disorders, which may influence the presentation of OSA.
... In general, among people who experience nightmares, those who are anxious and depressed are more likely to experience this problem and even suffer from more psychological effects. Research shows that nightmares are also linked to suicide (Hublin et al. 1999;Schredl et al. 2006;Schredl 2009;Hasler and Germain 2009). ...
Spices have been added to foods for centuries as flavors, preservatives, and colors and have also been used in traditional medicine in various countries to treat many diseases. Spices play an important role in human health and can be considered as the first functional foods. Although the amount of spices consumed is very low compared to many other foods, the role of spices in the daily diet should not be underestimated due to their health properties. Saffron, ginger, cinnamon, and turmeric are four globally common spices that have been widely used owing to well-known medical benefits in different traditional medicine systems, including Ayurveda, traditional Chinese, and Persian medicine since ancient times. Some general or specific health benefits of these spices include anti-inflammatory, antioxidantAntioxidant, antimicrobial, anti-diabetic, and antihypertensive activities, which have potential protective properties against some ailments such as cancer, type 2 diabetesDiabetes, neurodegenerative and cardiovascular diseases. Recent scientific studies on the therapeutic properties of these common spices have been reviewed in this chapter.
... In general, among people who experience nightmares, those who are anxious and depressed are more likely to experience this problem and even suffer from more psychological effects. Research shows that nightmares are also linked to suicide (Hublin et al. 1999;Schredl et al. 2006;Schredl 2009;Hasler and Germain 2009). ...
Nowadays, there is an ever-increasing trend in the case of nutraceuticals and superfoods as a result of growing concerns about the effects of diet on health. Nutraceuticals are natural biologically active compounds extractable from various food sources. In contrast, a superfood is any fresh or processed food claimed to have particular health-promoting attributes and/or can decrease the risk of chronic disease further than its basic nutritionalNutritional function. Different studies have shown that the nutraceuticals and superfoods have various beneficial physiological effects, and their consumption can reduce the risk for disease development or can even cure some diseases because they are rich sources of a wide range of bioactiveBioactive molecules and specific nutrients. Some examples of nutraceuticals and superfoods are curcumin, pomegranate, camel milk, bioactive peptides, and walnut, which their potential health benefits and applications for the development of functional foodFunctional food products with health-promoting properties have been studied in the present chapter.
... In der erst genannten älteren Studie von Schredl und Kollegen war ein hoher RDI mit einer Reduktion der Traum-Bizarrheit sowie realistischeren und weniger intensiveren Träumen assoziiert; die am geringsten gemessenen O2-Sättigungen korrelierten u.a. mit positiven Emotionen in den Träumen (Schredl et al. 1999 Abschließend ist zu erwähnen, dass in der Literatur auch von Einzelfällen berichtet wird, in denen die Apnoe-Patienten unter häufigen und intensiven Albträumen leiden und die Trauminhalte zudem atmungsbezogen sind (Schredl et al. 2006;Pagel und Kwiatkowski 2010 Hwang et al. 2011, Copyright © 2011 Gallina et al. 2010, © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Creative Commons Attribution Non-Commercial No Derivatives License) assoziiert ist, bzw. die häufig auftretenden hypoxischen Zustände die Ursache sein könnten (Mutlu et al. 2015 Castronovo et al. 2014;Kumar et al. 2012;Chen et al. 2015;Kumar et al. 2014b Regionen (Zhang et al. 2013;Li et al. 2016;Liu et al. 2018;Zhang et al. 2015;Park et al. 2016aPark et al. , 2016bSong et al. 2018;Li et al. 2015;Santarnecchi et al. 2013;Peng et al. 2014 (Zhang et al. 2013;Li et al. 2016;Liu et al. 2018). ...
Kurzzusammenfassung 1. Hintergrund und Ziele Ziel der vorliegenden Arbeit ist es, einen Überblick über neurophysiologische Auswirkungen des Krankheitsbildes „obstruktive Schlafapnoe“ (OSA) zu geben sowie darüber hinaus deren Pathogenese und klinische Manifestationen darzustellen. Die verwendeten Studien werden bezüglich ihrer Evidenz bewertet, um ein umfassendes Bild der potenziellen Folgen zu erhalten, die diese schlafbezogene Atmungsstörung auf Struktur, Aktivität und Metabolismus des Gehirns der betroffenen Patienten hat. 2. Methoden Die Suche nach Publikationen, wissenschaftlichen Artikeln und Büchern zur Thematik erfolgte überwiegend mittels elektronischer Datenbankrecherche. In Anlehnung an die Empfehlungen des Cochrane Instituts zur Literaturbewertung sowie anhand eines selbst erstellten Bewertungssystems wurden Meta-Analysen, Querschnittsstudien, Fall-Kontroll-Studien, Kohortenstudien sowie tierexperimentelle Studien ausgewählt und kritisch bewertet. Unter Berücksichtigung der entsprechenden Studienqualitäten konnten dann allgemeine Schlussfolgerungen gezogen werden. 3. Ergebnisse und Beobachtungen Da die Studienlage zur vorliegenden Thematik sehr umfangreich ist, sollen in dieser Kurzzusammenfassung nur die wesentlichen Aspekte genannt werden. Zerebrale Anomalitäten sowie neurophysiologische Defizite bei OSA-Patienten entstehen primär durch die pathologischen Bedingungen intermittierende Hypoxie und Schlaffragmentierung. Beide Faktoren führen über molekulare und zelluläre Signalwege zu anatomisch-strukturellen, funktionellen, biochemisch-metabolischen und elektrokortikalen Veränderungen im Gehirn der Betroffenen. Gemessen werden konnten etwa, um einige Beispiele zu nennen, Volumenveränderungen bestimmter Hirnareale, lokal veränderte Metabolitkonzentrationen, anomale Aktivierung und Vernetzung bestimmter Hirnregionen sowie Abweichungen im EEG-Rhythmus und der Schlafarchitektur. Neben dem Hauptsymptom der extremen Tagesschläfrigkeit lassen sich eine Reihe weiterer klinischer Dysfunktionen und Krankheitsbilder auf die gemessenen Abweichungen zurückführen. So gibt es Assoziationen mit Störungen der Sinneswahrnehmung, mit neurologischen Entitäten wie Alzheimer, Parkinson, Epilepsie, Kopfschmerzen oder Depressionen sowie mit der Beeinträchtigung kognitiver Funktionen. 4. Schlussfolgerungen Zusammenfassend ist festzuhalten, dass das Krankheitsbild OSA weitreichende Auswirkungen variabler Tragweite auf die Neurophysiologie der Betroffenen haben kann. Um der Entstehung irreversibler neurologischer Schäden und kognitiver Defizite bei OSA-Patienten vorzubeugen bzw. deren Ausmaß abzuschwächen, ist daher eine frühzeitige Eliminierung der pathologischen Bedingungen intermittierende Hypoxie und Schlaffragmentierung mittels adäquater Therapie von essenzieller Bedeutung.
... However, more dreams with emotional content, particularly violent and aggressive dreams, in OSA patients were found by others. [2][3][4][5] Previous study also found that severe sleep apnea can present with dream enacting behaviors and unpleasant dreams and could be eliminated with the therapy of continuous positive airway pressure (CPAP). [6] In a follow-up study on patients with severe OSA, Carrasco et al also demonstrated a decrease in the dream recall rate during the first night of CPAP therapy as well as the next 2-year CPAP treatment. ...
Introduction:
Dreaminess is one of the common symptoms of sleep disorders and often leads to complaint of poor sleep quality and morning fatigue. Literatures on the relationship between obstructive sleep apnea (OSA) and dreams have been reported with contradictory results. In this case report, we identified a moderate OSA related dreaminess that was successfully treated by continuous positive airway pressure (CPAP).
Patient concerns:
We present a case of a 47-year-old woman who was bothered by all-night dreaminess for over 20 years.
Diagnosis:
An overnight polysomnography (PSG) examination showed the apnea-hypopnea index (AHI) was 21.7 events/hour and the rapid eye movement (REM)-AHI was 46.3 events/hour. The patient was diagnosed with moderate OSA.
