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Álvarez-García HB, Jiménez-Correa U. Brief Psychoeducational and Cognitive Therapy for Nightmare Disorder (BPCT-ND). Sleep Sci 2024; 17:e216-e220. [PMID: 38846595 PMCID: PMC11152622 DOI: 10.1055/s-0043-1777707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/28/2023] [Indexed: 06/09/2024] Open
Abstract
In adults, nightmare disorder is related to sleep deprivation, drug consumption or abuse, or other comorbid sleep disorders such as insomnia or insufficient sleep syndrome. Behavioral treatment has solid scientific evidence in disorders such as insomnia and, more recently, parasomnias. The aim of the present study was to investigate the clinical effectiveness of a Brief Behavioral Telemedicine Therapy in Nightmare Disorder in a 23-year-old female patient. The procedure consisted of the case study, with pre and posttreatment measures as well as follow-up after 1 month; and the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Paris Arousal Disorders Severity Scale, and a sleep diary were applied. In parallel with changes recorded in the sleep diary, a decrease in nightmares, sleepiness, and insomnia symptoms was observed when the intervention was finished. The behavioral intervention was clinically effective; therefore, the present case report provides information on behavioral treatments for nightmare disorder.
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Affiliation(s)
- Horacio Balam Álvarez-García
- Research Division, Medicine Faculty, Sleep Disorder Clinic, National Autonomous University of Mexico UNAM, Ciudad de Mexico, Mexico
- Master's and Doctoral Program in Medical, Dental and Health Sciences, Faculty of Medicine, National Autonomous University of Mexico UNAM, Ciudad de Mexico, Mexico
| | - Ulises Jiménez-Correa
- Research Division, Medicine Faculty, Sleep Disorder Clinic, National Autonomous University of Mexico UNAM, Ciudad de Mexico, Mexico
- Master's and Doctoral Program in Medical, Dental and Health Sciences, Faculty of Medicine, National Autonomous University of Mexico UNAM, Ciudad de Mexico, Mexico
- Continuing Education and Innovation Division, National School of Higher Education, Leon Unit, National Autonomous University of Mexico UNAM, Leon, Guanajuato, Mexico
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2
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Schredl M. Seeking help for nightmares: Associated personality factors. J Sleep Res 2024; 33:e13972. [PMID: 37345305 DOI: 10.1111/jsr.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
Research indicated that patients suffering from nightmares are often undertreated. One reason for this gap is that nightmare sufferers themselves often have not sought professional help for their nightmares, and-if they did-it was not very helpful. The current study aimed at studying trait factors (personality, harm avoidance) in relation to the persons considering seeking professional help. In a population-sample of 1108 persons (712 women, 396 men) with a mean age of 50.55 ± 14.22 years, it was also found that only some of the persons who have problems with nightmares even considered seeking professional help as an option. As expected and after controlling for effects of nightmare frequency, persons with high harm avoidance and high introversion were more likely not seeking help for their problems with nightmares. The associations with low education, low agreeableness and low conscientiousness with considering seeking professional help might point to the fear of stigmatisation in nightmare sufferers. Interestingly, the association between harm avoidance and "Considering seeking professional help" was even stronger in the subsample of frequent nightmare sufferers (once a week or more often). Future efforts should aim at findings new ways to offer adequate help for nightmares and increase the knowledge about nightmare treatment in healthcare professionals.
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Affiliation(s)
- Michael Schredl
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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3
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Kehr T, Haeyen S. Drawing your way out: Imagery rehearsal based art therapy (IR-AT) for post-traumatic nightmares in borderline personality disorder. J Clin Psychol 2024; 80:1015-1030. [PMID: 38193630 DOI: 10.1002/jclp.23638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024]
Abstract
Posttraumatic nightmares (PTN) are a frequent symptom after a traumatic event and often play part in the psychopathology of patients with borderline personality disorder (BPD). Imagery rehearsal therapy (IRT) currently offers the best evidence for an effective treatment to reduce PTNs, although high drop-out rates are common. Art therapy in IRT may counteract this, by its indirect, nonverbal, and often playful approach that helps to break through avoidance. This case study focusses on the perception of a patient with BPD in an art therapy based IRT treatment for patients with PTNs. It tells the story of Aurelia, a 40-year-old woman who, within this treatment, processes traumatic contents of her childhood like physical and sexual violence, but also current interactional problems that manifest themselves in her nightmares. Following the IR-AT treatment for PTNs Aurelia noticed a reduction in her nightmares, was less afraid of them and felt calmer towards her trauma. She expressed herself in the art medium and by this developed more self-efficacy. Her process resulted in an integration of the trauma and a perceived decrease in borderline symptoms. Future research can build on this basis to further explore the mechanisms and effects of IR-AT for PTNs.
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Affiliation(s)
- Timea Kehr
- LVR, Psychosomatic Medicine and Psychotraumatology, Cologne, Germany
| | - Suzanne Haeyen
- Academy of Health and Vitality, Research Group Arts & Psychomor Therapies in Health Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- GGNet, Centre for Mental Health, Scelta, Expert Centre for Personality Disorders Apeldoorn, Warnsveld, The Netherlands
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4
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Sayk C, Saftien S, Koch N, Ngo HVV, Junghanns K, Wilhelm I. Cortical hyperarousal in individuals with frequent nightmares. J Sleep Res 2024; 33:e14003. [PMID: 37688512 DOI: 10.1111/jsr.14003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/09/2023] [Accepted: 07/01/2023] [Indexed: 09/11/2023]
Abstract
Nightmares are common among the general population and psychiatric patients and have been associated with signs of nocturnal arousal such as increased heart rate or increased high-frequency electroencephalographic (EEG) activity. However, it is still unclear, whether these characteristics are more of a trait occurring in people with frequent nightmares or rather indicators of the nightmare state. We compared participants with frequent nightmares (NM group; n = 30) and healthy controls (controls; n = 27) who spent 4 nights in the sleep laboratory over the course of 8 weeks. The NM group received six sessions of imagery rehearsal therapy (IRT), the 'gold standard' of cognitive-behavioural therapy for nightmares, between the second and the third night. Sleep architecture and spectral power were compared between groups, and between nights of nightmare occurrence and nights without nightmare occurrence in the NM group. Additionally, changes before and after therapy were recorded. The NM group showed increased beta (16.25-31 Hz) and low gamma (31.25-35 Hz) power during the entire night compared to the controls, but not when comparing nights of nightmare occurrence to those without. Moreover, low gamma activity in rapid eye movement sleep was reduced after therapy in the NM group. Our findings indicate, cortical hyperarousal is more of a trait in people with frequent nightmares within a network of other symptoms, but also malleable by therapy. This is not only a new finding for IRT but could also lead to improved treatment options in the future that directly target high-frequency EEG activity.
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Affiliation(s)
- Clara Sayk
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Sophia Saftien
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Nicole Koch
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Hong-Viet V Ngo
- Department of Psychology, University of Lübeck, Lübeck, Germany
- Center for Brain, Behaviour and Metabolism, University of Lübeck, Lübeck, Germany
- Department of Psychology, University of Essex, Colchester, UK
| | - Klaus Junghanns
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Ines Wilhelm
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
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5
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Fellman V, Heppell PJ, Rao S. Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents. Psychiatr Clin North Am 2024; 47:229-253. [PMID: 38302209 DOI: 10.1016/j.psc.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.
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Affiliation(s)
- Veronica Fellman
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA.
| | - Patrick J Heppell
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA
| | - Suchet Rao
- Psychiatry and Behavioral Health, NYC Administration for Children's Services, 150 William Street, 11th Floor, New York City, NY 10038, USA
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6
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Garriques VR, Dhruve DM, Nadorff MR. Nightmare Disorder. Sleep Med Clin 2024; 19:111-119. [PMID: 38368059 DOI: 10.1016/j.jsmc.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
This article presents a comprehensive review of nightmare disorder, covering diagnosis, treatment approaches, guidelines, and considerations. It begins with an introduction, defining the disorder and addressing its prevalence and psychosocial implications. The article explores assessment tools for diagnosis and then delves into psychological and pharmacologic treatment modalities, examining their efficacy and side effects. Considerations for optimizing therapeutic outcomes are highlighted, including medication versus psychotherapy, co-morbidities, cultural implications, and the use of technology and service animals. The review concludes by offering key recommendations for effective treatment and clinical care for individuals with nightmare disorder.
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Affiliation(s)
- Victoria R Garriques
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS 39762, USA
| | - Deepali M Dhruve
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS 39762, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS 39762, USA.
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7
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Barone DA. Trauma-Associated Sleep Disorder. Sleep Med Clin 2024; 19:93-99. [PMID: 38368073 DOI: 10.1016/j.jsmc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Trauma-associated sleep disorder (TASD) is a recently described parasomnia that develops following a traumatic event. It consists of trauma-related nightmares, disruptive nocturnal behaviors, and autonomic disturbances, and shares similarities with post-traumatic stress disorder and rapid eye movement behavior disorder. The underlying pathophysiology of TASD and how it relates to other parasomnias are still not entirely understood; proposed treatment is similarly nebulous, with prazosin at the forefront along with management of comorbid sleep disorders. The purpose of this article is to characterize and highlight the clinical features of this condition.
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Affiliation(s)
- Daniel A Barone
- Weill Cornell Center for Sleep Medicine, Weill Cornell Medicine, New York-Presbyterian, 425 East 61st Street, 5th Floor, New York, NY 10065, USA.
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8
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Robles-Ramamurthy B, Zaki S, Sandoval JF, Dube AR, Hlozek S, Fortuna LR, Williamson AA. Improving adolescent sleep in long-term Juvenile correctional settings: case examples with clinical, research, and policy implications. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae006. [PMID: 38425455 PMCID: PMC10904105 DOI: 10.1093/sleepadvances/zpae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/30/2023] [Indexed: 03/02/2024]
Abstract
Poor sleep during adolescence is a public health concern that may be especially important to address among youth in juvenile correctional facilities, who tend to experience greater mental health challenges, substance use disorders, and traumatic stress exposure. However, evidence for addressing sleep in correctional settings is limited. Using de-identified composite clinical cases, this paper describes challenges and opportunities for addressing sleep disorders (i.e. insomnia) and promoting sleep health (i.e. improving duration, regularity, and behaviors) among adolescents in long-term juvenile correctional facilities. These clinical cases highlight common presenting problems and underscore the need for integrated sleep and mental health interventions as well as adaptations to enhance feasibility and efficacy of behavioral sleep treatment and sleep health promotion in juvenile correctional contexts. We conclude by summarizing clinical, research, and policy implications for addressing adolescent sleep problems and promoting sleep health and well-being in these contexts.
