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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Paquet C, Lenker KP, Calhoun SL, Bixler EO, Vgontzas AN, Fernandez-Mendoza J. Short-term stability and night-to-night variability of sleep parameters in nightmares comorbid with chronic insomnia Disorder across multiple nights of polysomnography. Sleep 2024; 47:zsae032. [PMID: 38300896 DOI: 10.1093/sleep/zsae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/07/2024] [Indexed: 02/03/2024] Open
Abstract
STUDY OBJECTIVES The purpose of this study was to examine the degree of short-term stability of polysomnographic (PSG) measured sleep parameters and the overall differences between individuals with comorbid nightmares and insomnia compared to those with chronic insomnia disorder alone or good sleeping controls across four nights in the sleep lab. METHODS A total of 142 good sleeping controls, 126 chronic insomnia alone, and 24 comorbid insomnia/nightmare participants underwent four consecutive nights of 8-hour PSG recordings. Outcomes included sleep continuity, architecture, and REM-related parameters across nights one through four. Intraclass correlation coefficients with mixed-effect variances and repeated-measure analysis of covariance were used, respectively, to determine short-term stability as well as between-participants and time-by-group interaction effects. RESULTS Wake after sleep onset and stage 1 showed "poor stability" in the comorbid insomnia/nightmare group compared to "moderate stability" in the good sleeping controls and chronic insomnia alone group. Significant between-group effects (all ps < .05) showed that the comorbid insomnia/nightmare group took longer to fall asleep and had a greater first-night-effect in stage 1 compared to good sleeping controls and chronic insomnia alone group; in addition, the comorbid insomnia/nightmare and insomnia alone groups slept shorter, with fewer awakenings and REM periods, compared to the good sleeping controls. CONCLUSIONS Nightmares are associated with abnormal sleep above and beyond REM disruption, as sleep continuity was the primary aspect in which poor stability and group differences emerged. The greater inability to fall asleep and instability of sleep fragmentation in those with comorbid insomnia/nightmares compared to chronic insomnia alone may be attributed to the impact of presleep anticipatory anxiety and nightmare-related distress itself. CLINICAL TRIAL INFORMATION The data analyzed in this study does not come from any current or previous clinical trials. Therefore, there is no clinical trial information to report.
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Affiliation(s)
- Caitlin Paquet
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristina P Lenker
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
| | - Edward O Bixler
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
| | - Alexandros N Vgontzas
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
| | - Julio Fernandez-Mendoza
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yount G, Taddeo S, Stumbrys T, Kriegsman M, Wahbeh H. Trends in waking salivary alpha-amylase levels following healing lucid dreams. Front Psychol 2024; 15:1347499. [PMID: 38298517 PMCID: PMC10828844 DOI: 10.3389/fpsyg.2024.1347499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction Salivary alpha-amylase (sAA) is considered a marker of autonomic nervous system activity in stress research, and atypical waking sAA responses have been reported for traumatized individuals. Lucid dreams, characterized by a dreamer's awareness of their dream state while remaining asleep, have shown promising preliminary evidence of their potential to enhance mental health. This study's objective was to evaluate sAA in relation to healing lucid dreams. Methods Participants experiencing PTSD symptoms attended a six-day workshop delivered via live video designed to teach techniques for transforming trauma through dreamwork and dream lucidity. Participants (n = 20) collected saliva samples each morning, immediately upon awakening (Time 1) and 30 min afterward (Time 2). sAA levels were determined by enzymatic assay, and the waking sAA slope was calculated as the difference of Time 2 minus Time 1. Participants completed dream reports each morning, with a dream classified as a 'healing lucid dream' when they reported attaining lucidity and remembered their intention to manifest a healing experience within the dreamscape. Results Of eight participants experiencing healing lucid dreams, four were able to provide usable saliva samples. Statistical tests on these four participants were not significant because of low power. However, nonsignificant positive associations were observed between experiencing more healing lucid dreams and increased waking sAA slope. Conclusion The results did not reveal a consistent effect of healing lucid dreams on waking sAA slope. Identifying meaningful patterns in this relationship will require larger samples and more stringent control over saliva collection procedures in future studies.
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Affiliation(s)
- Garret Yount
- Institute of Noetic Sciences, Novato, CA, United States
| | - Sitara Taddeo
- Institute of Noetic Sciences, Novato, CA, United States
| | - Tadas Stumbrys
- Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | | | - Helané Wahbeh
- Institute of Noetic Sciences, Novato, CA, United States
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Lappas AS, Polyzopoulou ZA, Christodoulou N, Bozikas VP, Samara MT. Effects of Antidepressants on Sleep in Post-traumatic Stress Disorder: An Overview of Reviews. Curr Neuropharmacol 2024; 22:749-805. [PMID: 37533247 PMCID: PMC10845105 DOI: 10.2174/1570159x21666230801144328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 08/04/2023] Open
Abstract
Antidepressants are a commonly used, easily accessible, and overall safe treatment option for post-traumatic stress disorder (PTSD). The present review aims to evaluate the efficacy and safety of antidepressants in treating sleep disturbances in patients with PTSD. PubMed and the Cochrane Library were searched (July 2022) for systematic reviews and meta-analyses on the treatment of PTSD. Moreover, PubMed and ClinicalTrials.gov were searched for individual trials investigating the antidepressant treatment of PTSD (up to September 2022), and reference lists of all possibly relevant identified studies were screened. Sleep-related outcomes, i.e., total sleep time, sleep quality, dreams/ nightmares, insomnia, and somnolence, were extracted independently by at least two reviewers. Metaanalytic evaluations were performed wherever possible. 39 randomised controlled trials (RCTs) were identified; data from pooled analyses, reviews, and observational studies were used for antidepressants with a weak evidence base or when their findings were deemed important. Overall, scarce data exist on the effects of antidepressants on sleep outcomes among patients with PTSD. Some evidence may support the use of amitriptyline, nefazodone, paroxetine, and sertraline for improving sleep in patients with PTSD. Τhere was a meta-analytical trend indicating improvement of nightmares with fluoxetine, less insomnia with amitriptyline and more with brofaromine, as well as more somnolence with paroxetine vs. placebo, respectively. However, data from more than 1 RCT with a considerable number of patients were only available for paroxetine. Evidence is insufficient to draw safe conclusions. More and better-designed RCTs, with consistent reporting of sleep-related outcomes, are needed.