Interventions:
The patient received auto CPAP therapy.
Outcomes:
The symptoms of dreaminess and daytime functioning significantly improved after CPAP treatment. During the 4-month follow up, 3 CPAP titrations showed that OSA events and OSA related REM interruption almost disappeared. On the night of PSG diagnosis, only 1 non-rapid eye movement sleep 3 (N3) episode occurred before the first REM episode. Nevertheless, N3 episodes were observed before the majority of REM episodes on all three nights of CPAP titration.
Conclusion:
This case suggests that specific REM related OSA could be the main reason for dreaminess symptoms and could be successfully treated by CPAP. The identification of OSA, especially for mild-moderate OSA, has not received enough attention in the management of complaints of dissatisfactory sleep issues. We believe this case has educational value in clinical practice.
... One study of patients with PSG-confirmed OSA found that respiratory parameters, as a measure of sleep apnea severity, did not correlate with nightmare frequency, thereby refuting a simple oxygen hypothesis for nightmares (Schredl et al., 2006). ...
Rapid eye movement (REM) sleep behavior disorder (RBD), sleep paralysis, and nightmare disorder are the three REM sleep parasomnias outlined by the International Classification of Sleep Disorders. In this review we address the clinical neurophysiology of these disorders. The majority of neurophysiologic studies have been conducted in RBD, and fewer studies have evaluated patients with nightmare disorder or isolated sleep paralysis. Neurophysiologic studies of REM sleep parasomnias mostly used polysomnography (PSG), or were performed on animals to shed light on the pathophysiology of these disorders. Fewer studies used electoencephalography or electromyography outside the context of PSG, evoked potentials, or autonomic neurophysiologic studies. In this chapter, the main neurophysiologic findings in REM sleep parasomnias are described and their implications and relevance are discussed.
... There may be a few reasons for why nightmare frequency and severity decreased in both groups. First, ERRT is a treatment specifically targeting nightmares; therefore, it would be expected that individuals would receive the most benefit within [27] found that oxygen desaturation was not related to nightmare frequency; rather, factors associated with daytime stress or the PTSD diagnosis may contribute more substantially to the nightmare experience in our sample. Overall, these results indicate that trauma-related sleep disturbances may be modifiable to treatment, as observed by a decrease in symptoms over time, even in the context of comorbid sleep apnea. ...
... There may be a few reasons for why nightmare frequency and severity decreased in both groups. First, ERRT is a treatment specifically targeting nightmares; therefore, it would be expected that individuals would receive the most benefit within [27] found that oxygen desaturation was not related to nightmare frequency; rather, factors associated with daytime stress or the PTSD diagnosis may contribute more substantially to the nightmare experience in our sample. Overall, these results indicate that trauma-related sleep disturbances may be modifiable to treatment, as observed by a decrease in symptoms over time, even in the context of comorbid sleep apnea. ...
Purpose: Trauma exposure is associated with nightmares, insomnia, and increased reports of obstructive sleep apnea (OSA), which may exacerbate trauma symptoms and interfere with treatment outcome. This study explored the impact of suspected OSA on treatment outcomes following Exposure, Relaxation, and Rescripting Therapy (ERRT) for chronic trauma-related nightmares.
Methods: Seventy trauma-exposed adults participated in a trial of ERRT. Self-reported OSA was assessed at baseline. Nightmare frequency and severity, sleep quality, insomnia severity, depression and posttraumatic stress symptoms were measured at baseline, and then one-week, three-months, and six-months following the end of treatment.
Results: Individuals with suspected OSA reported greater baseline symptom severity across all outcomes, except nightmare frequency, compared to their non-apnea counterparts. All participants reported significant reductions across symptoms following treatment, yet symptom levels in those with suspected OSA remained elevated compared to the non-apnea group. No significant group by time moderation emerged.
Conclusions: Trauma-related nightmares and associated symptoms are amenable to treatment, despite suspected OSA. Yet, individuals with OSA may continue to report clinically-significant symptoms, highlighting the potential need for an integrated therapy approach.
... For a follow-up study, it would be interesting to elicit all diagnoses of the patients since, for example, it has been shown that comorbid depression correlates with nightmare frequency in patients with sleep apnea. 18,19 The finding that age and gender is not related to the "telephone counselling" variable also supports the notion that the primary diagnosis for admission to the sleep lab might not be the main influencing factor since men more often undergo diagnostic procedures for sleep-related breathing disorders and younger persons more often for different types of hypersomnia; for age and gender distribution in German sleep centers, see Schredl et al. 12 A limitation of the study is that no specific definition for nightmare was provided. One might hypothesize that this might lead to overestimations regarding nightmare frequency since participants might also include very distressing bad dreams without awakenings. ...
Study objectives:
Despite the considerable prevalence of the nightmare disorder and its burden on the patient, nightmares are underdiagnosed and undertreated, even in sleep centers.
Methods:
A total of 1125 patients in a sleep center undergoing routine diagnostic procedures for their sleep disorders completed a questionnaire about nightmares.
Results:
About 20% of the sample indicated an interest in more information about nightmare etiology and nightmare therapy-even patients who had never sought professional help previously.
Conclusions:
From a clinical viewpoint, health care professionals should be encouraged to ask about nightmares and, as a first step, internet-based self-help programs should be implemented for this patient group.
... The studies investigating the relationship between dreaming and breathing patterns might illustrate the possible effect of this factor. Experimental studies have reported relationships between breathing pauses and dream content, (Hobson, Goldfrank, & Snyder, 1965) and also Boerner (1855), who induced nightmares by blocking the nose and mouth of the sleeper with a cloth, whereas the dream content of sleep apnea patients, who experience regular breathing pauses, is quite unaffected by the resulting physiological processes (Schredl & Schmitt, 2009;Schredl et al., 2006). These findings may reflect the differences in novelty of the stimulus for the sleeper. ...
Since the continuity hypothesis of dreaming states that waking life is reflected in dreams, one would expect that something a dreamer has contact with every day would also show up quite frequently in his or her dreams. In order to test this hypothesis, the frequency of glasses appearing within a dream series of 7,747 dreams of a short-sighted person was analyzed. Glasses dreams are quite rare (0.96%). This indicates that novelty and thinking about something are important factors regarding the continuity between waking and dreaming. As some glasses dreams (putting on glasses, cleaning glasses) reflect waking life relatively directly, it would be very interesting to study the meaning of those glasses dreams (e.g., another person breaks the glasses of the dreamer) that are not congruent with the waking life of the dreamer.
... Studies showed that dream recall frequency in patients with sleep apnea, may be lower, higher or equal compared to that of control healthy subjects. Whereas Schredl et al. did not find any differences regarding to dream recall frequency in sleep apnea patients and control [20], in another study, this author reported that dream recall frequency in 323 patients with sleep apnea was lower than healthy controls [21]. In the third study [11] reported an increased dream recall frequency in forty-four sleep apnea patients. ...
Objective: The aim of this study was assess the association between risk of sleep apnea and reported unpleasant dream content in healthy individual. Methods: In this prospective study, participants completed Berlin questionnaire (BQ) to assess their risk for sleep apnea and also, completed a self-report questionnaire that assessed unpleasant dream experiences over the past month including frequency of recalled dreams. Based on BQ finding, participants divided in two groups (low and high risk for sleep apnea) and unpleasant dream content were compared between two groups. Results: four hundred forty eight participants completed questionnaires. 72 subjects (16%) were diagnosed as high risk for sleep apnea, and 376 (84%) were recognized as low risk. There were no significant differences on items related to the frequency of each unpleasant dream between two groups. Also, 32% of low risk subjects reported infrequent dream recall and 25% reported frequent dream recall. Whereas in high risk group, 30% subjects reported infrequent and 30% reported frequent dream recall. There were no significant differences on any of the general measures of dream recall. Conclusion: This study provides no evidence of an association between frequency of unpleasant dream and risk of sleep apnea. Light sleep, high arousal frequency and impaired short term memory might affect reported dream content as well as dream recall frequency.