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Affiliation(s)
- Barbara Robles-Ramamurthy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Saadia Zaki
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jessica F Sandoval
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Anish R Dube
- Department of Psychiatry, Charles R. Drew University College of Medicine and Science, Los Angeles, CA, USA
| | - Steven Hlozek
- Department of Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Neurosciences, University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Ariel A Williamson
- Ballmer Institute for Children’s Behavioral Health, University of Oregon, Portland, OR, USA
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9
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Naderifar N, Roohi E, Sharifi A, Jaafari N, Hashemian F. Therapeutic Effects of Tamsulosin in Nightmare Disorder: A Randomized, Double Blind, Placebo-Controlled, Cross-Over, Pilot Study. Drug Res (Stuttg) 2024; 74:53-59. [PMID: 38237637 DOI: 10.1055/a-2226-3604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Nightmare disorder is associated with functional impairment, distress, and low quality of life; however, studies on pharmacotherapy of this debilitating disorder yielded mixed results. Prazosin, a non-selective α1 blocker is reported to be effective in treatment of post-traumatic stress disorder-related nightmares. We aimed at investigating therapeutic effects of tamsulosin which has higher affinity for blocking α1A and α1D adrenoceptors in treatment of nightmare disorder. A randomized, double blind, cross-over, placebo-controlled pilot study was conducted. Patients were randomly assigned to receive Tamsulosin 0.4 mg once daily or placebo for period of four weeks. Following a 2-week wash-out period, they were crossed over to the other group and received drug or placebo for duration of 4 additional weeks. Nightmare frequency and intensity measurements were carried out using Disturbing Dreams and Nightmares Severity Index (DDNSI). Blood pressure measurements were also performed. According to per protocol analysis, mean DDNSI scores decreased following administration of tamsulosin and a statistical trend towards significance was reported (p=0.065, d=0.236). Results of intention to treat analysis showed significant difference in DDNSI scores after drug use (p=0.030, d=0.651). Additionally, DDNSI scores dropped significantly following placebo use. However, intention to treat analysis showed no statistically significant difference pre and post placebo period (0.064, d=0.040). Tamsulosin may be effective in treatment of nightmare disorder. However, further larger clinical trials are recommended to clarify the effectiveness of tamsulosin and α1 subtypes in pharmacotherapy of nightmares.
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Affiliation(s)
- Negin Naderifar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Elnaz Roohi
- Department of Experimental Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Ali Sharifi
- Iranian Scientific Society of Clinical Hypnosis, Tehran, Iran
| | - Nemat Jaafari
- Université de Poitiers, Unité de recherche clinique centre Hospitalier Henri Laborit, CeRCA CNRS7295, Poitiers, France
| | - Farshad Hashemian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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10
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Petrov ME, Calvin S, Wyst KBV, Whisner CM, Meltzer LJ, Chen ACC, Felix KN, Roe-Sepowitz D. Sleep Disturbances and Hygiene of Adolescent Female Survivors of Domestic Minor Sex Trafficking. J Pediatr Health Care 2024; 38:52-60. [PMID: 37610406 DOI: 10.1016/j.pedhc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION This cross-sectional quantitative study investigated the sleep hygiene and disturbances of adolescent female survivors of domestic minor sex trafficking (DMST) compared to an online sample of community-dwelling adolescent females. METHOD Community-dwelling adolescent females (aged 13-17 years, n = 61) and survivors of DMST housed in residental care (aged 12-17 years, n = 19) completed the Children's Report of Sleep Patterns (adolescent version). Descriptive statistics on sleep health in both samples were computed and compared using chi-square and t-tests. RESULTS Among the survivors of DMST, the majority reported insufficient sleep duration, okay-to-poor sleep quality, waking thirsty, and frequent nightmares. Compared with community-dwelling adolescents, survivors of DMST had more symptoms of insomnia, sleepiness, nightmares, and waking thirsty (p < .05). DISCUSSION Sleep disturbances among adolescent female survivors of DMST may be more prevalent than in community-dwelling adolescent females. Further empirical research on appropriate assessment and trauma-informed treatment of sleep in this population is needed.
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Wagner AM, Richards A, Chiros C, Thuras P, Parsons EC, Oien AD, Schenck CH, Irfan M. A Retrospective Pilot Study of Imagery Rehearsal Therapy Enhanced with Narrative Therapy Principles for the Treatment of Nightmares in US Military Veterans. Sleep Sci 2023; 16:e439-e445. [PMID: 38197021 PMCID: PMC10773522 DOI: 10.1055/s-0043-1776796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 02/14/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Chronic nightmares are a common and disabling feature of posttraumatic stress disorder (PTSD) for which broadly effective treatments are still lacking. While imagery rehearsal therapy (IRT) demonstrates benefits for patients with idiopathic nightmares and some patients with PTSD-related nightmares, research indicates it may be less beneficial for veterans. Narrative therapy (NT) is a form of psychotherapy which is client-centered and value-focused and has demonstrated benefits for PTSD patients. The application of NT principles to IRT may provide a valuable therapeutic approach for treatment in veterans. Objective To perform a retrospective chart review of veteran clients participating in a novel, brief intervention developed by the first author consisting of IRT enhanced with NT principles (N-IRT) for the treatment of nightmares. The primary outcomes were nightmare frequency and intensity, and the secondary outcome was the impact of the intervention on nightmare distress and coping, subjective sleep quality, and overall PTSD symptoms. Materials and Methods We conducted retrospective chart reviews for eight veterans referred to the first author for the treatment of nightmares, who completed N-IRT, including baseline and end-of-treatment measures. The protocol involved a single 60-minute NT-enhanced rescripting session and assigned homework to rehearse the revised dream script, and a follow-up evaluation 4 weeks later. The subjects completed a sleep and nightmare interview developed by the first author and the PTSD Checklist at baseline and after the intervention at the follow-up evaluation. Paired t -tests were conducted to test for pre-to-post differences. Results In the statistical analysis, we observed a statistically significant and clinically meaningful reduction in the frequency ( p = 0.04) and intensity of nightmares ( p = 0.001) from pretreatment to the 1-month follow-up. Measures of nightmare-associated emotional distress, the ability to cope with nightmares, sleep duration and sleep efficiency, as well as overall PTSD symptoms also demonstrated significant improvements. Conclusion These pilot data provide compelling preliminary evidence that a single-session IRT intervention modified with NT (N-IRT) is effective in reducing nightmare frequency and intensity, reducing nightmare distress, improving the act of coping with nightmares, and improving sleep quality and overall PTSD symptoms in veterans. Further investigation of this method with gold-standard clinical trial designs and larger sample sizes is indicated to confirm effectiveness and to better understand the possible mechanisms of treatment effect.
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Affiliation(s)
- Ann Marie Wagner
- Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
| | - Anne Richards
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States of America
- Mental Health Services, San Francisco Veteran's Affairs (VA) Health Care System, San Francisco, CA, United States of America
| | - Christine Chiros
- Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
| | - Paul Thuras
- Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
| | - Elizabeth C. Parsons
- Pulmonary and Critical Care, Puget Sound Veteran's Affairs (VA) Health Care System, Seattle, WA, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Angela D. Oien
- Pulmonary and Critical Care, Puget Sound Veteran's Affairs (VA) Health Care System, Seattle, WA, United States of America
| | - Carlos H. Schenck
- Department of Psychiatry, Minnesota Regional Sleep Disorders Center, Minneapolis, MN, United States of America
| | - Muna Irfan
- Pulmonary, Allergy, Critical Care and Sleep, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
- Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States of America
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12
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Frontera JA, Guekht A, Allegri RF, Ashraf M, Baykan B, Crivelli L, Easton A, Garcia-Azorin D, Helbok R, Joshi J, Koehn J, Koralnik I, Netravathi M, Michael B, Nilo A, Özge A, Padda K, Pellitteri G, Prasad K, Romozzi M, Saylor D, Seed A, Thakur K, Uluduz D, Vogrig A, Welte TM, Westenberg E, Zhuravlev D, Zinchuk M, Winkler AS. Evaluation and treatment approaches for neurological post-acute sequelae of COVID-19: A consensus statement and scoping review from the global COVID-19 neuro research coalition. J Neurol Sci 2023; 454:120827. [PMID: 37856998 DOI: 10.1016/j.jns.2023.120827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Post-acute neurological sequelae of COVID-19 affect millions of people worldwide, yet little data is available to guide treatment strategies for the most common symptoms. We conducted a scoping review of PubMed/Medline from 1/1/2020-4/1/2023 to identify studies addressing diagnosis and treatment of the most common post-acute neurological sequelae of COVID-19 including: cognitive impairment, sleep disorders, headache, dizziness/lightheadedness, fatigue, weakness, numbness/pain, anxiety, depression and post-traumatic stress disorder. Utilizing the available literature and international disease-specific society guidelines, we constructed symptom-based differential diagnoses, evaluation and management paradigms. This pragmatic, evidence-based consensus document may serve as a guide for a holistic approach to post-COVID neurological care and will complement future clinical trials by outlining best practices in the evaluation and treatment of post-acute neurological signs/symptoms.
