Dream recall frequency and nightmare frequency in patients with sleep-disordered breathing

Interest in telephone nightmare counselling in patients with sleep-related breathing disorders

Background and objective

Nightmares 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 methods

The 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.

Results

Of 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.

Dreams and Nightmares in Patients With Obstructive Sleep Apnea: A Review

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 content 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 content in patients with OSA, most studies that have assessed the dream content of patients with OSA revealed that respiratory-related dream content was unusual. A clear association between post-traumatic stress disorders, comorbid OSA, and nightmares has been reported in several studies. Furthermore, 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.

Pain Dreams and Dream Emotions in Patients with Chronic Back Pain and Healthy Controls

Background:

Although some theorists have suggested that pain sensations cannot be part of the dreaming world, research has shown that pain sensations occur in about 1% of the dreams in healthy persons and in about 30% of patients with acute, severe pain.

Objective:

The present study is the first to study pain dreams in patients with chronic pain.

Method:

A questionnaire was administered to 100 patients with chronic lower back pain and 270 controls.

Results:

The patients reported more pain dreams and more negatively toned dreams compared to healthy controls. In addition, patients reported more often that the dreamed pain persisted into waking state.

Conclusion:

In patients, pain dreams might be instigated by actual pain whereas for healthy persons pain dreams might be pain memories (self-experienced pain and/or seeing persons in pain). Future research should clarify how pain is processed during sleep. As patients with chronic pain experience negatively toned dreams, it will be beneficial to ask chronic pain patients about their dreams and, if necessary, offer specific treatment options like imagery rehearsal treatment.

Characteristics and contents of dreams

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.