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Affiliation(s)
- Andreas S. Lappas
- Department of Psychiatry, Medical School, General University Hospital of Larissa, University of Thessaly, Larissa, Greece
- Department of Geriatric Liaison Psychiatry, Royal Gwent Hospital, Newport, United Kingdom
| | - Zoi A. Polyzopoulou
- Department of Psychology, University of Western Macedonia, Florina, 53100, Greece
| | - Nikos Christodoulou
- Department of Psychiatry, Medical School, General University Hospital of Larissa, University of Thessaly, Larissa, Greece
- School of Medicine, University of Nottingham, Nottingham, England, United Kingdom
| | - Vasilios-Panteleimon Bozikas
- II Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Lagkada Str. 196, 56430Thessaloniki, Greece
| | - Myrto T. Samara
- Department of Psychiatry, Medical School, General University Hospital of Larissa, University of Thessaly, Larissa, Greece
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Mysliwiec V, Pruiksma KE, Matsangas P, Powell T, Straud CL, Taylor DJ, Hansen S, Foster SN, Mithani S, Zwetzig S, Martin J, Gerwell K, Young-McCaughan S, Blue Star JA, Cassidy DG, Gomes KD, Moore BA, Peterson AL, Brock MS. Sex differences in US military personnel with insomnia, obstructive sleep apnea, or comorbid insomnia and obstructive sleep apnea. J Clin Sleep Med 2024; 20:17-30. [PMID: 37584448 PMCID: PMC10758553 DOI: 10.5664/jcsm.10774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/17/2023]
Abstract
STUDY OBJECTIVES The aim of this study was to evaluate sex-related differences in symptoms of sleep disorders, sleep-related impairment, psychiatric symptoms, traumatic brain injury, and polysomnographic variables in treatment-seeking military personnel diagnosed with insomnia, obstructive sleep apnea (OSA), or comorbid insomnia and OSA (COMISA). METHODS Participants were 372 military personnel (46.2% women, 53.8% men) with an average age of 37.7 (standard deviation = 7.46) years and median body mass index of 28.4 (5.50) kg/m2. Based on clinical evaluation and video-polysomnography, participants were diagnosed with insomnia (n = 118), OSA (n = 118), or COMISA (n = 136). Insomnia severity, excessive daytime sleepiness, sleep quality, nightmare disorder, sleep impairment, fatigue, posttraumatic stress disorder, anxiety, depression symptoms, and traumatic brain injury were evaluated with validated self-report questionnaires. Descriptive statistics, parametric and nonparametric t-tests, and effect sizes were used to assess sex differences between men and women. RESULTS There were no significant differences between women and men with insomnia or OSA in sleep-related symptoms, impairment, or polysomnography-based apnea-hypopnea index. Military men with COMISA had a significantly greater apnea-hypopnea index as compared to military women with COMISA, but women had greater symptoms of nightmare disorder, posttraumatic stress disorder, and anxiety. CONCLUSIONS In contrast to civilian studies, minimal differences were observed in self-reported sleep symptoms, impairment, and polysomnography metrics between men and women diagnosed with the most frequent sleep disorders in military personnel (ie, insomnia, OSA, or COMISA) except in those with COMISA. Military service may result in distinct sleep disorder phenotypes that differ negligibly by sex. CITATION Mysliwiec V, Pruiksma KE, Matsangas P, et al. Sex differences in US military personnel with insomnia, obstructive sleep apnea, or comorbid insomnia and obstructive sleep apnea. J Clin Sleep Med. 2024;20(1):17-30.