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Affiliation(s)
- Jennifer A Frontera
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Mariam Ashraf
- Department of Anesthesiology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Betül Baykan
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, and EMAR Medical Center, Istanbul, Turkey
| | - Lucía Crivelli
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina
| | - Ava Easton
- The Encephalitis Society, Malton, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - David Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Raimund Helbok
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurology, Johannes Kepler University, Linz, Austria
| | - Jatin Joshi
- Department of Anesthesiology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Julia Koehn
- Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Igor Koralnik
- Departmentof Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Benedict Michael
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Annacarmen Nilo
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Aynur Özge
- Department of Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Karanbir Padda
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Gaia Pellitteri
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Kameshwar Prasad
- Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Marina Romozzi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Adam Seed
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kiran Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Derya Uluduz
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, and EMAR Medical Center, Istanbul, Turkey
| | - Alberto Vogrig
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy; Department of Medicine, University of Udine Medical School, Udine, Italy
| | - Tamara M Welte
- Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany; Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Erica Westenberg
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dmitry Zhuravlev
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Mundt JM, Schuiling MD, Warlick C, Dietch JR, Wescott AB, Hagenaars M, Furst A, Khorramdel K, Baron KG. Behavioral and psychological treatments for NREM parasomnias: A systematic review. Sleep Med 2023; 111:36-53. [PMID: 37716336 PMCID: PMC10591847 DOI: 10.1016/j.sleep.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Non-rapid eye movement (NREM) parasomnias are often benign and transient, requiring no formal treatment. However, parasomnias can also be chronic, disrupt sleep quality, and pose a significant risk of harm to the patient or others. Numerous behavioral strategies have been described for the management of NREM parasomnias, but there have been no published comprehensive reviews. This systematic review was conducted to summarize the range of behavioral and psychological interventions and their efficacy. METHODS We conducted a systematic search of the literature to identify all reports of behavioral and psychological treatments for NREM parasomnias (confusional arousals, sexsomnia, sleepwalking, sleep terrors, sleep-related eating disorder, parasomnia overlap disorder). This review was conducted in line with PRISMA guidelines. The protocol was registered with PROSPERO (CRD42021230360). The search was conducted in the following databases (initially on March 10, 2021 and updated February 24, 2023): Ovid (MEDLINE), Cochrane Library databases (Wiley), CINAHL (EBSCO), PsycINFO (EBSCO), and Web of Science (Clarivate). Given a lack of standardized quantitative outcome measures, a narrative synthesis approach was used. Risk of bias assessment used tools from Joanna Briggs Institute. RESULTS A total of 72 publications in four languages were included, most of which were case reports (68%) or case series (21%). Children were included in 32 publications and adults in 44. The most common treatment was hypnosis (33 publications) followed by various types of psychotherapy (31), sleep hygiene (19), education/reassurance (15), relaxation (10), scheduled awakenings (9), sleep extension/scheduled naps (9), and mindfulness (5). Study designs and inconsistent outcome measures limited the evidence for specific treatments, but some evidence supports multicomponent CBT, sleep hygiene, scheduled awakenings, and hypnosis. CONCLUSIONS This review highlights the wide breadth of behavioral and psychological interventions for managing NREM parasomnias. Evidence for the efficacy of these treatments is limited by the retrospective and uncontrolled nature of most research as well as the infrequent use of validated quantitative outcome measures. Behavioral and psychological treatments have been studied alone and in various combinations, and recent publications suggest a trend toward preference for multicomponent cognitive behavioral therapies designed to specifically target priming and precipitating factors of NREM parasomnias.
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Affiliation(s)
- Jennifer M Mundt
- Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall 11th Floor, 710 N Lake Shore Drive, Chicago, IL, 60611, USA; Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, USA.
| | - Matthew D Schuiling
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 119, Indianapolis, IN, 46202, USA.
| | - Chloe Warlick
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL, 60611, USA.
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA.
| | - Annie B Wescott
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
| | - Muriel Hagenaars
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, Netherlands.
| | - Ansgar Furst
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Mailcode 151Y, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, USA; Polytrauma System of Care, VA Palo Alto Health Care System, USA.
| | - Kazem Khorramdel
- Department of Psychology and Education Science, Shiraz University, Shiraz, Fars, 71345, Iran.
| | - Kelly G Baron
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Suite A, Room 142, Salt Lake City, UT, 84108, USA.
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14
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Ouchene R, El Habchi N, Demina A, Petit B, Trojak B. The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review. L'ENCEPHALE 2023; 49:525-531. [PMID: 37005191 DOI: 10.1016/j.encep.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Nightmares can be defined as "an unpleasant dream with anxiety and oppression". They represent a symptom possibly leading to serious psychiatric and physical consequences. It occurs to 2% to 8% of the general population. Lucid dreaming therapy (LDT) is an interesting upcoming psychotherapy for the treatment of nightmares. The aim of this study was to evaluate the efficacy of LDT in the treatment of nightmares in adults and children. METHODS We performed a systematic review of the literature, based on the Cochrane organisation's methodology. We explored the PubMed, Cochrane library, PsycINFO via Ovid and Embase databases and clinical trial registries (CTR), namely clinicaltrials.gov, EU clinical trials and the WHO clinical trials registry platform. RESULTS Four randomized controlled trials (RCT), 2 case series and 5 case reports were included. Most of the included studies found LDT effective in reducing nightmare frequency among adults with chronic and recurring nightmares. We did not identify any reports in children. CONCLUSIONS Despite a limited internal validity for the included studies, these first results are encouraging. Nonetheless, larger and more rigorous studies would allow to better assess the utility of LDT for nightmares.
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Affiliation(s)
- R Ouchene
- Centre Hospitalier La Chartreuse, 21000 Dijon, France.
| | - N El Habchi
- CHU Dijon Bourgogne, Université Bourgogne Franche-Comté, Bourgogne Franche-Comté, France
| | - A Demina
- CHU Dijon Bourgogne, Université Bourgogne Franche-Comté, Bourgogne Franche-Comté, France
| | - B Petit
- CHU Dijon Bourgogne, Université Bourgogne Franche-Comté, Bourgogne Franche-Comté, France
| | - B Trojak
- CHU Dijon Bourgogne, Université Bourgogne Franche-Comté, Bourgogne Franche-Comté, France; Université de Bourgogne Franche-Comté, UMR Inserm 1093, CAPS, Dijon, France
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15
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Malkani R. REM Sleep Behavior Disorder and Other REM Parasomnias. Continuum (Minneap Minn) 2023; 29:1092-1116. [PMID: 37590824 DOI: 10.1212/con.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article reviews rapid eye movement (REM) sleep behavior disorder (RBD) and other REM sleep parasomnias, particularly recurrent isolated sleep paralysis and nightmare disorder. LATEST DEVELOPMENTS People with RBD have dream enactment behaviors that can be distressing and cause injuries to themselves or a bed partner. Diagnosis of RBD still requires video polysomnography but new evaluative techniques are emerging. Automatic scoring of REM sleep without atonia, the polysomnographic RBD feature, has led to clearer diagnostic cutoff values. Isolated RBD is strongly linked with neurodegenerative disorders, particularly α-synucleinopathies, with a median latency to neurodegenerative disease diagnosis of 8 years. Mounting imaging, electrophysiologic, and pathologic evidence supports neurodegenerative changes in patients with isolated RBD. Safety precautions should be reviewed with patients to reduce the risk of injury. Clonazepam and melatonin are first-line agents for RBD symptoms, and rivastigmine appears to be beneficial for RBD in people with mild cognitive impairment. For nightmare disorder, image rehearsal therapy is effective and can be delivered through online platforms. ESSENTIAL POINTS While RBD symptoms can often be managed, patients with isolated RBD should be monitored for signs and symptoms of impending neurodegenerative disease. Individuals who wish to know about the associated risk should be counseled accordingly to allow planning and involvement in research if they choose. Exercise may have some neuroprotective effects, although no treatment has been shown to modify the neurodegenerative risk.
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Taylor DJ, Pruiksma KE, Mintz J, Slavish DC, Wardle-Pinkston S, Dietch JR, Dondanville KA, Young-McCaughan S, Nicholson KL, Litz BT, Keane TM, Peterson AL, Resick PA. Treatment of comorbid sleep disorders and posttraumatic stress disorder in U.S. active duty military personnel: A pilot randomized clinical trial. J Trauma Stress 2023; 36:712-726. [PMID: 37322836 PMCID: PMC11057368 DOI: 10.1002/jts.22939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 06/17/2023]
Abstract
Insomnia and nightmares are common in patients with posttraumatic stress disorder (PTSD). They are associated with worse psychological and physical health and worse PTSD treatment outcomes. In addition, they are resistant to PTSD treatments, which do not typically address sleep disorders. Cognitive behavioral therapy for insomnia and nightmares (CBT-I&N) and cognitive processing therapy (CPT) for PTSD are first-line treatments, but limited evidence exists guiding the treatment of individuals with all three disorders. The current study randomized U.S. military personnel (N = 93) to one of three conditions: CBT-I&N delivered before CPT, CBT-I&N delivered after CPT, or CPT alone; all groups received 18 sessions. Across groups, participants demonstrated significantly improved PTSD symptoms. Because the study was terminated prematurely due to challenges with recruitment and retention, it was underpowered to answer the initially intended research questions. Nonetheless, statistical findings and relevant clinically meaningful changes were observed. Compared to participants who received CPT alone, those who received CBT-I&N and CPT, regardless of sequencing, demonstrated larger improvements in PTSD symptoms, d = -0.36; insomnia, d = -0.77; sleep efficiency, d = 0.62; and nightmares, d = -.53. Compared to participants who received CBT-I&N delivered before CPT, those who received CBT-I&N delivered after CPT demonstrated larger improvements in PTSD symptoms, d = 0.48, and sleep efficiency, d = -0.44. This pilot study suggests that treating comorbid insomnia, nightmares, and PTSD symptoms results in clinically meaningful advantages in improvement for all three concerns compared to treating PTSD alone.
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Affiliation(s)
- Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Kristi E. Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Danica C. Slavish
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | | | - Jessica R. Dietch
- School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Karin L. Nicholson
- Department of Medicine, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA
| | - Brett T. Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Terence M. Keane
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Behavioral Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina, USA
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17
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Moore BA, Brager A, Judkins J, Mysliwiec V. Nightmare disorder in active-duty US military personnel. Sleep Health 2023; 9:283-287. [PMID: 36774213 DOI: 10.1016/j.sleh.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 11/29/2022] [Accepted: 12/22/2022] [Indexed: 02/11/2023]
Abstract
STUDY OBJECTIVES Military personnel experience high rates of traumatic experiences. Despite this, few studies have examined the presence of nightmare disorder in military personnel. The primary aim of this study was to examine diagnoses of nightmare disorder across the 4 largest branches of the active-duty US military. DESIGN & PARTICIPANTS Data and service branch densities used to derive the expected rates of diagnoses of nightmare disorder were drawn from the Defense Medical Epidemiology Database. The branches examined included all active-duty services members in the US Army, Navy, Marine Corps, and Air Force, who served between 2016 and 2021. Single-sample chi-square goodness of fit tests were conducted to examine within-variable differences for military relevant variables. RESULTS Between 2016 and 2019, the incidence rates of nightmare disorder (per 10,000 service members) in the US Department of Defense ranged from 11.3 in 2016 to a low of 6.9 in 2018. Service members who were classified as non-white, female, over the age of 35, married, in the Army, and/or a noncommissioned officer, were diagnosed at greater rates relative to their representation in the military population (p < .001). CONCLUSION Our findings of higher than expected rates of nightmare disorder in older, senior service members as well as those in the Army align with the known precipitant of nightmares, and trauma. However, the reason for the finding that female and Black service members have higher than expected rates is not readily apparent.