... 5,15 Hypoxia, sympathetic discharge from respiratory disturbances, dysfunctional REM sleep, and abnormal REM mechanism have been areas of interest in fi nding a connection between sleep apnea and PTSD symptoms. 16,17 Chronic sleep disruption associated with nightmares decreases the effi cacy of fi rst-line PTSD treatment; therefore, targeted sleep treatments have been recommended to accelerate Objectives: Post-Traumatic Stress Disorder (PTSD) is increasingly prevalent among Veterans characterized by recurrent nightmare and disrupted sleep. Veterans with PTSD also have a high prevalence of obstructive sleep apnea (OSA) and untreated OSA worsens the sleep-related symptoms of PTSD. ...
Objectives:
Post-Traumatic Stress Disorder (PTSD) is increasingly prevalent among Veterans characterized by recurrent nightmare and disrupted sleep. Veterans with PTSD also have a high prevalence of obstructive sleep apnea (OSA) and untreated OSA worsens the sleep-related symptoms of PTSD. In our study, we hypothesized that among PTSD-afflicted Veterans with OSA, CPAP therapy may reduce the frequency of nightmares and a better CPAP compliance may be associated with increased symptom improvement.
Methods:
We retrospectively reviewed medical records to identify OSA patients treated in a VA medical center who also carried a diagnosis of PTSD (n = 69). Data about patient characteristics and polysomnographic findings were extracted. Repeated-measures t-tests were performed, comparing mean nightmare frequency and Epworth sleepiness score (ESS) before and after CPAP treatment. Multiple linear regressions were done to identify factors predicting CPAP compliance. A logistic regression analysis was also done to estimate the odds of subjective improvement in PTSD symptoms with CPAP.
Results:
CPAP therapy reduced the mean ESS from 14.62 to 8.52 (p < 0.001) and the mean number of nightmares per week from 10.32 to 5.26 (p < 0.01). Reduced nightmare frequency after CPAP treatment was best predicted by CPAP compliance (p < 0.001). Every 10% increase in CPAP compliance almost doubled the odds of benefitting by CPAP (odds ratio = 1.92, 95% CI = 1.47-2.5).
Conclusions:
In Veterans with PTSD and OSA, CPAP therapy reduces PTSD-associated nightmares and improves overall PTSD symptoms. We recommend that all PTSD patients should be screened clinically for symptoms of OSA and receive CPAP treatment whenever possible to improve PTSD symptoms.
... Furthermore, relationships between dream recall frequency and sleep apnea parameters, such as respiratory disturbance index or oxygen saturation nadir, were not found [42]. Similarly, nightmare frequency was not related to sleep apnea severity [42,43]. Carrasco et al. [3] reported an increased number of violent and highly anxious dreams in 20 severe sleep apnea patients compared to healthy controls. ...
Dreaming is defined as a subjective experience, while sleeping is obviously closely related to sleep physiology. The present multicenter study (n = 4,001 patients) was designed to test whether differences in sleep physiology and daytime functioning, present in patients with sleep disorders, affect the dreaming process. Overall, patients with sleep disorders reported higher dream recall, more nightmares, and more negatively toned dreams. Whereas the differences in dream recall are most likely associated with altered sleep physiology (more frequent nocturnal awakenings and/or micro-arousals), the findings regarding nightmare frequency and dream emotions might reflect the distress associated with the sleep disorder. Desirable would be longitudinal studies; it would be expected that successful treatment should alter nightmare frequency and dream emotions in patients with insomnia, restless legs syndrome/periodic limb movement disorders, and other sleep disorders. Whether dream content reflects disorder-specific content in addition to general distress remains unanswered.
... Ein anderer interner Reiz, der untersucht wurde, ist die Atemnot. Während Boerner [2] für einige Versuchspersonen zeigen konnte, dass das Blockieren der Atemwege Albträume auslösen kann, war für Schlafapnoe-Patienten, die viele Atemstillstände pro Nacht aufweisen, die Albtraumhäufigkeit nicht erhöht [26,27] ...
Zusammenfassung Der Artikel gibt einen Überblick über die Forschung zur Inkorporation von während des Schlaf applizierten externen Reizen
in das Traumgeschehen. Der Vergleich der Inkorporationsraten zwischen den Studien legt 2 mögliche Einflussfaktoren auf die
Integration externer Reize in den Traum nahe: „Körpernähe“ (Hautreiz wirksamer als akustischer Reiz) und Bedeutsamkeit des
Stimulus. Eine Besonderheit stellen olfaktorische Reize dar, da sie kortikal anders verarbeitet werden als beispielsweise
akustische Stimuli (Umgehung des Thalamus, direkte Verbindungen zur Amygdala). Tatsächlich zeigt sich in einer neueren Studie,
dass die Traumemotionen, nicht jedoch der Trauminhalt, durch die Valenz des olfaktorischen Reizes beeinflusst werden. Die
bisherige Forschung zeigt sehr klar, dass eine Informationsverarbeitung während des Schlafes stattfindet. Eine Fortführung
dieser Forschungsrichtung wäre die Untersuchung von internen Reizen auf den Trauminhalt, z. B. Schmerzreize bei chronischen
Schmerzpatienten oder Atemstillstände bei Schlafapnoe-Patienten.
... Ein anderer interner Reiz, der untersucht wurde, ist die Atemnot. Während Boerner [2] für einige Versuchspersonen zeigen konnte, dass das Blockieren der Atemwege Albträume auslösen kann, war für Schlafapnoe-Patienten, die viele Atemstillstände pro Nacht aufweisen, die Albtraumhäufigkeit nicht erhöht [26,27] ...
... The significant relationship between nightmare frequency 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 disorder was ruled out in this patient group. Moreover, two studies (Schredl et al., 2006;Schredl & Schmitt, 2009) clearly demonstrated that sleep apnea patient do not report nightmares more often than healthy controls. The hypothesis put forward by Boerner (1855) that breathing pauses accompanied by oxygen desaturations cause nightmares is very ...
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.
... Another line of research investigated the effect of breathing pauses on nightmare frequency in sleep apnea patients (Schredl & Schmitt, 2009;Schredl, et al., 2006), but found no effects of such massive internal stimulus on dream content. ...
This article reviews the dissertation of Wilhelm Weygandt that was supervised by Wilhelm Wundt. The claim of the author that all dreams emanate from sensory impression is not valid anymore; nevertheless the careful observations and experiments yielded interesting results which should be studied in-depth using modern methodology, for example, the effect of internal stimuli on dream content.
In dream research there exists a multitude of dream questionnaires and dream content analysis scales. However, many of them are either limited, not standardized or validated, or require a lot of effort. At the same time there are often divergent or even contradictory results in dream research, and comparability between different studies is often limited. Large sample sizes are rare but would be necessary for representative and compelling findings. For studies analyzing large samples of dreams, short and easy-to-use questionnaires would be of great assistance. As an easy-to-use questionnaire that covers all relevant dream aspects, the Dreamland Questionnaire, was developed in 1997. The questionnaire has since been revised and partially validated. In this paper, we give an overview of the questionnaire and its underlying methodology. The questionnaire is separated into three parts measuring dream quantities and dream qualities as well as lucidity. The questionnaire further encourages the dreamer to write down their dream. In different studies it has already been used to show that dreams sampled in the laboratory and dreams sampled at home differ and that emotionality in dreams differs if rated by the dreamer themselves or by external raters. The questionnaire is also available in German.