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Affiliation(s)
- Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kristi E. Pruiksma
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | | | - Tyler Powell
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Shana Hansen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Shannon N. Foster
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Sara Mithani
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sarah Zwetzig
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jennifer Martin
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kelsi Gerwell
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - John A. Blue Star
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Daniel G. Cassidy
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Kimberly D. Gomes
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia
| | - Brian A. Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
| | - Matthew S. Brock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - on behalf of STRONG STAR Consortium
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Crew Endurance Team, Naval Postgraduate School, Monterey, California
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia
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Isaac F, Toukhsati SR, Klein B, Di Benedetto M, Kennedy GA. Differences in Anxiety, Insomnia, and Trauma Symptoms in Wildfire Survivors from Australia, Canada, and the United States of America. Int J Environ Res Public Health 2023; 21:38. [PMID: 38248503 PMCID: PMC10815777 DOI: 10.3390/ijerph21010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Many survivors of wildfires report elevated levels of psychological distress following the trauma of wildfires. However, there is only limited research on the effects of wildfires on mental health. This study examined differences in anxiety, depression, insomnia, sleep quality, nightmares, and post-traumatic stress disorder (PTSD) symptoms following wildfires in Australia, Canada, and the United States of America (USA). One hundred and twenty-six participants from Australia, Canada, and the USA completed an online survey. The sample included 102 (81%) women, 23 (18.3%) men, and one non-binary (0.8%) individual. Participants were aged between 20 and 92 years (M age = 52 years, SD = 14.4). They completed a demographic questionnaire, the Disturbing Dream and Nightmare Severity Index (DDNSI), Generalized Anxiety Disorder Questionnaire (GAD-7), the Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), and PTSD Checklist (PCL-5). Results showed that participants from the USA scored significantly higher on the GAD-7 (p = 0.009), ISI (p = 0.003), and PCL-5 (p = 0.021) than participants from Australia and Canada. The current findings suggest a need for more international collaboration to reduce the severity of mental health conditions in Australia, Canada, and the USA.
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Affiliation(s)
- Fadia Isaac
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
| | - Samia R. Toukhsati
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
| | - Britt Klein
- Health Innovation and Transformation Centre, Federation University, Mt Helen, VIC 3350, Australia;
- Biopsychosocial & eHealth Research & Innovation (BeRI) Hub, Federation University, Mt Helen, VIC 3350, Australia
| | | | - Gerard A. Kennedy
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, VIC 3084, Australia
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Pachi A, Tselebis A, Sikaras C, Sideri EP, Ivanidou M, Baras S, Milionis C, Ilias I. Nightmare distress, insomnia and resilience of nursing staff in the post-pandemic era. AIMS Public Health 2023; 11:36-57. [PMID: 38617404 PMCID: PMC11007420 DOI: 10.3934/publichealth.2024003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction The pandemic has led to notable psychological challenges among healthcare professionals, including nurses. Objective Our aims of this study were to assess insomnia and nightmare distress levels in nurses and investigate their association with mental resilience. Methods Nurses participated in an online survey, which included the Nightmare Distress Questionnaire (NDQ), Brief Resilience Scale (BRS) and Athens Insomnia Scale (AIS). Demographic information, such as age, professional experience and gender, was also collected. Results The study included 355 female and 78 male nurses. Findings revealed that 61.4% had abnormal AIS scores, 7% had abnormal NDQ scores and 25.4% had low BRS scores. Female nurses had higher AIS and NDQ scores but lower BRS scores compared to males. BRS demonstrated negative correlations with both AIS and NDQ. Multiple regression analysis indicated that NDQ accounted for 24% of the AIS variance, with an additional 6.5% explained by the BRS. BRS acted as a mediator, attenuating the impact of nightmares on insomnia, with gender moderating this relationship. Conclusions Nursing staff experienced heightened sleep disturbances during the pandemic, with nightmares and insomnia being prevalent. Nightmares significantly contributed to insomnia, but mental resilience played a vital role in mitigating this effect. Strategies are warranted to address the pandemic's psychological impact on nursing professionals.
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Affiliation(s)
- Argyro Pachi
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece
| | - Athanasios Tselebis
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece
| | - Christos Sikaras
- Nursing Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece
| | - Eleni Paraskevi Sideri
- Emergency Department of General Hospital of Athens Korgialeneio-Benakeio Hellenic Red Cross, 11526, Athens, Greece
| | - Maria Ivanidou
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece
| | - Spyros Baras
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece
| | | | - Ioannis Ilias
- Department of Endocrinology, “Elena Venizelou” Hospital, 11521 Athens, Greece
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Roland A, Windal M, Briganti G, Kornreich C, Mairesse O. Intensity and Network Structure of Insomnia Symptoms and the Role of Mental Health During the First Two Waves of the COVID-19 Pandemic. Nat Sci Sleep 2023; 15:1003-1017. [PMID: 38059205 PMCID: PMC10697149 DOI: 10.2147/nss.s432944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose Insomnia, being a mental disorder, is best conceived as a network of symptoms. With the important increase in insomnia prevalence during the COVID-19 pandemic, our aim was to investigate how the structure of insomnia symptoms in the general population has changed due to the pandemic. We also looked at the directional dependencies of nightmares and of covid- and lockdown-related stress/anxiety and depression in insomnia. Patients and Methods 5986 persons replied to our online questionnaire for the first wave and 2843 persons to our second wave questionnaire. Both questionnaires included the Insomnia Severity Index (ISI). Regularized Gaussian Graphical Models (GGM) and Bayesian Directed Acyclic Graphs (DAG) were estimated. Results The pre- and peri-lockdown networks were equally strongly connected (first wave: S = 0.13, p = 0.39; second wave: S = 0.03, p = 0.67), but differed for the first lockdown regarding only six edges (M = 0.13, p < 0.001) and for the second lockdown only five edges (M = 0.16, p < 0.001). These symptoms all worsened during the lockdowns in comparison to before the pandemic (p < 0.001). The diurnal items of the ISI had the highest predictability and centrality values in the GGMs. Lockdown-related stress/anxiety influenced indirectly nightmares through covid-related stress/anxiety, lockdown-related depressive affect and mental fatigue. These reported feelings of stress/anxiety and depression showed an indirect impact on insomnia symptoms through mental and physical fatigue. Conclusion Though the lockdown slightly intensified insomnia symptoms, it did not alter their network structure. Despite their differences, both GGMs and DAGs agree that the diurnal symptoms of the ISI, play an essential role in the network structure. Both methods confirm the need for emphasizing the cognitive/affective component in the treatment of insomnia (ie cognitive behavioral therapy).