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Affiliation(s)
- Brian A Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia, USA.
| | - Allison Brager
- Marketing & Engagement Brigade, United States Army Recruiting Command, Fort Knox, Kentucky
| | - Jason Judkins
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Vincent Mysliwiec
- Department of Psychiatry and Behavioral Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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18
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Gendy MNS, Frey BN, Van Ameringen M, Kuhathasan N, MacKillop J. Cannabidiol as a candidate pharmacotherapy for sleep disturbance in alcohol use disorder. Alcohol Alcohol 2023:7150867. [PMID: 37139966 DOI: 10.1093/alcalc/agad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/05/2023] Open
Abstract
Among individuals with alcohol use disorder (AUD), it is estimated that the majority suffer from persistent sleep disturbances for which few candidate medications are available. Our aim wass to critically review the potential for cannabidiol (CBD) as a treatment for AUD-induced sleep disturbance. As context, notable side effects and abuse liability for existing medications for AUD-induced sleep disturbance reduce their clinical utility. CBD modulation of the endocannabinoid system and favorable safety profile have generated substantial interest in its potential therapeutic use for various medical conditions. A number of preclinical and clinical studies suggest promise for CBD in restoring the normal sleep-wake cycle and in enhancing sleep quality in patients diagnosed with AUD. Based on its pharmacology and the existing literature, albeit primarily preclinical and indirect, CBD is a credible candidate to address alcohol-induced sleep disturbance. Well-designed RCTs will be necessary to test its potential in managing this challenging feature of AUD.
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Affiliation(s)
- Marie N S Gendy
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON L8P 3R2, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Women's Health Concerns Clinic at St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Nirushi Kuhathasan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON L8S 4K1, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON L8P 3R2, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Women's Health Concerns Clinic at St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON L8S 4K1, Canada
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19
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Gill P, Fraser E, Tran TTD, De Sena Collier G, Jago A, Losinno J, Ganci M. Psychosocial treatments for nightmares in adults and children: a systematic review. BMC Psychiatry 2023; 23:283. [PMID: 37085821 PMCID: PMC10122409 DOI: 10.1186/s12888-023-04703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/21/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND As nightmares may be a risk factor for, or symptom of, multiple psychological disorders, some researchers suggest that nightmares should be screened, diagnosed, and treated. Treatments for nightmares include trauma-focused Cognitive Behavioural Therapy and Image Rehearsal Therapy, and pharmacological interventions such as prazosin and nitrazepam. As recent research has put into question our current understanding of treatment efficacy, there is a need to systematically review findings related to the effectiveness of nightmare treatments to inform best practice. The current review assessed the efficacy of psychosocial treatments of nightmare in all cohorts. METHODS A systematic search of four databases for peer reviewed journal articles from 2000 onwards produced 69 (35 RCTs, 34 non-RCTs) eligible articles that underwent narrative synthesis. RESULTS The results provide strong evidence for exposure and image rehearsal treatments for the reduction of nightmare frequency, severity, and distress, in civilian, military, idiopathic, and posttraumatic stress disorder (PTSD) cohorts. There is emerging evidence that self-guided and brief treatment modalities offer efficient and effective treatment options. There is an urgent need for clinical trials of treatment effectiveness in children. CONCLUSIONS The results suggest that treatments for nightmares are most effective when they facilitate a sense of control or mastery by directly targeting the nightmare content and/or the client's emotional responses to the nightmare content. TRIAL REGISTRATION A review protocol was registered with PROSPERO (CRD42020204861).
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Affiliation(s)
- Peter Gill
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia.
| | - Emily Fraser
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Thong Thai Diep Tran
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Gabriel De Sena Collier
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Andrew Jago
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Joe Losinno
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Michael Ganci
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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Kim ES, Kang C. The treatment of post-traumatic nightmares requires more attention. DRUGS & THERAPY PERSPECTIVES 2023. [DOI: 10.1007/s40267-023-00988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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21
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Richards A, Woodward SH, Baquirin DPG, Yack LM, Metzler TJ, Udupa NS, Staggs EJ, Neylan TC. The sleep physiology of nightmares in veterans with psychological trauma: Evaluation of a dominant model using participant-applied electroencephalography in the home environment. J Sleep Res 2023; 32:e13639. [PMID: 35644523 DOI: 10.1111/jsr.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
Nightmares are a core feature of posttraumatic stress disorder, are poorly understood, and are associated with serious negative outcomes. Their biology has been difficult to study, and the feasibility of capturing them in the naturalistic home environment has been poor. This said, the published research and dominant scientific model has focused on nightmares as a manifestation of noradrenergic hyperarousal during rapid eye movement sleep. The current study used at-home, participant-applied devices to measure nightmare physiology in posttraumatic stress disorder treatment-seeking veterans, by examining heartrate measures as indicators of noradrenergic tone, and sleep-stage characteristics and stability in the sleep preceding time-stamped nightmare awakenings. Our data indicate the high feasibility of participant-administered, at-home measurement, and showed an unexpected stability of -rapid eye movement sleep along with no evidence of heartrate elevations in sleep preceding nightmare awakenings. Altogether, these data highlight new opportunities for the study of nightmares while questioning the sufficiency of dominant models, which to date are largely theoretically based.
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Affiliation(s)
- Anne Richards
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Steven H Woodward
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - David Paul G Baquirin
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Leslie M Yack
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Thomas J Metzler
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Nikhila S Udupa
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Emily J Staggs
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Thomas C Neylan
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
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Abstract
SUMMARY Non-REM parasomnias are often observed during childhood and adolescence, by which time they typically remit. For a small percentage, these nocturnal behaviors can persist into adulthood, or in some cases, present as a new onset in adults. Non-REM parasomnias (also known as disorders of arousal) can offer a diagnostic challenge in patients who have an atypical presentation where REM sleep parasomnias, nocturnal frontal lobe epilepsy, and overlap parasomnia should be considered as part of the differential. The purpose of this review is to discuss the clinical presentation, evaluation, and management of non-REM parasomnias. The neurophysiology behind non-REM parasomnias is considered, and this gives insights into their cause and the potential for treatment.
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23
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Vincent N, Dirkse D, Giannouli E, McQuarrie A. Transdiagnostic cognitive behavioral therapy for nightmares and parasomnias. J Clin Sleep Med 2023; 19:499-509. [PMID: 36468650 PMCID: PMC9978420 DOI: 10.5664/jcsm.10374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES This pilot study determined whether transdiagnostic cognitive behavioral therapy for parasomnias (CBTp) reduces parasomnia and activity levels during sleep in a sample of adult sleep clinic outpatients. A secondary objective was to assess whether treatment produces improvements in daytime fatigue/sleepiness, perceived cognition, mood, and depression/anxiety/stress, as well as functional impairment in work and leisure activities. METHODS This was a randomized controlled trial with CBTp and self-monitoring control conditions. Participants were 19 adults with a DSM 5 parasomnia disorder who received individual CBTp virtually from their homes. CBTp consisted of psychoeducation, sleep hygiene and safety instructions, relaxation training, parasomnia techniques, and relapse prevention in a 6-week manualized, structured program. RESULTS Using a repeated measures analysis of variance model, and relative to a self-monitoring control condition, results showed that CBTp produced statistically significant improvements in parasomnia frequency, severity, nocturnal activity, and sleep efficiency. There was a trend toward reduced sleep-onset latency and improved work and social adjustment. Of treated participants, 100% rated themselves as improved at study conclusion. CONCLUSIONS Implications of these findings are that cognitive behavioral interventions for parasomnias are effective in lessening parasomnias. More investigation into this type of treatment is warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Impact of Cognitive Behavioral Therapy on Parasomnias; URL: https://clinicaltrials.gov/ct2/show/NCT04633668; Identifier: NCT04633668. CITATION Vincent N, Dirkse D, Giannouli E, McQuarrie A. Transdiagnostic cognitive behavioral therapy for nightmares and parasomnias. J Clin Sleep Med. 2023;19(3):499-509.
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Affiliation(s)
- Norah Vincent
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dale Dirkse
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eleni Giannouli
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda McQuarrie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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Mäder T, Oliver KI, Daffre C, Kim S, Orr SP, Lasko NB, Seo J, Kleim B, Pace-Schott EF. Autonomic activity, posttraumatic and nontraumatic nightmares, and PTSD after trauma exposure. Psychol Med 2023; 53:731-740. [PMID: 34127168 PMCID: PMC9121310 DOI: 10.1017/s0033291721002075] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Nightmares are a hallmark symptom of posttraumatic stress disorder (PTSD). This strong association may reflect a shared pathophysiology in the form of altered autonomic activity and increased reactivity. Using an acoustic startle paradigm, we investigated the interrelationships of psychophysiological measures during wakefulness and PTSD diagnosis, posttraumatic nightmares, and nontraumatic nightmares. METHODS A community sample of 122 trauma survivors were presented with a series of brief loud tones, while heart rate (HRR), skin conductance (SCR), and orbicularis oculi electromyogram (EMGR) responses were measured. Prior to the tone presentations, resting heart rate variability (HRV) was assessed. Nightmares were measured using nightmare logs. Three dichotomous groupings of participants were compared: (1) current PTSD diagnosis (n = 59), no PTSD diagnosis (n = 63), (2) those with (n = 26) or without (n = 96) frequent posttraumatic nightmares, and (3) those with (n = 22) or without (n = 100) frequent nontraumatic nightmares. RESULTS PTSD diagnosis was associated with posttraumatic but not with nontraumatic nightmares. Both PTSD and posttraumatic nightmares were associated with a larger mean HRR to loud tones, whereas nontraumatic nightmare frequency was associated with a larger SCR. EMGR and resting HRV were not associated with PTSD diagnosis or nightmares. CONCLUSIONS Our findings suggest a shared pathophysiology between PTSD and posttraumatic nightmares in the form of increased HR reactivity to startling tones, which might reflect reduced parasympathetic tone. This shared pathophysiology could explain why PTSD is more strongly related to posttraumatic than nontraumatic nightmares, which could have important clinical implications.
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Affiliation(s)
- Thomas Mäder
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Katelyn I. Oliver
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Carolina Daffre
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Sophie Kim
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
| | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
| | - Jeehye Seo
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich, University of Zurich, Zurich, Switzerland
| | - Edward Franz Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
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25
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Abenza-Abildúa MJ, Lores-Gutiérrez V, Gutiérrez-Cueto G, Suárez-Gisbert E, Pérez-López C. Howl: Nightmare or REM Sleep Behavior Disorder? Neurol Clin Pract 2023; 13:e200093. [PMID: 36891279 PMCID: PMC9987201 DOI: 10.1212/cpj.0000000000200093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/07/2022] [Indexed: 01/20/2023]
Abstract
Objective Nightmare disorder consists of the appearance of unpleasant and vivid, repeated dreams, with a situation of discomfort and anguish on awakening. Its prevalence is 3%-4% in adults. They do not associate muscle mobilization during this phase. REM sleep behavior disorder (RSBD) is a rare parasomnia (0.5% of people older than 60 years of age), characterized by the presence of unpleasant dreams, with violent content, and vigorous movements of limbs (kicks and punches), reflecting a loss of muscle atony typical of the REM phase of sleep. Language (screams and words) can also be emitted. The same clinical manifestations of RSBD can appear in other sleep disorders. The diagnosis requires the performance of a polysomnography. Methods We present the case of a 41-year-old man referred for vivid and unpleasant dreams, beginning in the last year, related to work stress. Results The polysomnography showed the loss of atony in the REM phase and emission of a prolonged howl after which the patient continues in the REM phase. Discussion Prolonged howling is a very rare symptom in sleep disorders, and very atypical in RSBD, so polysomnography is essential to confirm the diagnosis and rule out other parasomnias.