Dreaming may be affected by sleep behavior; however, evidence of the effect of chronotypes on dreaming is limited. We investigated sleep patterns, dream recall, and nightmare distress according to chronotypes. This cross-sectional study retrospectively enrolled adult participants (age > 18 years) who visited a sleep laboratory between 2016 and 2021 and underwent standard polysomnography (PSG) and completed a self-reported questionnaire. Patients with major sleep disorders were excluded. Chronotypes and dreaming components were assessed using the Korean version of the morningness–eveningness questionnaire and a nine-item dreaming questionnaire (nightmare distress and dream recall), respectively. Among healthy participants without major sleep disorders, the eveningness chronotype correlated with better dream recall than the morningness and intermediate chronotypes. Participants with the eveningness chronotype were younger and more likely to be unmarried than those with the other chronotypes. No significant chronotype-based difference was observed in the subjective measurements of sleep quality, insomnia, daytime sleepiness, depression, and anxiety or in respiration and movement events on PSG. In multivariate linear regression analysis, the chronotypes were independently related to nightmare distress (b = − 0.296; p = 0.002) and dream recall (b = − 0.334; p = 0.002). The apnea–hypopnea index was associated with nightmare distress (b = − 0.209; p = 0.029) and dream recall (b = − 0.189; p = 0.044). Depression was positively correlated with nightmare distress (b = 0.450; p = 0.002). Dream recall was best in the eveningness group among healthy adults. Greater eveningness was associated with higher nightmare distress and better dream recall. Further research is needed to understand the role of chronotypes in dreaming.
“Rapid Eye Movement (REM) parasomnias” is a catch-all term referring to all sleep-related conditions thought to occur during REM sleep. The distinction between REM parasomnias and Non-Rapid Eye Movement (NREM) parasomnias may feel arbitrary, but it is clinically useful in that the two categories of disease generally confer different prognoses. Specifically, while NREM parasomnias are generally considered self-limited and relatively common, REM parasomnias are much less common and can have a foreboding association with neurodegenerative disease (Gagnon et al. Lancet Neurol 5:424–32, 2006; Postuma et al. Neurology 72:1296–300, 2009; Boeve Ann N Y Acad Sci 1184:15–54, 2010; Galbiati et al. Sleep Med Rev 43:37–46, 2019; Iranzo et al. Sleep Med Rev 13:385–401, 2009; Iranzo et al. Lancet Neurol 12:443–53, 2013; Heller et al. Sleep Med Rev 34:23–33, 2017). This general rule of thumb has exceptions, as discussed below.
Good quality sleep, which is important for health, is influenced by various chemical compounds such as melatoninMelatoninand adenosineAdenosine produced and released in the body in a 24-h cycle. The production of melatonin, which is made of tryptophanTryptophan in the pineal gland, increases in the evening with the onset of darkness, which tells us that it is time to go to bed. Unlike melatonin, adenosine is produced during the day, and with the beginning of darkness, its amount in the body reaches its maximum, playing an essential role in sleep-inducing sleep. The secretion of chemical sleep stimulants, especially melatonin, is also affected by hormones such as norepinephrine and cortisol. These two hormones, which also play a role in restlessness, anxietyAnxiety and stress, suppressing production of melatonin in the body and deprive a person of good quality sleep. The secretion of hormones such as prolactin and growth hormoneHormone is also dependent on sleep. Sleeping slows down the body activities and reduces body temperature, heart rate, respiration rate and energy expenditure. Sleep also plays an important role in stabilizing and improving memory, effective productivity and high concentration levels, maintaining hormonal balance, regulating temperature and heart rate, removing metabolic wastes from the brainBrain, strengthening the immune systemImmune system, healing wounds and reducing inflammation. Adequate sleep has been also reported to enhance athlete performance and lowers blood pressure, allowing the heart and blood vessels to rest.
Background and objectiveNightmares are typically underdiagnosed and undertreated, even though frequent nightmares are quite common in patients with sleep-related breathing disorders. Based on a previous study, we investigated whether patients would respond if they were specifically asked whether they would be interested in telephone counselling about nightmares and nightmare treatment.Materials and methodsThe present study included 537 patients with sleep-related breathing disorders who completed a nightmare questionnaire and—if interested—provided their contact data for a telephone counselling session.ResultsOf the total patients, 5.40% were interested in the telephone counselling. Most of these patients had never sought help for their nightmare condition before. This percentage is much lower than in a previous study, possibly due to the higher time expenditure related to the new consent procedure.Conclusion
The findings indicate that patients with nightmare problems can be reached with this approach even though they have never sought professional help before. In order to minimize the threshold, it would be desirable to have clinical in-house nightmare counselling, which would not require a detailed study information brochure and informed consent.
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.
Background and objectives
Sleep and dreaming are inseparable. Therefore, this study addressed the question of whether the presence of specific sleep disorders affects dreaming.
Materials and methods
The present study included 1467 patients with sleep-related breathing disorders who completed a dream questionnaire.
Results
Dream life in these patients differed from control samples, most notably in heightened dream recall frequency, nightmare frequency, and frequency of sharing dreams. On the other hand, the positive attitude towards dreams and nightmare distress were rated lower by the patient group.
Conclusion
The findings indicate that sleep physiology, e. g., arousals terminating sleep apneas, might affect the dreaming process. In addition, future studies should also take into account the daytime distress associated with having a severe sleep disorder, as distress might have an effect on dream content and nightmare frequency.
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.
A Síndrome da Apneia e Hipopneia do Sono (SAHOS) só recentemente foi reconhecida como uma das desordens mundialmente mais prevalentes e subdiagnosticadas, sendo ela a desordem mais comum e responsável pela maior morbidade e mortalidade entre os distúrbios do sono. Os sintomas mais comuns da síndrome são o ronco alto e descontínuo, episódios de ressonares, movimentação brusca do corpo para restabelecer a respiração, sudorese profusa, sonolência diurna excessiva, cansaço crônico e modificações da personalidade com redução da performance motora e intelectual. O diagnóstico da SAHOS é fechado baseando-se no histórico relatado pelo paciente e seu parceiro de sono; no exame de ouvido, nariz e garganta e no exame polissonográfico. As opções de tratamento da SAHOS incluem medidas terapêuticas como a adoção de hábitos para higiene do sono, a cirurgia de uvulopalatofaringoplastia, a cirurgia de avanço mandibular e maxilar, o uso de aparelhos de CPAP e o uso de aparelhos orais de protrusão mandibular (AOPM). Este estudo buscou discutir a relação entre os sinais, sintomas e tratamento do paciente portador da Síndrome da Apneia e Hipopneia do Sono (SAHOS) por meio de revisão de literatura.
Study objectives:
Few studies have addressed dreaming in patients with sleep apnea. We hypothesized that respiratory events and subsequent oxygen desaturation act as an important physiological trigger and may thus influence dream content in patients with a sleep-related breathing disorder.
Methods:
Seventy-six patients (28 women, mean age 54 years, range 20-82) who underwent polysomnography because of suspected sleep apnea participated in this study. Dream reports and dream questionnaires were collected immediately after first morning awakening, at 5:30 am, at the sleep laboratory. Dream content analysis with respect to possible respiratory-related content was performed. Patients were stratified into primary snoring, mild, moderate, and severe sleep apnea groups.
Results:
In 63 patients some severity of sleep apnea was diagnosed (mild n = 31, 49.2%, moderate n = 13, 20.6%, severe n = 19, 30.2%), and 13 subjects in whom a sleep-related breathing disorder was not confirmed were included as a control group with primary snoring. There was no significant difference in respiratory-related dream topics between patients and controls. Also, no influence of respiratory parameters measured during polysomnography on dream content was detectable.
Conclusions:
We failed to detect a difference in dream content between patients with sleep apnea and controls. Further studies are required to determine whether these results indicate that the incorporation of respiratory events into dreams is absent in patients with sleep apnea or represents a bias due to the collection of dream content in the early morning hours.
Even though most parasomnias like sleep terrors, sleepwalking, and REM sleep behavior disorder are quite rare in adults, waking-life impairments and problems associated with parasomnias can be quite severe. It is thus highly recommended that questions regarding parasomnias are included when taking a sleep history so that patients are correctly diagnosed and treated. For the most common parasomnia in adults, the nightmare disorder, an effective treatment (Imagery Rehearsal Therapy) has been developed and tested.