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Affiliation(s)
- Aurore Roland
- Brain, Body and Cognition, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels University Consultation Center, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maxime Windal
- Brain, Body and Cognition, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Psychology, Université Libre de Bruxelles, Brussels, Belgium
| | - Giovanni Briganti
- Laboratoire de Psychologie Médicale et Addictologie, CHU/UVC Brugmann, Brussels, Belgium
- Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
- Faculty of Medicine, Université de Mons, Mons, Belgium
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Charles Kornreich
- Laboratoire de Psychologie Médicale et Addictologie, CHU/UVC Brugmann, Brussels, Belgium
- Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
| | - Olivier Mairesse
- Brain, Body and Cognition, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels University Consultation Center, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Laboratoire de Psychologie Médicale et Addictologie, CHU/UVC Brugmann, Brussels, Belgium
- Vital Signs and PERformance Monitoring (VIPER), LIFE Department, Royal Military Academy, Brussels, Belgium
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Cromer LD, Pangelinan BAF, El Sabbagh E, Rischard ME, Capellupo C, Buck TR. Methodological changes to improve retention: Results from two pediatric cognitive behavioral therapy studies. J Clin Psychol 2023; 79:2478-2492. [PMID: 37347235 DOI: 10.1002/jclp.23557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/27/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Retention is challenging in clinical research with pediatric populations. The retention obstacles that are experienced in adult samples are compounded because child samples depend on caregiver support and engagement. The present paper describes retention improvements following protocol adaptations across a pair of cognitive behavioral pilot studies for nightmare sufferers aged 6-17. METHODS Study 1 (N = 20) focused retention efforts on rapport and engagement, flexible scheduling, treatment location choice, and incentives. Study 2 (N = 31) sought to increase retention by improving continuity of care, increasing scheduling flexibility, reducing participant time and effort, and increasing choice and attractiveness of incentives. RESULTS Only 13 participants (65%) were retained in Study 1; n = 6 (54.5%) treatment and n = 7 (77.78%) waitlist. In contrast, 29 participants (93.5%) were retained in Study 2; n = 15 (93.8%) treatment and n = 14 (93.3%) waitlist. CONCLUSION We conclude that asking for and responding to patient feedback to assess all perceived barriers and burdens for participants is essential to ensure that benefits exceed effort. Allowing choices in size and frequency of incentives, as well as improving continuity of care, and reducing session length even while increasing number of sessions, were noted improvements in Study 2.
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Affiliation(s)
| | | | | | - Mollie E Rischard
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma, USA
| | | | - Tara R Buck
- Department of Psychiatry, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA
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Hamilton NA, Russell JA, Youngren WA, Gallegos AM, Crean HF, Cerulli C, Bishop TM, Hamadah K, Schulte M, Pigeon WR, Heffner KL. Cognitive behavioral therapy for insomnia treatment attrition in patients with weekly nightmares. J Clin Sleep Med 2023; 19:1913-1921. [PMID: 37421316 PMCID: PMC10620662 DOI: 10.5664/jcsm.10710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVES This study's objective was to evaluate the effect of nightmares (NMs) on attrition and symptom change following cognitive behavioral therapy for insomnia (CBT-I) treatment using data from a successful CBT-I randomized controlled trial delivered to participants with recent interpersonal violence exposure. METHODS The study randomized 110 participants (107 women; mean age: 35.5 years) to CBT-I or to an attention-control group. Participants were assessed at 3 time periods: baseline, post-CBT-I (or attention control), and at time 3 (T3) post-cognitive processing therapy received by all participants. NM reports were extracted from the Fear of Sleep Inventory. Participants with weekly NMs were compared with those with fewer than weekly NMs on outcomes including attrition, insomnia, posttraumatic stress disorder, and depression. Change in NM frequency was examined. RESULTS Participants with weekly NMs (55%) were significantly more likely to be lost to follow-up post-CBT-I (37%) compared with participants with infrequent NMs (15.6%) and were less likely to complete T3 (43%) than patients with less frequent NMs (62.5%). NMs were unrelated to differential treatment response in insomnia, depression, or posttraumatic stress disorder. Treatment with CBT-I was not associated with reduced NM frequency; however, change in sleep-onset latency from post-CBT-I to T3 predicted fewer NMs at T3. CONCLUSIONS Weekly NMs were associated with attrition but not a reduced change in insomnia symptoms following CBT-I. NM symptoms did not change as a function of CBT-I, but change in sleep-onset latency predicted lower NM frequency. CBT-I trials should screen for NMs and consider augmenting CBT-I to specifically address NMs. CITATION Hamilton NA, Russell JA, Youngren WA, et al. Cognitive behavioral therapy for insomnia treatment attrition in patients with weekly nightmares. J Clin Sleep Med. 2023;19(11):1913-1921.
