Psychophysiological aspects of nightmares, night terrors, and sleepwalking

Monitoring sleep through electroencephalography and electroculography has identified the different sleep stages in which nightmares, night terrors, and sleepwalking occur. Questionnaire surveys have supplemented the findings of case studies of these sleep disorders. Neurotransmitters operative during these sleep disorders have enlarged the knowledge of the psychophysiological dimensions especially of nightmares.     

Prévalence,corrélats et traitements des cauchemars chez les enfants

Few studies have been conducted on nightmares in children. This article presents a review of the literature on the prevalence, correlates and treatment of nightmares while highlighting key methodological issues. Studies indicate that almost half of children experience nightmares and that the presence of nightmares is related to different variables including anxiety, stress, behavioral problems and other sleep disorders. Finally, there is very little information on the treatment of nightmares in children, but promising results have been obtained with techniques based on imagery rehearsal therapy. Based on this review, future directions for research are suggested.     

Republication : Impact de la pandémie COVID-19 sur le sommeil du personnel soignant

The COVID-19 pandemic significantly impacted the sleep quality of healthcare workers.With differences depending on the questionnaire used, the professional's specialty, and the country studied, about half of caregivers developed sleep disorders during this health crisis.Sleep disorders were associated primarily by symptoms of insomnia, poor sleep quality, reduced total sleep time, and frequent nightmares.Sleep alterations affected both frontline and backline caregivers during the COVID pandemic.Healthcare workers’ sleep studies confirm the importance of spreading the recommendations published by sleep experts.     

Developmental changes of parental-reported sleep disturbance symptoms in children with attention deficit disorder

The primary goal of this retrospective study was to assess parental report of current sleep disorders in school-aged attention deficit disorder (ADD) children, as well as recalled sleep problems from when the children were infants (0–12 months) and toddlers (1–3 years). Results of a sleep questionnaire completed by mothers of 48 ADD children and a comparison group of 30 patients with school problems indicate that ADD children were perceived to have significantly more sleep problems and that these problems had onset in infancy. Specific items in the questionnaire which were increased included latency to sleep onset of more than 30 min at least 3 nights per week, fatigue upon awakening, and recall of nightmares. Pediatric clinicians should be alert to possible sleep disorders in children suspected of attention disorders and should consider sleep hygiene measures as a component of treatment.     

Behavioral Sleep Problems in Children and Adolescents

Sleep problems in children and adolescents are common, and they impact multiple domains of child and family functioning. Psychologists have a critical role in the assessment and treatment of sleep problems and are integral to interdisciplinary sleep teams. Certain sleep problems may be related to co-morbid psychological or developmental conditions, and others are considered to be primarily medical, yet behavioral approaches may be applicable. There are also sleep problems considered to be behavioral in etiology (e.g. inadequate sleep hygiene, behavioral insomnia of childhood, nightmares/bad dreams/nighttime fears, delayed sleep phase syndrome, and psychophysiological insomnia). In this article, the assessment of behavioral sleep problems, as well as specific behavioral sleep disorders, and their treatments will be discussed.     

Sleep Symptoms as a Partial Mediator Between Combat Stressors and Other Mental Health Symptoms in Iraq War Veterans

Sleep symptoms are a prominent feature of mental health disorders like PTSD and depression. However, it is unknown whether sleep symptoms mediate the relationship between combat stress and these disorders. We examined the mediating role of sleep symptoms on the relationship between combat stress and PTSD; and the relationship between combat stress and depression using data from 576 Army veterans of the Iraq War surveyed in 2004. Correlational analyses revealed that when insomnia was included in the model, the correlation between combat stressors and other depression symptoms decreased by 65%; and when nightmares were included in the model, the correlation between combat stressors and other PTSD symptoms decreased by 69%. We replicated these analyses using individual items assessing PTSD and depression and found that the insomnia and nightmare items had the largest and second largest mediation effect between combat stressors and PTSD and depression symptoms. Our result support the theory that sleep symptoms contribute to the development and/or maintenance of other mental health symptoms and that early treatment of sleep symptoms may mitigate the other mental health consequences of combat stress.     