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Affiliation(s)
- Maria Jose Abenza-Abildúa
- Neurology Department (MJA-A), Infanta Sofía University Hospital; Pneumology Department (VL-G, GG-C), Infanta Sofía University Hospital; Psychiatry Department (ES-G), Infanta Sofía University Hospital; and Neurosurgery Department (CP-L), La Paz University Hospital, Madrid, Spain
| | - Vanesa Lores-Gutiérrez
- Neurology Department (MJA-A), Infanta Sofía University Hospital; Pneumology Department (VL-G, GG-C), Infanta Sofía University Hospital; Psychiatry Department (ES-G), Infanta Sofía University Hospital; and Neurosurgery Department (CP-L), La Paz University Hospital, Madrid, Spain
| | - Guadalupe Gutiérrez-Cueto
- Neurology Department (MJA-A), Infanta Sofía University Hospital; Pneumology Department (VL-G, GG-C), Infanta Sofía University Hospital; Psychiatry Department (ES-G), Infanta Sofía University Hospital; and Neurosurgery Department (CP-L), La Paz University Hospital, Madrid, Spain
| | - Eugenio Suárez-Gisbert
- Neurology Department (MJA-A), Infanta Sofía University Hospital; Pneumology Department (VL-G, GG-C), Infanta Sofía University Hospital; Psychiatry Department (ES-G), Infanta Sofía University Hospital; and Neurosurgery Department (CP-L), La Paz University Hospital, Madrid, Spain
| | - Carlos Pérez-López
- Neurology Department (MJA-A), Infanta Sofía University Hospital; Pneumology Department (VL-G, GG-C), Infanta Sofía University Hospital; Psychiatry Department (ES-G), Infanta Sofía University Hospital; and Neurosurgery Department (CP-L), La Paz University Hospital, Madrid, Spain
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26
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Davenport ND, Werner JK. A randomized sham-controlled clinical trial of a novel wearable intervention for trauma-related nightmares in military veterans. J Clin Sleep Med 2023; 19:361-369. [PMID: 36305584 PMCID: PMC9892731 DOI: 10.5664/jcsm.10338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES Persistent nightmares are common among individuals exposed to trauma and are especially prevalent among veterans. While behavioral and pharmacological interventions are available, they have demonstrated limited efficacy. Innovations in wearable technology provide a potential avenue to match or exceed these existing treatments by directly targeting nightmare physiology. METHODS We conducted a randomized, sham-controlled study to determine the efficacy of a novel wearable device-based application in 65 veterans with impaired sleep secondary to trauma-related nightmares. Changes in measures of sleep quality, posttraumatic stress disorder/depression symptoms, and quality of life across the 30-day trial were compared between the Active and Sham systems. RESULTS Both groups demonstrated statistically significant within-person improvement on all measures. While the Active system was generally associated with stronger magnitude of improvement, none of the comparisons of individual measures across conditions reached statistical significance. However, a post-hoc analysis excluding participants with low frequency of usage demonstrated significantly better improvement in perceived sleep quality with the Active device than Sham. CONCLUSIONS Overall, these results provide preliminary evidence that a wearable device may improve self-reported sleep quality for veterans reporting frequent trauma-related nightmares, especially in compliant users. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Traumatic Nightmares Treated by NightWare (To Arouse Not Awaken) (TNT/NW); URL: https://www.clinicaltrials.gov/ct2/show/NCT04040387; Identifier: NCT04040387. CITATION Davenport ND, Werner JK. A randomized sham-controlled clinical trial of a novel wearable intervention for trauma-related nightmares in military veterans. J Clin Sleep Med. 2023;19(2):361-369.
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Affiliation(s)
- Nicholas D. Davenport
- Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis, Minnesota
| | - J. Kent Werner
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Maryland
- Department of Neurology, Uniformed Services University, Bethesda, Maryland
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda Maryland
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27
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Raggi A, Mogavero MP, DelRosso LM, Ferri R. Clonazepam for the management of sleep disorders. Neurol Sci 2023; 44:115-128. [PMID: 36112279 DOI: 10.1007/s10072-022-06397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/06/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The objectives of this review and meta-analysis of polysomnographic data are those to focus on the clinical use of clonazepam for the management of sleep disorders by re-analyzing clinical trials and randomized clinical trials which have been published in peer-reviewed journals. METHODS A review of the literature including clinical trials and randomized controlled trials was performed in PubMed®, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. A random effects model meta-analysis was then carried out for the four more frequently reported polysomnographic measures: total sleep time, sleep latency, sleep efficiency, and periodic leg movement during sleep (PLMS) index. RESULTS A total of 33 articles were retrieved and screened in full text, of which 18 met the criteria for review; among the latter, nine met the criteria for meta-analysis. The studies included in the review involved patients with insomnia, REM sleep behavior disorder, sleep bruxism, and restless leg syndrome or PLMS which reported, most often, an increase in total sleep time with clonazepam. A clear sleep-promoting effect of clonazepam was found also by meta-analysis. DISCUSSION AND CONCLUSIONS Our results indicate that the pharmacological treatment of sleep disorders with clonazepam must always be personalized according to the type of patient, the risk of addiction and the concomitant presence of respiratory disorders are key factors to take into account. However, in light of the clinical evidence of the few studies in the literature on the different types of disorders, more studies on the use of clonazepam (also in association with first choice treatments) are definitely needed.
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Affiliation(s)
- Alberto Raggi
- Unit of Neurology, G.B. Morgagni - L. Pierantoni Civic Hospital, 34 Via Carlo Forlanini, 47121, Forlì, Italy.
| | - Maria Paola Mogavero
- Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy.,Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Lourdes M DelRosso
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
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28
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Skeie-Larsen M, Stave R, Grønli J, Bjorvatn B, Wilhelmsen-Langeland A, Zandi A, Pallesen S. The Effects of Pharmacological Treatment of Nightmares: A Systematic Literature Review and Meta-Analysis of Placebo-Controlled, Randomized Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:777. [PMID: 36613097 PMCID: PMC9820008 DOI: 10.3390/ijerph20010777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Nightmares are highly prevalent and distressing for the sufferer, which underlines the need for well-documented treatments. A comprehensive literature review and meta-analysis of the effects of different pharmacological placebo-controlled randomized clinical trials, covering the period up to 1 December 2022, was performed. Searches were conducted in PubMed, Embase, Web of Science, PsychInfo, Cinahl, and Google Scholar, resulting in the identification of 1762 articles, of which 14 met the inclusion criteria: pharmacological intervention of nightmares, based on a placebo-controlled randomized trial published in a European language, reporting outcomes either/or in terms of nightmare frequency, nightmare distress, or nightmare intensity, and reporting sufficient information enabling calculation of effect sizes. Most studies involved the effect of the α1-adrenergic antagonist prazosin in samples of veterans or soldiers suffering from posttraumatic stress disorder. Other medications used were hydroxyzine, clonazepam, cyproheptadine, nabilone, and doxazosin. The vast majority of studies were conducted in the USA. The studies comprised a total of 830 participants. The Clinician-Administered PTSD Scale was the most frequently used outcome measure. The results showed an overall effect size of Hedges' g = 0.50 (0.42 after adjustment for publication bias). The synthetic cannabinoid nabilone (one study) showed the highest effect size (g = 1.86), followed by the histamine H1-antagonist hydroxyzine (one study), and prazosin (10 studies), with effect sizes of g = 1.17 and g = 0.54, respectively. Findings and limitations are discussed, and recommendations for future studies are provided.
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Affiliation(s)
| | - Rebekka Stave
- Department of Psychosocial Science, University of Bergen, 5007 Bergen, Norway
| | - Janne Grønli
- Department of Biological and Medial Psychology, University of Bergen, 5007 Bergen, Norway
| | - Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, 5007 Bergen, Norway
| | - Ane Wilhelmsen-Langeland
- Bjørgvin District Psychiatric Center, Division of Psychiatry, Haukeland University Hospital, 5021 Bergen, Norway
| | - Amin Zandi
- Faculty of Psychology and Educational Sciences, University of Tehran, Tehran 1417935840, Iran
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, 5007 Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, 5021 Bergen, Norway
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29
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Brock MS, Matsangas P, Creamer JL, Powell T, Hansen SL, Foster SN, Self TC, Mysliwiec V. Clinical and polysomnographic features of trauma associated sleep disorder. J Clin Sleep Med 2022; 18:2775-2784. [PMID: 35962771 PMCID: PMC9713908 DOI: 10.5664/jcsm.10214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Trauma associated sleep disorder is a proposed parasomnia that develops after trauma with clinical features of trauma related nightmares, disruptive nocturnal behaviors, and autonomic disturbances. The purpose of this case series is to better characterize the clinical and video-polysomnographic features of patients meeting clinical criteria for this proposed parasomnia. METHODS Semistructured clinical interview and detailed video-polysomnography review of 40 patients. Movements and vocalizations in rapid eye movement sleep were quantified according to the rapid eye movement sleep behavior disorder severity scale. RESULTS Patients (n = 40, 32 males) were service members and veterans with a median age of 38.9 years (range 24-57 years) who reported trauma related nightmares and disruptive nocturnal behaviors at home. On video-polysomnography, 28 (71.8%) patients had disruptive nocturnal behaviors in rapid eye movement sleep consisting of limb, head, and axial movements; vocalizations were present in 8 (20%). On the rapid eye movement sleep behavior disorder severity scale, most (n = 28, 71.8%) had a low rating but those with greater severity (n = 11, 28.2%) had a higher prevalence of posttraumatic stress disorder (P = .013) and markedly less N3 sleep (P = .002). The cohort had a high rate of insomnia (n = 35, 87.5%) and obstructive sleep apnea (n = 19, 47.5%). Most patients were treated with prazosin (n = 29, 72.5%) with concomitant behavioral health interventions (n = 25, 64.1%); 15 (51.7%) patients receiving prazosin reported improved symptomatology. CONCLUSIONS Disruptive nocturnal behaviors can be captured on video-polysomnography during rapid eye movement sleep, although they may be less pronounced than what patients report in their habitual sleeping environment. Clinical and video-polysomnographic correlations are invaluable in assessing patients with trauma associated sleep disorder to document objective abnormalities. This case series provides a further basis for establishing trauma associated sleep disorder as a unique parasomnia. CITATION Brock MS, Matsangas P, Creamer JL, et al. Clinical and polysomnographic features of trauma associated sleep disorder. J Clin Sleep Med. 2022;18(12):2775-2784.