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Affiliation(s)
| | | | - Westley A. Youngren
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
| | - Autumn M. Gallegos
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Hugh F. Crean
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Susan B. Anthony Center and Laboratory of Interpersonal Violence and Victimization, University of Rochester Medical Center, Rochester, New York
| | - Todd M. Bishop
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | | | - Wilfred R. Pigeon
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Kathi L. Heffner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, New York
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York
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13
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Prguda E, Evans J, McLeay S, Romaniuk M, Phelps AJ, Lewis K, Brown K, Fisher G, Lowrie F, Saunders-Dow E, Dwyer M. Posttraumatic sleep disturbances in veterans: A pilot randomized controlled trial of cognitive behavioral therapy for insomnia and imagery rehearsal therapy. J Clin Psychol 2023; 79:2493-2514. [PMID: 37392411 DOI: 10.1002/jclp.23561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) is associated with sleep disturbances including insomnia and nightmares. This study compared cognitive behavioral therapy for insomnia (CBT-I) with CBT-I combined with imagery rehearsal therapy (IRT) for nightmares to evaluate if the combined treatment led to greater reductions in trauma-related sleep disturbances in Australian veterans. METHODS Veterans with diagnosed PTSD, high insomnia symptom severity, and nightmares (N = 31) were randomized to eight group CBT-I sessions or eight group CBT-I + IRT sessions. Self-reported sleep, nightmare, and psychological measures (primary outcome: Pittsburgh Sleep Quality Index), and objective actigraphy data were collected; the effect of obstructive sleep apnea (OSA) risk on treatment outcomes was also examined. RESULTS No treatment condition effects were detected for the combined treatment compared to CBT-I alone, and no moderating effect of OSA risk was detected. On average, participants from both groups improved on various self-report measures over time (baseline to 3 months posttreatment). Despite the improvements, mean scores for sleep-specific measures remained indicative of poor sleep quality. There were also no significant differences between the groups on the actigraphy indices. CONCLUSIONS The findings indicate that there is potential to optimize both treatments for veterans with trauma-related sleep disturbances.
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Affiliation(s)
- Emina Prguda
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Justine Evans
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
| | - Sarah McLeay
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
| | - Madeline Romaniuk
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea J Phelps
- Department of Psychiatry, Phoenix Australia-Centre for Posttraumatic Mental Health, University of Melbourne, Carlton, Victoria, Australia
| | - Kerri Lewis
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
| | - Kelly Brown
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Gina Fisher
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Fraser Lowrie
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | | | - Miriam Dwyer
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
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Rolling J, Rabot J, Reynaud E, Kolb O, Bourgin P, Schroder CM. Nightmares and Sleep Disturbances in Children with PTSD: A Polysomnographic and Actigraphy Approach Evaluation. J Clin Med 2023; 12:6570. [PMID: 37892709 PMCID: PMC10607571 DOI: 10.3390/jcm12206570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
RATIONALE Sleep disturbances (insomnia and nightmare symptoms) are the most sensitive and persistent symptoms of pediatric post-traumatic stress disorder (PTSD). Untreated, these sleep disturbances (SD) associated with PTSD are predictive of PTSD persistence and increased psychiatric complications. The aim of this study was to evaluate sleep and circadian rhythms in children with PTSD under both laboratory and ecological conditions in comparison with a control population and to test for the first time the hypothesis that SD and circadian rhythms are positively correlated with PTSD severity and its comorbidities. METHOD This prospective pilot study evaluated PTSD, SD (insomnia, nightmares), and sleep-wake rhythms in 11 children with PTSD (aged 3-18), compared with the age and sex-matched control groups. Assessment of PTSD and subjective and objective measures of sleep and sleep-wake rhythms (questionnaires, 24-h in-laboratory video-polysomnography, 15-day at-home actigraphy recording) were performed between 1 and 6 months after the traumatic event. RESULTS Children with PTSD had higher sleep fragmentation (increased wake-after-sleep onset, increased number of sleep stage changes) compared to controls, with a change in sleep microarchitecture (micro-arousal index at 14.8 versus 8.2, p = 0.039). Sleep fragmentation parameters correlated with PTSD symptomatology, insomnia, and post-traumatic nightmare severity. The within-group comparison revealed a better sleep architecture in the controlled (sleep laboratory) than in the ecological condition (at home) (total sleep time 586 versus 464 min, p = 0.018). CONCLUSIONS Sleep and rhythm disturbances are strongly associated with PTSD in children. The assessment of SD in children with PTSD should be carried out systematically and preferentially under ecological conditions, and management of SD should integrate the environment (environmental design, psycho-education for the children and their parents) more fully into therapy focused on sleep and trauma.
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Affiliation(s)
- Julie Rolling
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, 67091 Strasbourg, France
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Juliette Rabot
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
- Center for Research, Integrated University Health and Social Services Center (CIUSSS) Nord-de-l’Île-de-Montréal, Montréal, QC H2M 2W1, Canada
- Department of Psychiatry & Addictology, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Eve Reynaud
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
- CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Forgetting, Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Oriane Kolb
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Patrice Bourgin
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Carmen M. Schroder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
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Geoffroy PA, Stern E, Maruani J, Cornic R, Bazin B, Clerici E, Ambar Akkaoui M, Lopez R, Frija Masson J, d'Ortho MP, Lejoyeux M, Micoulaud Franchi JA, Couffignal C. The nightmare severity index (NSI): A short new multidimensional tool for assessing nightmares. J Sleep Res 2023:e14065. [PMID: 37846776 DOI: 10.1111/jsr.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/18/2023]
Abstract
This psychometric pilot study aims to evaluate a new multidimensional simple scale, named the nightmare severity index (NSI) - close to the existing insomnia (ISI) and hypersomnia (HSI) severity indexes. The NSI encompasses all main dimensions of nightmare disorder, evaluating four subdimensions: frequency, emotional impact, diurnal impact, and nocturnal impact of nightmares. The NSI was completed by a total of 102 patients. The majority of the population consisted of women (64%) and outpatient individuals (76%) diagnosed with mood disorders such as depression (31%) and bipolar disorder (41%). Comorbidity with post-traumatic stress disorder (PTSD) was prevalent (44%), and psychotropic medications were commonly used (47%). Internal validity analyses indicated that the NSI was well suited for exploratory factor analysis. All items demonstrated satisfactory correlations with the factors, and the questionnaire exhibited good internal consistency (Cronbach's alpha >0.7). Higher NSI scores were observed among individuals experiencing nightmare symptoms considering the DSM-5/ICSD-3 criteria. In summary, the NSI proves to be a promising and valuable tool for clinical practice, demonstrating good acceptability, internal validity, and the ability to assess nightmare severity.