Sleep Problems in Childhood and Borderline Personality Disorder Symptoms in Early Adolescence

Sleep disorders, such as insomnia and nightmares, are commonly associated with Borderline Personality Disorder (BPD) in adulthood. Whether nightmares and sleep-onset and maintenance problems predate BPD symptoms earlier in development is unknown. We addressed this gap in the literature using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants included 6050 adolescents (51.4 % female) who completed the UK Childhood Interview for DSM-IV BPD at 11 to 12 years of age. Nightmares and sleep onset and maintenance problems were prospectively assessed via mother report when children were 2.5, 3.5, 4.8 and 6.8 years of age. Psychopathological (i.e., emotional temperament; psychiatric diagnoses; and emotional and behavioural problems) and psychosocial (i.e., abuse, maladaptive parenting, and family adversity) confounders were assessed via mother report. In logistic regressions, persistent nightmares (i.e., regular nightmares at 3 or more time-points) were significantly associated with BPD symptoms following adjustment for sleep onset and maintenance problems and all confounders (Adjusted Odds Ratio = 1.62; 95 % Confidence Interval = 1.12 to 2.32). Persistent sleep onset and maintenance problems were not significantly associated with BPD symptoms. In path analysis controlling for all associations between confounders, persistent nightmares independently predicted BPD symptoms (Probit co-efficient [β] = 0.08, p = 0.013). Emotional and behavioural problems significantly mediated the association between nightmares and BPD (β =0.016, p < 0.001), while nightmares significantly mediated associations between emotional temperament (β = 0.001, p = 0.018), abuse (β = 0.015, p = 0.018), maladaptive parenting (β = 0.002, p = 0.021) and subsequent BPD. These findings tentatively support that childhood nightmares may potentially increase the risk of BPD symptoms in early adolescence via a number of aetiological pathways. If replicated, the current findings could have important implications for early intervention, and assist clinicians in the identification of children at risk of developing BPD.     

Impaired executive functions in subjects with frequent nightmares as reflected by performance in different neuropsychological tasks

Nightmare disorder is a prevalent parasomnia characterized by vivid and highly unpleasant dream experiences during night time sleep. The neural background of disturbed dreaming was proposed to be associated with impaired prefrontal and fronto-limbic functioning during REM sleep. We hypothesized that the impaired prefrontal and fronto-limbic functioning in subjects with frequent nightmares would be reflected at the behavioral level during waking tasks as well. 35-35 Subjects with frequent nightmares and matched controls participated in Study 1, involving an Emotional Go/NoGo, an Emotional Stroop task, and a Verbal Fluency task. Nightmare subjects exhibited longer reaction times in the Emotional Go/NoGo and Emotional Stroop tasks. Moreover, they committed more perseveration errors and showed less fluent word generation in the Verbal Fluency task. Nightmare subjects showed an overall slowing irrespective of the valence of the stimuli. While the effects of sleep quality and waking anxiety were associated to these deficits in some cases, these factors could not solely explain the difference between the two groups. In Study 2, 17 subjects with frequent nightmares and 18 controls were compared by a Color-word and an Emotional, block design Stroop task in order to avoid the slow effects of emotional interference potentially caused by previous items. Nightmare subjects were characterized by an overall slowing in the Emotional Stroop task, irrespective of the valence of the stimuli. In the Color-word Stroop task, nightmare subjects were not significantly slower in comparison with controls. Our results suggest that individuals with frequent nightmares are impaired in executive tasks involving the suppression of task-irrelevant semantic representations.     

Post-Traumatic Stress Disorder Nightmares and Sleep Disturbance in Iraq War Veterans: A Feasible and Promising Treatment Combination

A substantial proportion of returnees from the Iraq war have significant psychological symptoms related to war zone exposure, including high rates of post-traumatic stress disorder (PTSD), nightmares, and sleep disturbances. This pilot investigation examined the feasibility and efficacy of a promising cognitive-behavioral treatment (CBT) for nightmares, Imagery Rehearsal, combined with CBT for insomnia. Seven veterans completed treatment and showed promising pre-post effects regarding nightmare frequency, sleep quality, and PTSD. This report further examined the content of participants' nightmares, changes made during treatment, and potentially important modifying variables of treatment outcome. Those with redeployment fears, guilt due to perpetration issues, or traumatic brain injuries may receive some but not full benefits of the treatment.     