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Affiliation(s)
- Matthew S. Brock
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | | | - Jennifer L. Creamer
- Madigan Army Medical Center, Department of Sleep Medicine, Tacoma, Washington
| | - Tyler Powell
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | - Shana L. Hansen
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | - Shannon N. Foster
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | - Tyler C. Self
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | - Vincent Mysliwiec
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
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30
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Salwen-Deremer JK, Sun M. Management of Sleep and Fatigue in Gastrointestinal Patients. Gastroenterol Clin North Am 2022; 51:829-847. [PMID: 36375999 DOI: 10.1016/j.gtc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Sleep is an essential physiologic process, and unfortunately, people with gastrointestinal (GI) conditions are more likely than people in the general population to experience poor sleep quality, sleep disorders, and fatigue. Herein, we present information on common sleep disorders, fatigue, and data on these problems in various GI populations. We also discuss several treatments for sleep concerns and emerging research on the use of these treatments in GI populations. Cases that illustrate the GI/sleep relationship are presented, in addition to guidance for your own practice and cultural considerations.
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Affiliation(s)
- Jessica K Salwen-Deremer
- Departments of Psychiatry and Medicine, Section of Gastroenterology & Hepatology, The Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Michael Sun
- Department of Psychological and Brain Sciences, Dartmouth College, 3 Maynard Street, Hanover, NH 03755, USA
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31
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Walsh SM, Forward CL, Flaherty GT. Parasomnias during trans-meridian and long-distance travel: Critical literature review and clinical practice recommendations. J Sleep Res 2022; 31:e13672. [PMID: 35726362 PMCID: PMC9786733 DOI: 10.1111/jsr.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 12/30/2022]
Abstract
Parasomnias are undesirable events that occur during sleep. They can be classified into rapid eye movement parasomnias and non-rapid eye movement parasomnias. Those who experience parasomnias may be anxious about travel for many reasons, including the occurrence of unwanted events during the trip, increased exposure to environmental trigger factors, and the propensity for harm to occur due to unfamiliar surroundings while travelling. There is a paucity of literature examining this area. This review summarizes the relevant literature and the clinical experience of the authors to compile clinical practice recommendations. The clinical features of parasomnias and how they relate to trans-meridian and long-distance travel are described. Triggers for non-rapid eye movement parasomnias, particularly the use of sedative hypnotic drugs, alcohol, drug withdrawal, sleep deprivation, emotional stress and environmental stimulations, are described. Management of parasomnias whilst travelling is reviewed, with a particular focus on trigger minimalization. The role for clonazepam and melatonin is outlined. At the pre-travel health consultation, the physician is strongly advised to screen the traveller for co-morbid sleep conditions, which exacerbate parasomnias. Areas for further research are explored, including the extent to which these sleep disorders impact on the travel experience.
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Affiliation(s)
- Sinead M. Walsh
- School of MedicineNational University of Ireland GalwayGalwayIreland,Department of Respiratory and Sleep MedicineGalway University HospitalsGalwayIreland
| | - Cameron L. Forward
- Department of Respiratory and Sleep MedicineGalway University HospitalsGalwayIreland
| | - Gerard T. Flaherty
- School of MedicineNational University of Ireland GalwayGalwayIreland,School of MedicineInternational Medical UniversityKuala LumpurMalaysia
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32
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Mallegni N, Molinari G, Ricci C, Lazzeri A, La Rosa D, Crivello A, Milazzo M. Sensing Devices for Detecting and Processing Acoustic Signals in Healthcare. BIOSENSORS 2022; 12:835. [PMID: 36290973 PMCID: PMC9599683 DOI: 10.3390/bios12100835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Acoustic signals are important markers to monitor physiological and pathological conditions, e.g., heart and respiratory sounds. The employment of traditional devices, such as stethoscopes, has been progressively superseded by new miniaturized devices, usually identified as microelectromechanical systems (MEMS). These tools are able to better detect the vibrational content of acoustic signals in order to provide a more reliable description of their features (e.g., amplitude, frequency bandwidth). Starting from the description of the structure and working principles of MEMS, we provide a review of their emerging applications in the healthcare field, discussing the advantages and limitations of each framework. Finally, we deliver a discussion on the lessons learned from the literature, and the open questions and challenges in the field that the scientific community must address in the near future.
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Affiliation(s)
- Norma Mallegni
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Giovanna Molinari
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Claudio Ricci
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Andrea Lazzeri
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Davide La Rosa
- ISTI-CNR, Institute of Information Science and Technologies, 56124 Pisa, Italy
| | - Antonino Crivello
- ISTI-CNR, Institute of Information Science and Technologies, 56124 Pisa, Italy
| | - Mario Milazzo
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
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33
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Taylor DJ, Dietch JR, Wardle-Pinkston S, Slavish DC, Messman B, Ruggero CJ, Kelly K. Shift Work Disorder Index: initial validation and psychosocial associations in a sample of nurses. J Clin Sleep Med 2022; 18:2339-2351. [PMID: 35702020 PMCID: PMC9516570 DOI: 10.5664/jcsm.10108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Shift work is common yet does not always result in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)-defined shift work sleep disorder (SWD). This study reports on the reliability and validity of the DSM-5 informed Shift Work Disorder Index (SWDI), the presence of probable SWD in nurses, and demographic, sleep, and psychosocial correlates. METHODS Nurses (n = 454) completed the SWDI, psychosocial, and demographic questionnaires. Of the sample, n = 400 completed 14 days of sleep diaries, actigraphy, and additional questionnaires. RESULTS The global SWDI demonstrated excellent internal consistency (α = .94), as well as good convergent and divergent validity in the nurse sample. Thirty-one percent of nurses were past-month shift workers, with 14% (ie, 44% of shift workers) having probable SWD based on SWDI. Nurses who worked shift work and/or met SWD criteria were more likely to be younger and unmarried and less likely to have children than day workers and reported greater evening chronotype, insomnia, nightmares, and sleep-related impairment, greater depression, anxiety, posttraumatic stress, and perceived stress symptoms, as well as later and more variable sleep midpoint (actigraphy), shorter sleep duration (actigraphy, diaries), and lower sleep efficiency (diaries). CONCLUSIONS The SWDI is an efficient and valid self-report assessment of DSM-5-defined SWD. Shift work and/or SWD were prevalent and associated with worse sleep and psychosocial health, particularly among nurses with probable SWD. CITATION Taylor DJ, Dietch JR, Wardle-Pinkston S, et al. Shift Work Disorder Index: initial validation and psychosocial associations in a sample of nurses. J Clin Sleep Med. 2022;18(10):2339-2351.
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Affiliation(s)
- Daniel J. Taylor
- Department of Psychology, University of North Texas, Denton, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Jessica R. Dietch
- Department of Psychology, University of North Texas, Denton, Texas
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Sophie Wardle-Pinkston
- Department of Psychology, University of North Texas, Denton, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
| | | | - Brett Messman
- Department of Psychology, University of North Texas, Denton, Texas
| | | | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, Texas
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Tzioridou S, Dresler M, Sandberg K, Mueller EM. The role of mindful acceptance and lucid dreaming in nightmare frequency and distress. Sci Rep 2022; 12:15737. [PMID: 36131106 PMCID: PMC9492730 DOI: 10.1038/s41598-022-19624-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022] Open
Abstract
A theoretical and empirical association between lucid dreaming and mindfulness, as well as lucid dreaming and nightmares has previously been observed; however, the relationship between nightmares and mindfulness has received surprisingly little attention. Here, we present the findings of two studies exploring the relation of nightmare frequency and distress with two components of mindfulness, termed presence and acceptance, as well as lucid dreaming. Study 1 (N = 338) consisted of a low percentage of frequent lucid dreamers whereas Study 2 (N = 187) consisted primarily of frequent lucid dreamers that used lucid dream induction training techniques and meditation. Across studies, nightmare-related variables showed a more robust association with mindful acceptance as opposed to mindful presence. Moreover, individuals with high levels of meditation expertise and practice of lucid dreaming induction techniques reported lower nightmare frequency. Finally, in Study 2, which consisted of frequent lucid dreamers, a positive correlation between lucid dreaming frequency and mindfulness was apparent. The present findings support the notion that wakeful mindfulness is associated with the quality of dreams and extend previous research by suggesting a disentangled role of the two facets of mindfulness in dream variation. This association remains open for experimental manipulation, the result of which could have clinical implications.
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Affiliation(s)
- Sofia Tzioridou
- Department of Psychology, Philipps University Marburg, Marburg, Germany. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kristian Sandberg
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Erik M Mueller
- Department of Psychology, Philipps University Marburg, Marburg, Germany
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35
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Taylor KA, Schwartz SW, Alman AC, Goode AP, Dagne GA, Sebastião YV, Foulis PR. Nightmare disorder and low back pain in veterans: cross-sectional association and effect over time. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2022; 3:zpac030. [PMID: 36387301 PMCID: PMC9648406 DOI: 10.1093/sleepadvances/zpac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/29/2022] [Indexed: 12/15/2022]
Abstract
Low back pain (LBP) disproportionately impacts US military veterans compared with nonveterans. Although the effect of psychological conditions on LBP is regularly studied, there is little published to date investigating nightmare disorder (NMD) and LBP. The purpose of this study was to (1) investigate whether an association exists between NMD and LBP and (2) estimate the effect of NMD diagnosis on time to LBP. We used a retrospective cohort design with oversampling of those with NMD from the Veterans Health Administration (n = 15 983). We used logistic regression to assess for a cross-sectional association between NMD and LBP and survival analysis to estimate the effect of NMD on time to LBP, up to 60-month follow-up, conditioning on age, sex, race, index year, Charlson Comorbidity Index, depression, anxiety, insomnia, combat exposure, and prisoner of war history to address confounding. Odds ratios (with 95% confidence intervals [CIs]) indicated a cross-sectional association of 1.35 (1.13 to 1.60) and 1.21 (1.02 to 1.42) for NMD and LBP within 6 months and 12 months pre- or post-NMD diagnosis, respectively. Hazard ratios (HRs) indicated the effect of NMD on time to LBP that was time-dependent-HR (with 95% CIs) 1.27 (1.02 to 1.59), 1.23 (1.03 to 1.48), 1.19 (1.01 to 1.40), and 1.10 (0.94 to 1.29) in the first 3, 6, 9, and 12 months post-diagnosis, respectively-approximating the null (1.00) at >12 months. The estimated effect of NMD on LBP suggests that improved screening for NMD among veterans may help clinicians and researchers predict (or intervene to reduce) risk of future back pain.