History Nightmare reports can be found throughout history. It was assumed, for example, that demons or devils send nightmares to torment the more or less innocent sleeper. Sexual connotations like mythical creatures having intercourse with the dreamer (“succubus” for men, “incubus” for women) have been linked to nightmares. The picture of Johann Heinrich Füssli “Der Nachtmahr” painted in 1781 in different versions is widely known; a hairy beast is sitting on the chest of a beautiful woman causing the feeling of being choked. Having occasional nightmares is a very common experience; 70–90% of young adults have reported that they experienced a nightmare at least once in their lifetime. Nightmares are usually defined as frightening dreams that awaken the dreamer (DSM IV,). There are two problems, though, with this restricted definition. First, several researchers have demonstrated that very negatively toned dreams that do not wake the dreamer can be as disturbing as nightmares and have coined the term “bad dreams” for this class of dreams. On average, the emotional intensity of nightmares is higher than that of bad dreams, but there is a large overlap. Whether or not the sleeper is able to judge if the dream emotion was really the cause for waking is still an open question. Some characteristic dreams – like being chased and waking up just before the attacker grabs you, or falling dreams with waking up just before hitting the ground – are obvious examples of dreams that awaken the dreamer, but other dream themes may not be that clear.
Dreaming is broadly construed as a form of mental activity in sleep that is recalled by the dreamer. Although several theories have been historically proposed to examine the origins and functions of dreaming, it has been challenging to empirically test these theories from psychological and neurophysiological perspective. Recent progress in neuroscience has provided insights into the historic models such as activation synthesis hypothesis to generate the integrated neurocognitive models of underlying brain mechanisms in the synthesis of dreams. Electrophysiological correlates of dreaming are distinct during rapid eye movement and non-rapid eye movement sleep stages. Major neurochemical systems including serotonin (5-HT), epinephrine, and dopamine influence dreaming. Neuroimaging and brain lesion studies indicate forebrain areas being mainly associated with generation of dreams. The robust methods of dream content analysis have provided systematic and relatively objective ways to classify dreams based on sleep stages and predict important psychological and biological functions of dreams. Dreams are thought to have several functions including sleep preservation, mood regulation, information processing, and memory consolidation. Alterations in dream content that are unique to underlying sleep and psychiatric disorders have been observed. A careful consideration of dream contents in evaluating the course of underlying sleep or psychiatric disorder as well as predicting the response to treatment can be utilized. Further research in better characterization of dream content is needed for clinical utility of dreams.
There appears to be a lot of confusion in the medical community about what constitutes a parasomnia and how prevalent these conditions are. In the past, any sleep disorder that was not breathing related or did not present with prominent insomnia or daytime sleepiness was called a parasomnia. The International Classification of Sleep Disorders second edition (ICSD 2) restructured the different sleep disorders into pathophysiologically based categories. According to the ICSD 2, parasomnias are undesirable physical or experiential events that occur in and around sleep. It lists 16 parasomnias divided into three categories: NREM parasomnias or disorders of arousal, REM parasomnias, and other parasomnias.
Zusammenfassung Alpträume treten universell auf und sind Ausdruck der conditio humana. Lediglich eine starke Häufung oder chronische Persistenz
machen Alpträume zum klinischen Problem. Alpträume sind klinisch-phänomenologisch von anderen Parasomnien wie Pavor nocturnus
oder Schlafwandeln zu unterscheiden. Alpträume können als vielschichtiges Symptom polysomnographisch charakterisiert und in
pathogenetischen Kontexten somatischer Erkrankungen, pharmakologischer Einflüsse, psychischer Störungen, vor allem aber nach
Traumaexpositionen psychopathologisch und psychodynamisch beschrieben werden. Sowohl psychologische als auch medikamentöse
Behandlungsansätze sind verfügbar.
To assess prospectively the emotional content of dreams in individuals with the obstructive sleep apnea hypopnea syndrome (OSAHS) and sleepy snorers.
Prospective observational study. Forty-seven patients with sleepiness and snoring attending a sleep-disordered breathing clinic, completed a morning diary concerning pleasantness/unpleasantness of their dreams for 10 days, and then had AHI assessed by a limited-channel home sleep study. Participants and groups: Sleepy snorers, AHI < 5: n = 12 (mean age = 51.00 years [SD 7.01], 7 males); AHI 5 -14.9, n = 14 (mean age = 49.71 y [9.73], 12 males); AHI ≥ 15, n = 21 (mean age = 56.33 [11.24], 16 males).
All groups reported similar numbers of dreams and nightmares during the diary period. The AHI ≥ 15 group were significantly higher on dream unpleasantness than were the sleepy snorers (p < 0.05); and when only males were analyzed, this difference was also significant (p = 0.01). As AHI increased across the 3 groups, there was a significant decrease in variability of dream emotions (Levene test for homogeneity of variance between the 3 groups, p = 0.018). Mean daytime anxiety and daytime depression were significantly correlated with mean dream unpleasantness and with mean number of nightmares over the diary period.
Patients with AHI ≥ 15 had more emotionally negative dreams than patients with AHI < 5. The variation in mean dream emotion decreased with increasing AHI, possibly because sleep fragmentation with increasing AHI results in fewer and shorter dreams, in which emotions are rarer.
Several large-scale studies showed that women tend to report nightmares more often than men. Despite this robust finding, empirically tested interpretations of these sex differences are lacking. Levin and Nielsen put forward the hypothesis that sex-specific socialization might be one of the risk factors for nightmare occurrence. The present findings of an online survey indicate that expressivity/femininity and instrumentality/masculinity were related to nightmare fre quency and, thus, supported this hypothesis. Since the sex difference in nightmare frequency was not fully explained by these two variables, future studies should investigate other variables--in addition to sex-role orientation--like depressive symptoms, history of sexual and/or physical abuse, ruminative coping styles, and physiological measures of processing emotional stimuli within the brain.
Dreams have been studied from different perspectives: psychoanalysis, academic psychology, and neurosciences. After presenting the definition of dreaming and the methodological tools of dream research, the major findings regarding the phenomenology of dreaming and the factors influencing dream content are briefly reviewed. The so-called continuity hypothesis stating that dreams reflect waking-life experiences is supported by studies investigating the dreams of psychiatric patients and patients with sleep disorders, i.e., their daytime symptoms and problems are reflected in their dreams. Dreams also have an effect on subsequent waking life, e.g., on daytime mood and creativity. The question about the functions of dreaming is still unanswered and open to future research.
To clarify the association of reported nightmare recall with polysomnographically defined obstructive sleep apnea (OSA) in a sleep laboratory population.
This study included 393 individuals undergoing clinical polysomnography including a general intake questionnaire with questions on dream and nightmare recall frequency. Mean age was 50.5 and a range of 13 to 82 years, with 33% of the sample female and 67% male. Reported dream and nightmare recall were classified as infrequent when reported at less than once a month, or frequent when reported at a frequency greater than once per week.
Mean Apnea-hypopnea Index AHI was 34.9 (std. 32.0) indicating a high frequency of severe (AHI > 30) OSA in this clinical study population. Both AHI and Apnea Index (AI) were significantly higher (p = 0.000) for the grouping reporting infrequent nightmare recall. As the AHI score increased, the percent of participants with frequent nightmare recall decreased linearly.
Patients with higher AHI report a lower nightmare frequency, indicating that significant OSA suppresses the cognitive experience of nightmare recall. Depressed nightmare recall may occur secondary to the REMS suppression know to occur in patients with significant OSA.
The present study was undertaken to investigate the influence of apneas on REM-elicited dream reports, and to examine the influence of clinically successful treatment of the apneas on dreaming. Thirty-three volunteers suffering from sleep apnea syndrome (SAS) slept during two nights in the sleep laboratory. Sixteen were treated with nasal continuous positive air pressure (CPAP) during the first night and 17 during the second. There was a total of 150 awakenings: 78 from REM sleep without apneas, and 72 from REM sleep with apneas. After apneas, dream recall tended to be higher (60% vs. 72%, p = 0.09) and dream reports were significantly longer (16 words vs. 24 words, p = 0.05), than after healthy sleep. No systematic incorporation of the apnea stimulus into the dream reports could be demonstrated. Dreams after apneas were found to be significantly more negative than dreams after healthy sleep (p < 0.01). This suggests that REM-elicited dreams are basically resistant to powerful internal stimulation. The stress caused by the apneas exerted only a very global emotional influence on manifest dreaming.