Investigating the Interaction Between Sleep Symptoms of Arousal and Acquired Capability in Predicting Suicidality

Heightened arousal significantly interacts with acquired capability to predict suicidality. We explore this interaction with insomnia and nightmares independently of waking state arousal symptoms, and test predictions of the Interpersonal Theory of Suicide (IPTS) and Escape Theory in relation to these sleep arousal symptoms. Findings from our e‐survey (n = 540) supported the IPTS over models of Suicide as Escape. Sleep‐specific measurements of arousal (insomnia and nightmares) showed no main effect, yet interacted with acquired capability to predict increased suicidality. The explained variance in suicidality by the interaction (1%–2%) using sleep‐specific measures was comparable to variance explained by interactions previously reported in the literature using measurements composed of a mix of waking and sleep state arousal symptoms. Similarly, when entrapment (inability to escape) was included in models, main effects of sleep symptoms arousal were not detected yet interacted with entrapment to predict suicidality. We discuss findings in relation to treatment options suggesting that sleep‐specific interventions be considered for the long‐term management of at‐risk individuals.     

Nightmares, Bad Dreams, and Emotion Dysregulation: A Review and New Neurocognitive Model of Dreaming

ABSTRACT— Nightmares—vivid, emotionally dysphoric dreams—are quite common and are associated with a broad range of psychiatric conditions. However, the origin of such dreams remains largely unexplained, and there have been no attempts to reconcile repetitive traumatic nightmares with nontraumatic nightmares, dysphoric dreams that do not awaken the dreamer, or with more normative dreams. Based on recent research in cognitive neuroscience, sleep physiology, fear conditioning, and emotional-memory regulation, we propose a multilevel neurocognitive model that unites waking and sleeping as a conceptual framework for understanding a wide spectrum of disturbed dreaming. We propose that normal dreaming serves a fear-extinction function and that nightmares reflect failures in emotion regulation. We further suggest that nightmares occur as a result of two processes that we term affect load—a consequence of daily variations in emotional pressures—and affect distress—a disposition to experience events with high levels of negative emotional reactivity.     

Epidemiologic study of sleep disorders in Kuwaiti adolescents.

A sample of 2,574 volunteer Kuwaiti boys (n = 1,309) and girls (n = 1,265) in secondary schools were recruited. Their ages ranged from 14 to 18 years. 13 items were used to assess prevalence of insomnia, hypersomnia, nightmares, sleepwalking, sleep terror, and narcolepsy. Participants were requested to respond according to the past month on a 5-point scale. The summation of responses in the last two options, i.e., "Much" and "Very much" was considered as the point prevalence rates. Girls had significantly higher mean ratings than boys on the following items: difficulty initiating sleep, fitful and disturbed sleep, waking up several times, nightmares, and sleep terror, while boys had significantly higher mean ratings on sleepwalking and "watching TV causes naps or sleep." The point prevalence on all the items for boys ranged from 4.6% to 35.2%, and that for girls ranged between 1.0% and 37.5%. One should keep in mind that the present sample was not a clinical one.     

Sleep paralysis and hallucinosis

Background: Sleep paralysis is one of the many conditions of which visual hallucinations can be a part but has received relatively little attention. It can be associated with other dramatic symptoms of a psychotic nature likely to cause diagnostic uncertainty. Methods and results: These points are illustrated by the case of a young man with a severe bipolar affective disorder who independently developed terrifying visual, auditory and somatic hallucinatory episodes at sleep onset, associated with a sense of evil influence and presence. The episodes were not obviously related to his psychiatric disorder. Past diagnoses included nightmares and night terrors. Review provided no convincing evidence of various other sleep disorders nor physical conditions in which hallucinatory experiences can occur. A diagnosis of predormital isolated sleep paralysis was made and appropriate treatment recommended. Conclusions: Sleep paralysis, common in the general population, can be associated with dramatic auxiliary symptoms suggestive of a psychotic state. Less common forms are either part of the narcolepsy syndrome or (rarely) they are familial in type. Interestingly, sleep paralysis (especially breathing difficulty) features prominently in the folklore of various countries.     

Insomnia Symptoms,Nightmares, and Suicide Risk: Duration of Sleep Disturbance Matters

Duration of insomnia symptoms or nightmares was investigated to see if it was related to suicide risk independent of current insomnia symptoms, nightmares, anxiety symptoms, depressive symptoms, and posttraumatic symptoms. The cross‐sectional study involved analyses of survey responses from undergraduate students who endorsed either insomnia symptoms (n = 660) or nightmares (n = 312). Both insomnia symptom and nightmare duration were significantly associated with suicide risk independent of current insomnia symptoms or nightmares, respectively. Relations were also significant after controlling for anxiety symptoms, depressive symptoms, and posttraumatic symptoms. Results suggest that duration of sleep disturbance is relevant when assessing suicide risk.     