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Affiliation(s)
- Kenneth A Taylor
- Corresponding author. Kenneth A. Taylor, Duke Clinical Research Institute, 300 West Morgan Street, Ste 800, Durham, NC 27701, USA.
| | - Skai W Schwartz
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Amy C Alman
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Adam P Goode
- Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA,Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Getachew A Dagne
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Yuri V Sebastião
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip R Foulis
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA,Pathology and Laboratory Medicine, James A. Haley Veterans’ Hospital, Tampa, FL, USA
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36
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Tighe CA, Buysse DJ, Weiner DK, Beehler GP, Forman DE. Prevalence, Impact, and Trajectories of Sleep Disturbance in Cardiac Rehabilitation: A NARRATIVE REVIEW AND SUGGESTIONS FOR EVALUATION AND TREATMENT. J Cardiopulm Rehabil Prev 2022; 42:316-323. [PMID: 35522949 PMCID: PMC9437109 DOI: 10.1097/hcr.0000000000000694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this review was to summarize literature examining the prevalence, impact, and trajectories of sleep disturbance in cardiac rehabilitation (CR) patients and discuss how CR programs may incorporate targeted evaluation and interventions to promote sleep health. REVIEW METHODS A narrative review of literature allowed for an examination of the prevalence of sleep disturbance in CR patients, the effects of sleep disturbance on CR outcomes, and trajectories of sleep disturbance in CR. SUMMARY Sleep disturbance is prevalent in CR patient populations and is related to clinical and functional outcomes. Sleep may be an important biobehavioral process to target in CR to improve important patient outcomes and achieve secondary prevention goals.
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Affiliation(s)
- Caitlan A. Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Debra K. Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine
| | - Gregory P. Beehler
- VA Center for Integrated Healthcare
- Community Health and Health Behavior, School of Public Health and Health Professions, University of Buffalo
| | - Daniel E. Forman
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
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Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med 2022; 18:2291-2312. [PMID: 35678060 PMCID: PMC9435330 DOI: 10.5664/jcsm.10074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022]
Abstract
Scientific evidence that acute, posttrauma sleep disturbances (eg, nightmares and insomnia) can contribute significantly to the pathogenesis of trauma-induced disorders is compelling. Sleep disturbances precipitating from trauma are uniquely predictive of daytime posttrauma symptom occurrence and severity, as well as subsequent onset of mental health disorders, including post-traumatic stress disorder. Conversely, adequate sleep during the acute posttrauma period is associated with reduced likelihood of adverse mental health outcomes. These findings, which are broadly consistent with what is known about the role of sleep in the regulation of emotion, suggest that the acute posttrauma period constitutes a "window of opportunity" during which treatment of sleep disturbances may be especially effective for preventing or mitigating progression of aberrant psychophysiological processes. At this point, the weight of the scientific evidence supporting this possibility warrants initiation of clinical trials to confirm the benefits of targeted prophylactic sleep enhancement, and to establish treatment guidelines as appropriate. CITATION Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med. 2022;18(9):2291-2312.
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Affiliation(s)
- Kevin M. Swift
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Connie L. Thomas
- Department of Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Psychiatry, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Thomas J. Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Emily G. Lowery-Gionta
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Liana M. Matson
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
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38
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Pharmacological Management of Nightmares Associated with Posttraumatic Stress Disorder. CNS Drugs 2022; 36:721-737. [PMID: 35688992 DOI: 10.1007/s40263-022-00929-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for suicide. Nightmare cessation can lead to improved quality of life, fewer hospital admissions, lower healthcare costs, and reduced all-cause mortality. Effective treatment of nightmares is critical and often leads to improvement of other PTSD symptomatology. However, approved pharmacological agents for the treatment of PTSD have modest effects on sleep and nightmares, and may cause adverse effects. No pharmacological agent has been approved specifically for the treatment of PTNs, but multiple agents have been studied. This current narrative review aimed to critically appraise proven as well as novel pharmacological agents used in the treatment of PTNs. Evidence of varying quality exists for the use of prazosin, doxazosin, clonidine, tricyclic antidepressants, trazodone, mirtazapine, atypical antipsychotics (especially risperidone, olanzapine and quetiapine), gabapentin, topiramate, and cyproheptadine. Evidence does not support the use of venlafaxine, β-blockers, benzodiazepines, or sedative hypnotics. Novel agents such as ramelteon, cannabinoids, ketamine, psychedelic agents, and trihexyphenidyl have shown promising results. Large randomized controlled trials (RCTs) are needed to evaluate the use of these novel agents. Future research directions are identified to optimize the treatment of nightmares in patients with PTSD.
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Zhang Y, Ren R, Vitiello MV, Yang L, Zhang H, Shi Y, Sanford LD, Tang X. Efficacy and acceptability of psychotherapeutic and pharmacological interventions for trauma-related nightmares: A systematic review and network meta-analysis. Neurosci Biobehav Rev 2022; 139:104717. [PMID: 35661755 DOI: 10.1016/j.neubiorev.2022.104717] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/22/2022] [Accepted: 05/27/2022] [Indexed: 02/05/2023]
Abstract
This network meta-analysis compares the efficacy and acceptability of all published psychotherapeutic and pharmacological interventions for trauma-related nightmares (TRN) in adults. The analysis included data from 29 randomized clinical trials involving 14 psychotherapeutic and pharmacological interventions and involved 2214 trauma survivors. Prazosin and image rehearsal therapy (IRT) were found to be the two effective interventions for TRN. Other interventions such as risperidone, paroxetine, cognitive behavioral therapy for insomnia (CBT-I), CBT-I+IRT, prolonged exposure (PE), and IRT+PE, did not show significantly greater efficacy compared with control conditions. The rates of all-cause discontinuations were comparable among majority of the interventions and did not show significant differences compared with control conditions. Prazosin and IRT should be considered as the initial choice of pharmacological and psychotherapeutic interventions for TRN. The efficacy of other pharmacological and psychotherapeutic interventions remains to be demonstrated. Future guidelines and daily clinical decision making on the choice of interventions for TRN should consider these findings.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Haipeng Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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40
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Otaiku DAI. Distressing dreams and risk of Parkinson's disease: A population-based cohort study. EClinicalMedicine 2022; 48:101474. [PMID: 35783487 PMCID: PMC9249554 DOI: 10.1016/j.eclinm.2022.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background Parkinson's disease (PD) is associated with alterations to the phenomenology of dreaming - including an increased frequency of distressing dreams. Whether distressing dreams may precede the development of PD is unknown. This study investigated the association between frequent distressing dreams and the risk of incident PD. Methods 3818 men aged 67 years or older from the Osteoporotic Fractures in Men Study (MrOS), a population-based cohort from the USA, who were free from PD at baseline (December 2003 - April 2011) and completed item 5h of the Pittsburgh Sleep Quality Index - which probes the frequency of distressing dreams in the past month, were included in this analysis. Incident PD was based on doctor diagnosis. Multivariable logistic regression was used to estimate odds ratios (OR) for incident PD according to distressing dream frequency, with adjustment for potential confounders. Findings During a mean follow-up of 7·3 years, 91 (2·4%) cases of incident PD were identified. Participants with frequent distressing dreams at baseline had a 2-fold risk for incident PD (OR, 2·01; 95% CI, 1·1-3·6, P = 0.02). When stratified by follow-up time, frequent distressing dreams were associated with a greater than 3-fold risk for incident PD during the first 5 years after baseline (OR, 3·38; 95% CI, 1·3-8·7; P = 0·01), however no effect was found during the subsequent 7 years (OR, 1·55; 95% CI, 0·7-3·3; P = 0·26). Interpretation In this prospective cohort, frequent distressing dreams were associated with an increased risk for incident PD. The association was only significant within the 5 years prior to diagnosis, which suggests that frequent distressing dreams may be a prodromal symptom of PD. Funding The study received no external funding.
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Affiliation(s)
- Dr Abidemi I. Otaiku
- Department of Neurology, Birmingham City Hospital, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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41
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Jones MB, Agrawal R, Sharafkhaneh A, Kunik ME, Jorge RE, Marsh L. Dream Enactment Behaviors Associated With Posttraumatic Stress Disorder. J Neuropsychiatry Clin Neurosci 2022; 34:124-131. [PMID: 34763524 DOI: 10.1176/appi.neuropsych.21050115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The investigators aimed to draw attention to current debates surrounding the etiologies of dream enactment behaviors in patients with posttraumatic stress disorder (PTSD). The phenomenological overlap between PTSD-related nocturnal symptoms, rapid eye movement sleep behavior disorder (RBD), and trauma-associated sleep disorder (TASD) is discussed. Strategies used to diagnose and manage dream enactment behaviors, whether due to RBD or another confounding sleep disorder, are considered. Finally, the need for further research on the pathophysiological overlap and integrated treatment of PTSD, RBD, and, possibly, TASD is highlighted.
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Affiliation(s)
- Melissa B Jones
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Ritwick Agrawal
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Amir Sharafkhaneh
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Mark E Kunik
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Ricardo E Jorge
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
| | - Laura Marsh
- Michael E. DeBakey VA Medical Center, Houston (Jones, Agrawal, Sharafkhaneh, Kunik, Jorge, Marsh); Menninger Department of Psychiatry and Behavioral Sciences, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston (Jones, Kunik, Jorge, Marsh); and Department of Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston (Agrawal, Sharafkhaneh)
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Abstract
The pandemic caused by the coronavirus disease 2019 (COVID-19) had a huge impact on public mental health. This was also reflected in dreams. Not only did people start to remember more dreams, but dream content changed as themes like sickness, confinement, and—in the English-speaking world—even bugs began to dominate. This also led to an increase in nightmare frequency. There are various factors that contributed to this change in the dream landscape. Some people have started to sleep more and hereby spend more time in REM sleep, which is known to increase dream recall and further lead to bizarre and vivid dreams. On the other hand, stress and poor mental health had an impact on sleep, and sleep quality thus dropped in many individuals. Poor sleep quality can also lead to an increase in dream recall. Dreams are known to regulate mood, so the rise in dreams and the change in dream content could also reflect a reaction to the overall rise in stress and decline in mental health. Recent studies have shown that as the pandemic progresses, further changes in mental health, dream recall, and dream content arise, but data are still scarce. Further research could help understand the impact the pandemic still has on mental health and dreams, and how this impact is changing over the course of the pandemic.