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Affiliation(s)
- Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212, Strasbourg, France
| | - Emilie Stern
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
| | - Julia Maruani
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
| | - Renaud Cornic
- Département d'Epidémiologie, Biostatistique et Recherche Clinique AP-HP, DMU PRISME, Hôpital Bichat - Claude Bernard, Paris, France
| | - Balthazar Bazin
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
| | | | - Marine Ambar Akkaoui
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- Centre Psychiatrique d'Orientation et d'Accueil (CPOA), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Régis Lopez
- Universite de Montpellier Faculte de Medecine Montpellier-Nimes, Montpellier, France
| | - Justine Frija Masson
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- Département de Physiologie - Explorations Fonctionnelles et Centre du Sommeil AP-HP, DMU DREAM, Hôpital Bichat - Claude Bernard, Paris, France
| | - Marie-Pia d'Ortho
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- Département de Physiologie - Explorations Fonctionnelles et Centre du Sommeil AP-HP, DMU DREAM, Hôpital Bichat - Claude Bernard, Paris, France
| | - Michel Lejoyeux
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
| | - Jean-Arthur Micoulaud Franchi
- University Sleep Medicine Department, University Hospital of Bordeaux, Bordeaux, France
- 2 UMR CNRS 6033 SANPSY, University Hospital of Bordeaux, Bordeaux, France
| | - Camille Couffignal
- Département d'Epidémiologie, Biostatistique et Recherche Clinique AP-HP, DMU PRISME, Hôpital Bichat - Claude Bernard, Paris, France
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Pruiksma KE, Taylor DJ, Wachen JS, Straud CL, Hale WJ, Mintz J, Young-McCaughan S, Peterson AL, Yarvis JS, Borah EV, Dondanville KA, Litz BT, Resick PA. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial. J Clin Sleep Med 2023; 19:1389-1398. [PMID: 36988304 PMCID: PMC10394372 DOI: 10.5664/jcsm.10584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES Sleep disturbances are common in military personnel with posttraumatic stress disorder (PTSD) and may persist following treatment. This study examined service members seeking treatment for PTSD, reporting insomnia symptoms, nightmares, excessive daytime sleepiness, and potential obstructive sleep apnea at baseline and the impact of sleep disturbances on a course of PTSD treatment. METHODS In this secondary analysis, sleep was evaluated in 223 service members who participated in a randomized clinical trial comparing Cognitive Processing Therapy for PTSD delivered in individual or group formats. Sleep assessments included the Insomnia Severity Index, the Trauma-Related Nightmare Survey, and Epworth Sleepiness Scale administered at baseline and 2 weeks posttreatment. RESULTS Following PTSD treatment, there were significant improvements for insomnia symptoms (MΔ = -1.49; d = -0.27), nightmares (MΔ = -0.35; d = -0.27), and excessive daytime sleepiness (MΔ = -0.91; d = -0.16). However, mean scores remained in clinical ranges at posttreatment. Participants with baseline insomnia symptoms had worse PTSD severity throughout treatment. Participants with baseline excessive daytime sleepiness or probable obstructive sleep apnea had greater PTSD severity reductions when treated with Cognitive Processing Therapy individually vs. in a group. Those with insomnia symptoms, nightmare disorder, and sleep apnea had greater depressive symptoms throughout treatment. CONCLUSIONS Insomnia symptoms, nightmares, and excessive daytime sleepiness were high at baseline in service members seeking treatment for PTSD. While sleep symptoms improved with PTSD treatment, these sleep disorders were related to worse treatment outcomes with regards to symptoms of PTSD and depression. Individual Cognitive Processing Therapy is recommended over group Cognitive Processing Therapy for patients with either excessive daytime sleepiness or probable obstructive sleep apnea. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Group vs. Individual Cognitive Processing Therapy for Combat-related PTSD; URL: https://clinicaltrials.gov/ct2/show/NCT02173561; Identifier: NCT02173561. CITATION Puriksma KE, Taylor DJ, Wachen JS, et al. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial. J Clin Sleep Med. 2023;19(8):1389-1398.