Effects of a brief behavioral treatment for PTSD-related sleep disturbances: a pilot study

OBJECTIVE: Sleep disturbances are a core feature of post-traumatic stress disorder (PTSD), and are often resistant to first-line pharmacological and psychological PTSD interventions. The goal of this pilot study was to explore the effects of a very brief intervention for PTSD-related nightmares and insomnia in victims of violent crimes with PTSD. METHODS: Seven adult victims of violent crimes with a current diagnosis of PTSD received a single, 90-min intervention session that used cognitive-behavioral techniques aimed at reducing post-traumatic nightmares and insomnia. Sleep diary measures, and measures of sleep quality, PTSD severity, anxiety, and depression were completed at baseline and 6 weeks post-intervention. RESULTS: Improvements in self-report and sleep diary measures of sleep quality and dream frequency were observed post-intervention. Clinically meaningful reductions in daytime PTSD symptom severity were also observed. CONCLUSIONS: A very brief behavioral intervention targeting post-traumatic nightmares and insomnia was associated with significant improvements in sleep and daytime PTSD symptom severity. Brief sleep-focused intervention may be helpful adjuncts to first-line PTSD treatments.     

Associations between sleep variables and ostensibly paranormal experiences and paranormal beliefs: A scoping review

Night-time is a period of great significance for many people who report paranormal experiences. However, there is limited understanding of the associations between sleep variables and seemingly paranormal experiences and/or beliefs. The aim of this review is to improve our understanding of these associations while unifying a currently fragmented literature-base into a structured, practical review. In this pre-registered scoping review, we searched for relevant studies in MEDLINE (PubMed), PsycINFO (EBSCO), Web of Science and EMBASE using terms related to sleep and ostensibly paranormal experiences and beliefs. Forty-four studies met all inclusion criteria. All were cross-sectional and most investigated sleep paralysis and/or lucid dreaming in relation to ostensibly paranormal experiences and paranormal beliefs. Overall, there were positive associations between many sleep variables (including sleep paralysis, lucid dreams, nightmares, and hypnagogic hallucinations) and ostensibly paranormal experiences and paranormal beliefs (including those of ghosts, spirits, and near-death experiences). The findings of this review have potential clinical implications such as reducing misdiagnosis and treatment development and provide foundations for further research. Our findings also highlight the importance of understanding why so many people report ‘things that go bump in the night’.     

Treatment of nocturnal headbanging by behavior modification techniques: a case report

The application of behavior modification techniques to the alleviation of maladaptive behavior occurring during the waking state is well documented (Bandura, 1969; Franks, 1969). Recently, several case studies have been reported which demonstrate the successful extension of behavior modification techniques such as the desensitization procedure to the modification of sleep state maladaptive behavior, e.g. recurrent nightmares (Cautela, 1968; Geer and Silverman 1966; Silverman and Geer, 1968) and sleep walking (Clement, 1969). The present case study illustrates that other sleep state maladaptive behavior, in this case nocturnal headbanging, is amenable to the same behavior modification techniques which are used to modify maladaptive behavior during the waking state. Case background     

Sleep disturbances in the aftermath of trauma and posttraumatic stress disorder

Sleep disturbances, including nightmares and insomnia, are prominent following trauma and with posttraumatic stress disorder (PTSD) and likely contribute to the pathogenesis of the disorder. Findings from laboratory studies of PTSD have been inconsistent in terms of documenting objective impaired sleep maintenance but have been somewhat more consistent in indicating alterations of rapid eye movement (REM) sleep. Studies of the early aftermath of trauma can reduce the complexity associated with chronicity and comorbidity, and may have implications for early diagnosis and prevention. Multiple studies indicate that dream content is affected by recent threatening experiences. The development of PTSD is associated with a more replicative type of nightmare content. Sleep is reported to be generally disrupted following trauma especially among those developing PTSD. The limited number of studies that provide objective recorded indices during the early aftermath of trauma also provide a mixed picture regarding overall sleep maintenance. Recent data suggest that a more specific disruption of REM sleep may be associated with the development of PTSD and that this disruption is associated with an increased signal of sympathetic nervous system activation during REM sleep. Disrupted REM sleep and increased sympathetic/noradrenergic activity may have implications for understanding recent promising interventions for PTSD sleep disturbance that can be applied to early intervention.