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Affiliation(s)
- Severin Ableidinger
- Institut für Bewusstseins- und Traumforschung, Canongasse 13/1, 1180 Vienna, Austria
| | - Franziska Nierwetberg
- Institut für Bewusstseins- und Traumforschung, Canongasse 13/1, 1180 Vienna, Austria
| | - Brigitte Holzinger
- Institut für Bewusstseins- und Traumforschung, Canongasse 13/1, 1180 Vienna, Austria
- Medizinisches Schlafcoaching, Postgraduate Medizinische Universität Wien, Spitalgasse 23, 1090 Vienna, Austria
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DeMarni Cromer L, Pangelinan BAF, Buck TR. Case Study of Cognitive Behavioral Therapy for Nightmares in Children With and Without Trauma History. Clin Case Stud 2022. [DOI: 10.1177/15346501221081122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
These case examples depict the adaptation of Exposure, Relaxation, and Rescripting Therapy (ERRT) for use with children. ERRT was developed for trauma-related nightmares in adults. The current study modified ERRT to be developmentally appropriate for children, incorporating child appropriate language, interactive activities, and parent coaching. The modified treatment, called cognitive-behavioral therapy for nightmares in children (CBT-NC), added additional stress-management components to further adapt the treatment for children with anxiety-related nightmares and no trauma history. These case studies describe the course of treatment for two girls whose nightmares had different etiologies—one experiencing trauma-related nightmares and the other experiencing idiopathic anxiety-related nightmares. This was the first application of CBT-NC for idiopathic nightmares. Both children responded positively to treatment, and treatment gains were maintained at 3- and 6-month follow-up. Improvements were seen not only for nightmare frequency and distress, but overall sleep also improved. Findings demonstrate that this adapted nightmare treatment for children is feasible and promising for nightmares in children, regardless of nightmare etiology.
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Affiliation(s)
- Lisa DeMarni Cromer
- University of Tulsa Institute of Trauma, Adversity, and Injustice, Tulsa, OK, USA
| | | | - Tara R. Buck
- Department of Psychiatry, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
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44
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Weber FC, Wetter TC. The Many Faces of Sleep Disorders in Post-Traumatic Stress Disorder: An Update on Clinical Features and Treatment. Neuropsychobiology 2022; 81:85-97. [PMID: 34474413 PMCID: PMC9153357 DOI: 10.1159/000517329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
Sleep disorders and nightmares are core symptoms of post-traumatic stress disorder (PTSD). The relationship seems to be bidirectional, and persistent disturbed sleep may influence the course of the disorder. With regard to sleep quality, insomnia and nocturnal anxiety symptoms, as well as nightmares and stressful dreams, are the most prominent sleep symptoms. Polysomnographic measurements reveal alterations of the sleep architecture and fragmentation of rapid eye movement sleep. In addition, sleep disorders, such as sleep-related breathing disorders and parasomnias are frequent comorbid conditions. The complex etiology and symptomatology of trauma-related sleep disorders with frequent psychiatric comorbidity require the application of multimodal treatment concepts, including psychological and pharmacological interventions. However, there is little empirical evidence on the effectiveness of long-term drug treatment for insomnia and nightmares. For nondrug interventions, challenges arise from the current lack of PTSD-treatment concepts integrating sleep- and trauma-focused therapies. Effective therapy for sleep disturbances may consequently also improve well-being during the day and probably even the course of PTSD. Whether early sleep interventions exert a preventive effect on the development of PTSD remains to be clarified in future studies.
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Bamgbade OA, Tai-Osagbemi J, Bamgbade DO, Murphy-Akpieyi O, Fadire A, Soni NK, Mumporeze L. Clonidine is better than zopiclone for insomnia treatment in chronic pain patients. J Clin Sleep Med 2022; 18:1565-1571. [PMID: 35112665 DOI: 10.5664/jcsm.9930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Chronic pain is associated with insomnia. The objective of this clinical study is to compare the efficacy and safety of different prescribed doses of zopiclone and clonidine; for the management of insomnia in patients with chronic pain. METHODS A prospective observational crossover study of 160 consenting adult patients who underwent pain management. For insomnia treatment, each patient ingested different prescribed doses of zopiclone or clonidine on alternate nights. Each patient used a special validated sleep diary to collect data including pain score, sleep scores, sleep duration, sleep medication dose, and adverse effects. Each patient completed the diary for 3 continuous weeks. Pain was measured using the numeric pain rating scale. Sleep score was measured using the Likert sleep scale. A change in the pain or sleep scores by 2-points was considered significant. Of the 160 study participants, 150 (93.8%) completed the study successfully; and their data were analyzed. Data were analyzed with IBM SPSS Statistics 25 (IBM Corp, Armonk, NY); using Student's t-test, ANOVA, Pearson Chi-square test, and regression analysis. P-value <0.05 was considered significant. RESULTS Pain score was lower with clonidine than zopiclone (p=0.025). Time to fall asleep was shorter with clonidine than zopiclone (p=0.001). Feeling rested on waking in the morning was better with clonidine than zopiclone (p=0.015). Overall sleep quality was better with clonidine than zopiclone (p=0.015). Total Likert sleep score was better with clonidine than zopiclone (p=0.005). Total sleep duration was better with clonidine than zopiclone (p=0.013). Adverse effects were commoner with zopiclone; including collapse, fall, confusion, amnesia, mood disorder, hallucination, nightmare, nocturnal restlessness, locomotor dysfunction, hunger, nausea and headache. Minor adverse effect of dry mouth was commoner with clonidine. CONCLUSIONS Clonidine is significantly better than zopiclone regarding sleep quality, analgesia, tolerability profile, and patient safety. Further studies will be beneficial to compare clonidine with other insomnia medications.
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Affiliation(s)
- Olumuyiwa A Bamgbade
- Department of Anesthesiology, University of British Columbia, Vancouver, BC, Canada
| | - Jemima Tai-Osagbemi
- Research Department, Salem Anaesthesia Pain Clinic Surrey, Vancouver, BC, Canada
| | - Daniel O Bamgbade
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Abisola Fadire
- Department of Medicine, University of Lagos, Lagos, Nigeria
| | - Nikki K Soni
- Department of Pharmacy, Mathari National Teaching Hospital, Nairobi, Kenya
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Korabelnikova E, Tkachenko V. Nightmares in patients with insomnia. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:42-47. [DOI: 10.17116/jnevro202212205242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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47
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Non-REM Parasomnias. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maddison KJ, Kosky C, Walsh JH. Is There a Place for Medicinal Cannabis in Treating Patients with Sleep Disorders? What We Know so Far. Nat Sci Sleep 2022; 14:957-968. [PMID: 35611178 PMCID: PMC9124464 DOI: 10.2147/nss.s340949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/06/2022] [Indexed: 02/02/2023] Open
Abstract
The legalization of cannabis for medicinal, and in some countries, recreational, purposes in addition to growth in the cannabis industry has meant that cannabis use and interest in the area has increased rapidly over the past 20 years. Treatment of poor sleep and sleep disorders are two of the most common reasons for the current use of medicinal cannabis. However, evidence for the role of medical cannabis in the treatment of sleep disorders has not been clearly established, thus making it challenging for clinicians to make evidence-based decisions regarding efficacy and safety. This narrative review summarizes the highest quality clinical evidence currently available in relation to the use of medicinal cannabis for the treatment of sleep disorders including insomnia, obstructive sleep apnea, restless legs syndrome, rapid eye movement sleep behavior disorder, nightmare disorder and narcolepsy. A summary of the effect of cannabis on sleep quality and architecture is also presented. Currently, there is insufficient evidence to support the routine use of medicinal cannabis as an effective and safe treatment option for any sleep disorder. Nevertheless, emerging evidence is promising and warrants further investigation using standardized cannabinoid products and validated quantitative measurement techniques.
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Affiliation(s)
- Kathleen J Maddison
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Centre for Sleep Science, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher Kosky
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jennifer H Walsh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Centre for Sleep Science, University of Western Australia, Perth, Western Australia, Australia
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49
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Albanese M, Liotti M, Cornacchia L, Mancini F. Nightmare Rescripting: Using Imagery Techniques to Treat Sleep Disturbances in Post-traumatic Stress Disorder. Front Psychiatry 2022; 13:866144. [PMID: 35444578 PMCID: PMC9013762 DOI: 10.3389/fpsyt.2022.866144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Besides affecting 8% of the general population, nightmares are one of the most frequent symptoms of traumatized individuals. This can be a significant factor in the treatment of post-traumatic disorders; indeed, several studies demonstrated its strong predictive and prognostic value. Sleep disorders, nightmares in particular, could be very distressing for individuals and need targeted interventions, especially if they are associated with a PTSD diagnosis. To date, the best technique for the treatment of traumatic sleep disturbances seems to be Imagery Rehearsal Therapy (IRT), an empirically supported method. Through a review of the literature on this matter, this article aims to outline the incidence and consequences of nightmares in PTSD, illustrate how IRT could prove useful in their treatment, and investigate its clinical applications.
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Affiliation(s)
- Marzia Albanese
- School of Cognitive Psychotherapy, Rome, Italy.,Crossing Dialogues Association, Rome, Italy
| | - Marianna Liotti
- School of Cognitive Psychotherapy, Rome, Italy.,Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Mancini
- School of Cognitive Psychotherapy, Rome, Italy.,Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
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50
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Friedmann F, Hill H, Santangelo P, Ebner-Priemer U, Neubauer AB, Rausch S, Steil R, Müller-Engelmann M, Lis S, Fydrich T, Priebe K. Women with abuse-related PTSD sleep more fitfully but just as long as healthy controls: an actigraphic study. Sleep 2021; 45:6473455. [PMID: 34932818 DOI: 10.1093/sleep/zsab296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Subjective reports of sleep impairments are common in individuals with posttraumatic stress disorder (PTSD), but objective assessments of sleep have yielded mixed results. METHODS We investigated sleep via actigraphy and e-diary on 6 consecutive nights in a group of 117 women with PTSD after childhood abuse (CA; PTSD group), a group of 31 mentally healthy women with a history of CA (healthy trauma controls, HTC group) and a group of 36 non-traumatized mentally healthy women (healthy controls, HC group). RESULTS The PTSD group reported lower sleep quality, more nights with nightmares, and shorter sleep duration than both HTC and HC. Actigraphic measures showed more and longer sleep interruptions in the PTSD group compared to HTC and HC, but no difference in sleep duration. While the PTSD group underestimated their sleep duration, both HTC and HC overestimated their sleep duration. HTC did not differ from HC regarding sleep impairments. CONCLUSIONS Sleep in women with PTSD after CA seems to be more fragmented but not shorter compared to sleep patterns of mentally healthy control subjects. The results suggest a stronger effect of PTSD psychopathology on sleep compared to the effect of trauma per se.
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Affiliation(s)
- Franziska Friedmann
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
| | - Holger Hill
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Philip Santangelo
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Ulrich Ebner-Priemer
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Andreas B Neubauer
- Department of Education and Human Development, DIPF
- Leibniz Institute for Research and Information in Education, P.O. Box 900270, 60442 Frankfurt am Main, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, 60323 Frankfurt am Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, 60323 Frankfurt am Main, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
| | - Kathlen Priebe
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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