The notion that dreaming is isolated from sensory activity is challenged by demonstrations that somatosensory stimuli are frequently incorporated into dream content. To further study such effects, four volunteers were administered pressure stimulation to either the left or the right leg during REM sleep and awakened to report their dreams. These dreams were rated and compared to non-stimulated dreams. Stimulated dreams more frequently contained leg sensations and references to the pressure stimulus than did non-stimulated dreams; dreamed leg activity, but not dreamed arm activity, was also rated as more intense. Incorporations of the stimulus were typically simple, direct kinesthetic sensations of pressure or squeezing but were also sometimes embedded in more extended ‘problem-solving’ sequences. Stimulation also increased bodily bizarreness. The latter included changes in kinesthetic quality of movement, instabilities of posture and the environment, as well as visual-kinesthetic synthesias. Although micro-arousals may be an explanatory factor, the results suggest that somatosensory stimulation influences ‘kinesthetic fantasy’, a dimension of dreaming associated with both central and peripheral sources of kinesthetic activity.
48 patients (aged 20–85 yrs) with obstructive airways disease (OAD), including 21 with and 27 without asthma, were compared with 149 sex- and age-matched controls without respiratory disease. OAD Ss with asthma reported approximately 3 times as many nightmares as controls or OAD Ss without asthma. OAD Ss, whether with or without asthma, were nearly 3 times more likely than controls to report that their nightmares were a "problem." It is concluded that nightmares are more frequent among asthmatics than among either normal individuals of the same age and gender or OAD patients without asthma. Subsidiary findings indicated that OAD patients may exhibit elevated levels of psychological distress and anxiety, and that nightmare frequency declines with age. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To investigate the dimensional structure of dreams, the Typical Dreams Questionnaire (TDQ) was administered to 1181 first-year University students in three Canadian cities. A profile of themes was found that varied little by age, gender or region; however, differences that were identified could be interpreted as due to developmental milestones, personality attributes or sociocultural factors. Factor analysis produced a solution consisting of 16 coherent factors that were differentially associated with demographic variables and that accounted for 51% of the variance. Women loaded primarily on negative factors (failure, loss of control, snakes-insects), men primarily on positive factors (magic-myth, alien life). Results support the concept of typical dream themes as consistent over time, region and gender and as reflecting the influence of fundamental dream dimensions that may be influenced by sociocultural, personality, cognitive or physiological factors.
Many patients with asthma are troubled by nocturnal wheeze. The cause of this symptom is unknown, but sleep is an important factor. A study was carried out to determine whether nocturnal bronchoconstriction is related to any specific stage of sleep. Eight asthmatics with nocturnal wheeze and eight control subjects performed forced expiratory manoeuvres immediately after being woken from rapid eye movement (REM) or non-REM sleep, wakings being timed to differentiate temporal effects from those related to the stage of sleep. The control subjects showed no significant temporal bronchoconstriction or bronchoconstriction related to the stage of sleep. All patients showed bronchoconstriction overnight, the mean peak expiratory flow rate falling from 410 (SEM 50) 1/min before sleep to 186 (49)1/min after sleep. After the patients had been woken from REM sleep the forced expiratory volume in one second was on average 300 ml lower (p less than 0.02) and peak expiratory flow rate 45 1/min lower (p less than 0.03) than after they had been woken from non-REM sleep. As wakenings from REM sleep were 21(8) minutes later in the night than those from non-REM sleep multivariate analysis was performed to differentiate temporal effects from those related to the stage of sleep. This showed that the overnight decreases in forced expiratory volume in one second and peak expiratory flow rate were significantly related both to time and to REM sleep. This study suggests that asthmatics may suffer bronchoconstriction during REM sleep.
In order to determine the prevalence of reported sleep disturbances in a general adult population and the relationship of these complaints to age, gender and coexistent obstructive airways disease, 2,187 subjects in the Tucson Epidemiologic Study of Obstructive Airways Disease were surveyed in 1985 regarding their sleep symptoms. At least one symptom of disturbed sleep was present in 41.4 percent of all subjects. Women generally reported a significantly higher prevalence of both disorders of initiating and maintaining sleep (DIMS) and nightmares (NM)(p less than .001). Before age 64 years, the prevalence of complaints of excessive daytime sleepiness (EDS) among men and women were similar. However, the frequency of EDS was significantly higher in men than women after age 64 years. Prevalence of at least one sleep symptom and DIMS increased with advancing age. The prevalence of nightmares appeared to be age-related only among women, who displayed a declining prevalence with advancing age. EDS increased only after age 64 years. There was a significant relationship between DIMS and EDS with coexistent chronic bronchitis, concomitant asthma and chronic bronchitis, and emphysema, but not asthma as a solitary diagnosis. Nightmares were reported with much greater frequency among subjects with asthma, asthma and chronic bronchitis, and emphysema but not in subjects with chronic bronchitis alone. The presence of coexistent asthma and chronic bronchitis was associated with particularly high prevalence of complaints of DIMS, EDS and nightmares. We conclude that, in the general adult population, sleep disorder symptoms increase with age and usually are greater in women. Furthermore, there is an increased prevalence of sleep symptoms among adults with chronic airways obstructive disease, especially those with coexistent asthma and chronic bronchitis.
In a group of elderly males who had been exposed to excessive stress during World War II, 56% of whom suffered from current post-traumatic stress disorder, a significant association was found between snoring and the occurrence of anxiety dreams, independent of the use of sedatives, antidepressants, smoking and alcohol and coffee consumption. Anxiety dream incidence was highest when snoring was accompanied by respiratory pauses. The underlying pathophysiologic mechanisms are thought to be hypercapnia and autonomic-vegetative arousal, resulting from obstructive sleep apneic episodes in heavy snoring. Polysomnographic sleep studies are needed to confirm this hypothesis.
This study, for the first time, distinguishes between nightmares and bad dreams, measures the frequency of each using dream logs, and separately assesses the relation between nightmares, bad dreams, and well-being. Eighty-nine participants completed 7 measures of well-being and recorded their dreams for 4 consecutive weeks. The dream logs yielded estimated mean annual nightmare and bad-dream frequencies that were significantly (ps < .01) greater than the mean 12-month and 1-month retrospective estimates. Nightmare frequency had more significant correlations than bad-dream frequency with well-being, suggesting that nightmares are a more severe expression of the same basic phenomenon. The findings confirm and extend evidence that nightmares are more prevalent than was previously believed and underscore the need to differentiate nightmares from bad dreams.
The relationship between nightmare prevalence, nightmare distress, and self-reported psychological disturbance was assessed prospectively.
Differences in self-reported psychological disturbance as a function of nightmare prevalence was investigated by MANCOVA's with non-nightmare dreams as the covariate as well as Pearson correlations. The relative contribution of nightmare prevalence and distress to the prediction of psychological disturbance was investigated through multiple regression analyses.
N/A.
116 participants (mean age = 20 years) completed self-report indices of depression, anxiety, dissociation, psychosis-proneness, and a psychiatric symptom checklist and kept a nightmare log for 21 consecutive nights.
N/A.
Frequent nightmares were associated with higher levels of psychological disturbance. Individuals who reported 3 or more nightmares across the 3 weeks reported more dissociation, psychosis-proneness and psychiatric symptoms than participants reporting 2 nightmares or less. However, nightmare prevalence and distress were not significantly correlated and differentially predicted to different types of waking psychological disturbance. Multiple regressions further indicated that nightmare distress accounted for much of the unique explanatory variance in predicting clinical states associated with high negative affect (anxiety and depression). Last, there was no evidence for a specific relationship between nightmares and psychosis-proneness.
The findings suggest that it is not the incidence of nightmares which is associated with poorer waking psychological functioning, especially anxiety and depression states, but the reported distress associated with the nightmare experience which is the critical variable in predicting higher psychological disturbance.