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Affiliation(s)
- Kristi E. Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona
- Department of Psychology, University of North Texas, Denton, Texas
| | - Jennifer Schuster Wachen
- Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Willie J. Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jeffrey S. Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- School of Social Work, Tulane University, New Orleans, Louisiana
| | - Elisa V. Borah
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- School of Social Work, University of Texas at Austin, Austin, Texas
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brett T. Litz
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
| | - on behalf of the STRONG STAR Consortium
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
- Department of Psychology, University of North Texas, Denton, Texas
- Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- School of Social Work, Tulane University, New Orleans, Louisiana
- School of Social Work, University of Texas at Austin, Austin, Texas
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
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Bottari SA, Trifilio ER, Janicke DM, Porges EC, Cohen RA, Jaffee MS, Williamson JB. Effects of sleep disturbance on trauma-focused psychotherapy outcomes in posttraumatic stress disorder: A systematic review. Ann N Y Acad Sci 2023; 1526:30-49. [PMID: 37393069 DOI: 10.1111/nyas.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
This study aimed to synthesize existing research on the effects of sleep disturbances on trauma-focused psychotherapy outcomes in adults with posttraumatic stress disorder (PTSD). A systematic review using PubMed, PsycINFO, Embase, Web of Science, and PTSDpubs was performed up to April 2021. Two independent reviewers screened articles for inclusion, performed data extraction, and assessed risk of bias and certainty of the evidence. Narrative synthesis was conducted based on the type of sleep disorder symptom assessed. Sixteen primary studies were included in this review, the majority of which had a high overall risk of bias. Results suggested that sleep disorder symptoms were associated with higher overall PTSD severity across treatment; however, they did not interfere with treatment effectiveness, with the exception of sleep-disordered breathing. Improvements in insomnia, sleep duration, and sleep quality during treatment were associated with greater treatment gains. Certainty of the evidence ranged from low to very low. These results suggest that it may not be necessary to address sleep disorder symptoms prior to initiating trauma-focused psychotherapy. Instead, concurrent treatment of sleep- and trauma-related symptoms may be most beneficial. Continued research is needed to clarify the mechanistic relationship between sleep and treatment outcomes and to guide clinical decision-making.
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Affiliation(s)
- Sarah A Bottari
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for OCD, Anxiety, and Related Disorders, Department of Psychiatry, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Erin R Trifilio
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Department of Neurology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - David M Janicke
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Eric C Porges
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, College of Medicine, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, College of Medicine, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Michael S Jaffee
- Department of Neurology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - John B Williamson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for OCD, Anxiety, and Related Disorders, Department of Psychiatry, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, College of Medicine, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
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18
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Mahr F, Waschbusch DA, Vgontzas A. A Pilot Study on the Effectiveness of Prazosin as a Treatment of Post-Traumatic Stress Disorder-Related Nightmares in Women with Bulimia Nervosa. Cureus 2023; 15:e42433. [PMID: 37637523 PMCID: PMC10448916 DOI: 10.7759/cureus.42433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives Post-traumatic stress disorder (PTSD) symptoms are reported in over 36% of individuals with bulimia nervosa. To date, none of the clinical trials have examined nightmare reduction in this population. We evaluated the effectiveness of prazosin in bulimic females experiencing PTSD-related nightmares. We hypothesized that prazosin will decrease nightmares, normalize cortisol levels and secretory patterns, and improve sleep. Methods Our seven-week prospective, randomized, double-blind, placebo-controlled crossover pilot trial recruited eight adult women. Each participant received three weeks of prazosin and a placebo, separated by a one-week washout period. The order of treatment was counterbalanced across participants. Self-reports, clinician-administered scales, and salivary cortisol was collected to measure outcomes. Results A significant treatment effect was seen in nightmare intensity on the Clinician-Administered PTSD Scale (CAPS-I) (p=0.026) and a marginally significant effect on nightmare frequency (p=0.069). The only significant main effect of treatment on self-reported sleep parameters was on nightmares. Cortisol secretory patterns did not change, but on average, study participants had significantly higher cortisol levels compared to normative values. ANOVA showed a significant main effect of time for cortisol (F(4, 28) = 6.15, p=.001) but no within or between groups significant effects (ps>.179). Follow-up tests showed the effect of time was linear (F(1, 7) = 10.77, p=.013). Conclusion Prazosin significantly reduced intensity and marginally reduced the frequency of PTSD-related nightmares in bulimia nervosa but did not affect subjective sleep efficiency, quality, cortisol levels, or diurnal cortisol secretory pattern. Larger trials using objective sleep measures are warranted to replicate these findings.
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Affiliation(s)
- Fauzia Mahr
- Pediatrics and Eating Disorders, Penn State College of Medicine, Hershey, USA
| | - Daniel A Waschbusch
- Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, USA
| | - Alexandros Vgontzas
- Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, USA
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19
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Campbell AA, Taylor KA, Augustine AV, Sherwood A, Wu JQ, Beckham JC, Hoerle JM, Ulmer CS. Nightmares: an independent risk factor for cardiovascular disease? Sleep 2023; 46:zsad089. [PMID: 36996027 DOI: 10.1093/sleep/zsad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
STUDY OBJECTIVES Prior work has established associations between post-traumatic stress disorder (PTSD), disrupted sleep, and cardiovascular disease (CVD), but few studies have examined health correlates of nightmares beyond risks conferred by PTSD. This study examined associations between nightmares and CVD in military veterans. METHODS Participants were veterans (N = 3468; 77% male) serving since September 11, 2001, aged 38 years (SD = 10.4); approximately 30% were diagnosed with PTSD. Nightmare frequency and severity were assessed using the Davidson Trauma Scale (DTS). Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study Self-report Medical Questionnaire. Mental health disorders were established using the Structured Clinical Interview for DSM-IV. The sample was stratified by the presence or absence of PTSD. Within-group associations between nightmare frequency and severity and self-reported CVD conditions, adjusting for age, sex, race, current smoking, depression, and sleep duration. RESULTS Frequent and severe nightmares during the past week were endorsed by 32% and 35% of participants, respectively. Those endorsing nightmares that were frequent, severe, and the combination thereof were more likely to also evidence high blood pressure (ORs 1.42, OR 1.56, and OR 1.47, respectively) and heart problems (OR 1.43, OR 1.48, and OR 1.59, respectively) after adjusting for PTSD diagnosis and other covariates. CONCLUSIONS Nightmare frequency and severity among veterans are associated with cardiovascular conditions, even after controlling for PTSD diagnosis. Study findings suggest that nightmares may be an independent risk factor for CVD. Additional research is needed to validate these findings using confirmed diagnoses and explore potential mechanisms.