The amount of observed eye movement was related to the degree of participation of Ss in the events of the dreams. The last eye movement before awakening corresponded in direction to the last reported fixation of the dreamer. Certain external and internal stimuli did not influence the dream content. The course of time in the dream was comparable to the time elapsing for that activity while awake. The implications of these findings are discussed. 15 references. (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Introduction
The present paper introduces the three most common methods for measuring dream recall: laboratory awakenings, dream diaries and questionnaire scales. An easy applicable seven-point scale, its retest reliability and validity analyses will be presented.
Patients and Methods
Within several studies, 941 healthy persons rated their dream recall frequency using the scale. The retest sample (70 days retest interval) consisted of 42 patients with sleep disorders.
Results
The data of the healthy persons replicated the previous significant findings of gender differences (women tend to recall their dreams more often than men) and the decline of dream recall frequency with age. Retest relibility was high.
Conclusions
The introduced scale is well qualified for measuring interindividual differences and permits—by breaking down of the data into four age groups—comparisons with samples stemming from different settings, e. g. patient groups.
The aim of the present article is to carefully review the research carried out hitherto regarding factors influencing dream recall. With respect to the hypotheses explaining the variation in dream recall frequency (DRF) and a model of the dream recall process, the empirical data has been divided into two groups, trait factors and state factors. In the first part of the article the studies on the influence of trait factors are reviewed. The second part includes data concerning state factors, new empirical data and some final conclusions. State factors such as nocturnal awakening and focusing on dreams in the morning and trait factors such as fantasy life, creativity and visual memory play a major role in explaining variability in dream recall. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The so-called continuity hypothesis of dreaming states that waking experiences are reflected in dreams. The formulation of the continuity hypothesis is very broad and vague, however, so that it seems necessary to investigate factors which might affect the incorporation rate of waking-life experiences. A review of the different research paradigms, e. g. assessing temporal references of dream elements, studying the effects of the pre-sleep situation on dreams, will be presented. Various methodological issues which limit the generalizability of the findings in this area will also be addressed. After this overview, several factors such as (a) the time interval between waking-life experience and dream occurrence, (b) emotional involvement, (c) the type of waking-life experience, (d) personality traits and (e) the time of the night (time interval between sleep onset and dream onset) for which empirical data indicates an influence on incorporation rates of waking-life experiences will be listed. A mathematical model is proposed which should enable researchers to identify influencing factors and their interactions making a more precise formulation of the continuity hypothesis possible. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Previous research has shown that external stimuli were often incorporated into the dream to some extend. The aim of the present
study was to investigate whether the internal stimulus sleep apnea is also incorporated into dreams. Findings showed, however,
that direct incorporation occurs very seldom. On the other hand, arousals accompanying sleep apneas seem to interfere with
dream formation since a marked reduction of dream bizarreness is related to high RDI (respiratory disturbance index). Additionally,
small indirect effects on dream content by day-time stressors such as cognitive deficits and sleepiness are suggested by the
data. A heightened dream recall frequency in patients with sleep apnea was found. Future dream research should focus on studies
including sophisticated EEG analysis methods and detailed measures of day-time symptoms present in patients with sleep apnea.
Die bisherige Forschung zeigte, daß externe Stimuli teilweise Eingang in den Traum finden. Das Ziel der vorliegenden Studie
war die Untersuchung, ob dies in ähnlicher Weise auf für einen internen Stimulus wie die Apnoephase gilt. Die Ergebnisse zeigen
jedoch, daß ein direkter Einfluß auf den Trauminhalt sher selten vorkommt. Auf der anderen Seite zeigte sich, daß die Weckreaktionen,
die mit den Apnoephasen einher gehen, mit dem Traumbildungsprozeß interferieren, da eine deutliche Reduktion der Traumbizarrheit
mit cinem hohen RDI (Respiratory Disturbance Index) korreliert. Eine erhöhte Traumerinnerung wurde für die Schlaf-Apnoe-PatientInnen
gefunden. Zukünftige Forschung sollte sich auf Studien konzentrieren, die ausgeklügelte EEG-Analysemethoden und genauere Maße
fü das Vorkommen von Stressoren im Wachleben von Schlaf-Apnoe-PatientInnen beinhalten.
The present study investigates dreams reports of patients with sleep disorders. Whereas, the findings scarcely showed specific dream contents for different sleep disorders, e.g. problematic dreams in insomniacs, breathing-related dreams in sleep-apnea-patients, a remarkable relationship between waking life and dream contents did occur. Private problems and occupational stress are reflected in dreams by means of increased negative feelings, aggression and occupational themes. The results suggest that dreams can be made use of in psychological invention methods in sleep disorders, e.g. stress management.
Zugl.: Mannheim, Universiẗat, Diss., 1998. Mikrofiche-Ausg.
Thesis (Ph. D.)--St. Mary's University of San Antonio, Texas, 1993. Includes bibliographical references (leaves 101-114).
The prevalence of sleep complaints and sleep disturbances was studied prospectively in 98 consecutive adult asthmatic patients (mean age 45 years, 46% men) attending an out-patient clinic by means of questionnaires and sleep diaries. The results were compared with those from an age- and sex-matched group of 226 healthy individuals. The most common sleep disturbances among the asthmatic patients were early morning awakening (51%), difficulty in maintaining sleep (DMS; 44%) and daytime sleepiness (44%). With decreasing asthma control (i.e. increased number of acute asthmatic attacks) there was an increase of DMS, nocturnal wakefulness, nocturnal breathing problems and bronchodilator inhalations at night. A decrease in estimated sleep time (P less than 0.05) and increase in nocturnal wakefulness (P less than 0.05) was seen with decreasing daytime FEV1--measured as percentage of the predicted value (%FEV1). There was also significant correlation between increasing age and decreasing %FEV1 (P less than 0.01). Among the 26 patients who were only taking one oral bronchodilator, no definite difference regarding sleep quality was found between those treated with theophylline and those taking an oral beta 2-agonist. The prevalence rates of DIS, DMS and daytime sleepiness were about twice as high among the asthmatic patients than in the healthy population. It is concluded that impaired quality of sleep, with disturbed sleep during the night, early morning awakenings and daytime sleepiness, is common among patients with bronchial asthma.
In patients with obstructive sleep apnea and associated rapid-eye-movement (REM) sleep deprivation and disruption, the first night of nasal continuous positive airway pressure (CPAP) is often associated with increases in REM sleep time and REM density (REM rebound). The amount of REM rebound, however, varies considerably. We sought to characterize the magnitude of REM rebound and to determine what factors determine individual differences in REM rebound with initial CPAP treatment. Twenty-six patients with sleep apnea had a baseline nocturnal polysomnogram and a second night with a trial of CPAP. REM sleep time increased by 69% with CPAP, REM density increased by 73%, and REM activity by 169%. REM density was highest in the second REM period. Improvement in respiratory disturbance index with CPAP correlated significantly with increased minutes of REM sleep with CPAP. Of polysomnographic measures on the baseline night, change in minutes of REM sleep with CPAP correlated best with minimum oxygen saturation and to a lesser degree with respiratory disturbance index, and minutes of Stage 1 sleep. One possible explanation for the effect of hypoxemia on subsequent REM rebound is that some physiological functions of REM sleep may fail when oxygen saturation falls below a certain level.
The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) published by the American Psychiatric Association in 1980, and now translated in many languages, has raised a great interest in the whole world. It has probably had on psychiatric thinking as important an impact as the Treatise of Psychiatry of E. Kraepelin at the beginning of the century. The evolution of psychiatric nosology and the circumstances of the birth of DSM-III are described. In discussing the general principles and the technical aspects, the influence of several currents of thought are emphasized: recent remedicalization of psychiatry in the United States, suspicion about speculative theories, return to an a-theoretical clinical descriptive nosology, influence of quantitative differential psychology and of the models provided by computer diagnosis. The nature of the two basic principles: the necessity of attaining a proven high interjudge reliability in diagnosis, and the descriptive a-theoretical nature of the description of each category is analyzed. From those principles derive the most original features of the DSM-III: the use of stringent diagnostic criteria, of a possible quantitative nature and the adoption of a multi-axial system. Some of the most striking changes introduced are the logical consequences of the principles e.g. the deletion of the term "neurosis". Others changes such as the introduction of new diagnostic categories or changes in the limits of classical ones (especially schizophrenia and manic-depressive psychosis) reflect a reaction against previous trends of American psychiatry and a strict adherence to a pragmatic and empirical thinking. In addition, the flexibility of its structure allows for the incorporation of new empirical results. In spite of many criticisms, either against the general orientation or against specific positions, some of which are presented in the course of this article, it is concluded that the success of the DSM-III results from a trend in psychiatric thinking not confined to the United States. Its controversial nature has stimulated the reappraisal of old concepts, and it can be considered as an important contribution towards a closer integration of psychiatry to medicine.
Our Series of 24 dreams can be used for validating hostility scales. Nocturnal migraine represents an ideal archimedian point (C. G. Jung) from which psychology can reach certainties comparable to those of physics. By Pearsons Phi coefficient psychological findings can be solidly moored to the "non-psychical", the somatic sphere. Revalidation of the Dream-Hostility-Count lead us to a higher degree of significance (p < 0.005 instead of p < 0.01) than that reached by Saul and Sheppard who used hypertensives for a critical group.
Assessed whether the relationship that J. H. de Groen et al (see record
1993-25855-001) claimed between snoring and disturbing dreams could be extended to a younger population who were not being treated for exposure to excessive stressful experience. Ss in the study by de Groen et al were 98 elderly men who had been exposed to excessive stress during World War II. In the present study, 199 undergraduates responded to a questionnaire that assessed their level of snoring and the frequency with which they experienced fantastic nightmares. A significant relationship was not found between snoring and disturbing dreams. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Parasomnias are generally described as disorders of arousal that arise out of stage 3 and 4 nonrapid eye movement (NREM) sleep without identifiable cause. We present a case of a 35-year-old man who during nasal continuous positive airway pressure (nCPAP) treatment for severe obstructive sleep apnea experienced an intense night terror triggered by a residual obstructive apnea during rebound deep sleep. The role of rebound deep sleep was thought to be essential in creating a state of sleep with a high arousal threshold hypothesized to be important for the occurrence of parasomnias. This case supports the clinical wisdom that identifiable sources of arousal can trigger parasomnias.
Clinical observations of a relationship between unpleasant dreams and migraine headaches have been reported previously.
Due to the anecdotal quality of these case reports, this study empirically investigated the significance of this relationship. Dream content categories were selected corresponding to emotional factors associated with stress that trigger migraine headaches. A total of 37 migraineurs recorded 10 dreams each, 5 that preceded migraines and 5 that did not.
Univariate F tests revealed that 4 of the 5 variables contributed significantly to the overall effect, specifically anger, misfortune, apprehension, and aggressive interactions.
Recommendations include discussing the predictive value of dreams with regard to nocturnal migraine attacks, and therapeutic implications are suggested.
To assess the impact of treatment for co-morbid sleep-disordered breathing (SDB) on patients with nightmares and post-traumatic stress.
Twenty-three chronic nightmare sufferers (15 with post-traumatic stress disorder, PTSD) who also suffered co-morbid SDB (obstructive sleep apnea, OSA, n=16; upper airway resistance syndrome, UARS, n=7) completed a telephone interview, on average, 21 months after having been offered treatment for SDB at a university sleep disorders clinic.
At follow-up, 14 reported maintaining treatment (Treatment Group) and 9 reported discontinuing treatment (No-Treatment Group). More patients in the Treatment Group reported improvement in sleep (93% vs. 33%) and in daytime well being (93% vs. 33%) compared with those in the No-Treatment group. The Treatment Group reported a median improvement in nightmares of 85% compared with a median 10% worsening in the No-Treatment Group. In the PTSD subset (n=15), nine in the Treatment Group reported a median 75% improvement in PTSD symptoms whereas six in the No-Treatment Group reported a median 43% worsening.
In this small sample of patients, treatment of SDB was associated with improvements in nightmares and PTSD. Relationships between nightmares, PTSD and SDB are discussed.
The present study investigated the dream recall frequency and the pattern of influencing factors of patients with restless legs syndrome in comparison with healthy controls. The patients' dream recall frequency did not differ from that of healthy controls. Dream recall, however, was negatively associated with the number of periodic leg movements with arousal (PLMAI). Subjective estimates of sleep quality or feeling of being refreshed in the morning, on the other hand, did not correlate with the PLMAI index. Whereas subjective sleep parameters were related to dream recall frequency in healthy controls, no substantial relationships were found in the patient group, except for the positive correlation between sleep latency and dream recall frequency. The results of the present study can not be interpreted as clear evidence for the arousal-retrieval model of dream recall; it seems plausible that other factors, e.g. the functional state of the brain, are of importance in explaining dream recall in this patient group.
Recent clinical trials have included patient complaints of nightmares as a category of reportable medication side effects. This study integrates that data into current experimental and theoretical research of drug effects that may alter dreaming and nightmares. The objective is to provide a clinical and theoretical framework useful in categorizing the potential and reported drug effects on nightmares.
This study reviews case reports and clinical trials that have reported nightmares or alterations in dreaming occurring secondary to medication usage. These data are analysed as to the probability of the drug/nightmare association, and integrated into current electrophysiological and neurochemical theories of dreaming and nightmares.
Pharmacological agents affecting the neurotransmitters norepinephrine, serotonin and dopamine are clearly associated with patient reports of nightmares. Agents affecting immunological response to infectious disease are likely to induce nightmares in some patients. A possible association exists between reports of nightmares and agents affecting the neurotransmitters acetylcholine, GABA and histamine, as well as for some anesthetics, antipsychotics and antiepileptic agents.
By utilizing our current experimental and theoretical knowledge base, the potential etiology of a majority of reported drug effects on nightmares can be classified. These data support current neurochemical theories of dreaming, as well as suggesting that the biochemical basis for dreaming and nightmare induction may be more complex than generally suggested.
Previous research has indicated that personality factors such as openness to experience, creativity, visual memory, attitude toward dreams, and sleep behavior is related to home dream recall frequency (DRF). However, a study investigating all areas simultaneously within one sample in order to determine the percentage of variance explained by all variables and to take intercorrelations between the influencing factors into account has not been performed till now. The present study with 444 participants fills this gap. Using several indicators for each of the variables mentioned above, a structural equation model was tested. Although the model fit was satisfying, the four factors which were significantly related to DRF: personality (openness to experience, thin boundaries, absorption), creativity, nocturnal awakenings, and attitude toward dreams, explained only 8.4% of the total variance. As this value is considerably lower than those of studies investigating a single influencing factor and using similar measurement instruments in similar samples, one might speculate about possible expectancy effects in these previous studies, an effect which has been demonstrated for DRF in the laboratory setting. In addition, the small percentage of explained variance of each single factors (<3%) may indicate that other, in this study unmeasured, variables such as sleep duration (state aspect), introspection, and cognitive functioning immediately upon awakening (sleep inertia) show substantial covariance with the interindividual differences in DRF. Future studies should focus on longitudinal aspects in order to differentiate between state versus trait factors (although methodologic issues, e.g. the effect of the measurement technique on DRF itself, have to be clarified) and investigate additional variables which might be associated with DRF (see above).
In a new approach, this study compared the effects of trait and state factors on nightmare frequency in a non-clinical sample. Although neuroticism and boundary thinness were related to nightmare frequency, regression analyses indicated that the trait measures did not add to the variance explained by the state measures. This finding supports the so-called continuity hypothesis of dreaming, i. e., nightmares reflect negative waking-life experiences. Second, the moderate relationship between nightmare frequency and poor sleep quality was partly explained by the day-time measures of neuroticism and stress, but it can be assumed that nightmares are an independent factor contributing to complaints of insomnia. Longitudinal studies measuring nightmare frequency and stress on a daily basis will shed light on the temporal relationship between daytime measures and the occurrence of nightmares. It will be also very interesting to study the relationship between stress and nightmare frequency in a sample who have undergone cognitive-behavioral treatment for nightmares.
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