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Affiliation(s)
| | - Kenneth A Taylor
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Ann V Augustine
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jade Q Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Jeffrey M Hoerle
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Christi S Ulmer
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Xu T, Zheng K, Wu X. Risk Perception, Perceived Government Coping Validity, and Individual Sleep Problems in the Early Stage of the COVID-19 Pandemic in China: Mediation Analysis Based on Negative Emotions. Healthcare (Basel) 2023; 11:healthcare11070986. [PMID: 37046913 PMCID: PMC10094412 DOI: 10.3390/healthcare11070986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
This study aimed to investigate the relationship among risk perception, negative emotions, perceived government coping validity, and the sleep problem of the public, through regression analysis and mediation analysis of data from the early stages of the COVID-19 outbreak in China (three months after the outbreak). It found that people's perception of the risk of the pandemic, negative emotions, and perceived government coping validity significantly affected people's sleep quality and nightmares. Further analysis found that individuals' perception of risk not only affected their sleep but also intensified their negative emotions, ultimately impairing the quality of their sleep and leading to nightmares. However, having a high level of coping validity can mitigate negative emotions and consequently decrease the occurrence of nightmares, thereby enhancing the quality of sleep. Specifically, perceived government coping validity could not only directly reduce nightmares, but also indirectly reduce nightmares by lowering negative emotions. However, it could only indirectly improve sleep by reducing negative emotions. It implicated that improving and resolving sleep problems required not only medical intervention but also psychological intervention. Simultaneously, improving the government's response effectiveness could strengthen people's trust in the government, stabilize their mental states, and significantly improve their quality of life by reducing negative emotions and improving sleep.
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Affiliation(s)
- Tao Xu
- Department of Social Work, College of International Culture and Social Development, Zhejiang Normal University, Jinhua 321000, China
- Institute for Silk Road Culture and International Sinology, Zhejiang Normal University, Jinhua 321000, China
| | - Kai Zheng
- Department of Economics and International Trade, School of Economics, Management & Law, Hubei Normal University, Huangshi 435002, China
| | - Xiaoqin Wu
- Department of Social Work, College of International Culture and Social Development, Zhejiang Normal University, Jinhua 321000, China
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22
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Kelly WE. Taking Heart: Cardiac Symptoms and Nightmares Differentiate Nightmare Proneness and Psychological Distress among Young Adults. Sleep Sci 2023; 16:59-67. [PMID: 37151775 PMCID: PMC10157822 DOI: 10.1055/s-0043-1767752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/14/2022] [Indexed: 05/09/2023] Open
Abstract
Introduction Nightmare proneness, a trait-like disposition to experience frequent nightmares, has been strongly related to psychological distress. The aim of the present study was to examine if cardiac symptoms and hypothetically-related variables, nightmares, and perceived physical health could be used to differentiate nightmare proneness and psychological distress. Materials and Methods In the present cross-sectional study, 254 young adults completed measures of nightmare proneness, psychological distress, cardiac symptoms, nonspecific and posttraumatic nightmares, nightmare distress, health behaviors, perceptions of physical health, perceived stress, Type-D personality, sleep fragmentation, and dream recall. Results After controlling for psychological distress, nightmare proneness remained significantly correlated with nightmares, nightmare distress, cardiac symptoms, sleep fragmentation, physical health, perceived stress, and Type-D personality. After controlling for nightmare proneness, distress remained correlated with perceived stress and Type-D personality. Regression analyses indicated that after accounting for all variables, nightmare distress, physical health, and nightmare proneness predicted cardiac symptoms. Posttraumatic nightmares, sleep fragmentation, distress, perceived stress, Type-D personality, and chest pain predicted nightmare proneness. Conclusion Nightmare proneness and psychological distress can be considered separate constructs. The findings were consistent with those of previous research and supported the theoretical propositions that nightmare proneness includes hyperarousal, vulnerability to stressors, and concretization, a mental process in which vague internal states are made more concrete.
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Affiliation(s)
- William E. Kelly
- California State University, Bakersfield, Department of Psychology, Bakersfield, California, United States
- Address for correspondence William E. Kelly
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23
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Taylor KA, Mysliwiec V, Kimbrel NA, Augustine AV, Ulmer CS. Probable trauma associated sleep disorder in post-9/11 US Veterans. Sleep Adv 2023; 4:zpad001. [PMID: 37193287 PMCID: PMC10108646 DOI: 10.1093/sleepadvances/zpad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/10/2022] [Indexed: 05/18/2023]
Abstract
Study Objectives The purpose of this study was to (1) estimate trauma associated sleep disorder (TASD) prevalence among post-9/11 era veterans and to describe differences in service and comorbid mental health clinical characteristics among individuals with and without probable TASD, and (2) estimate TASD prevalence and characteristics of reported traumatic experiences stratified by sex. Methods We used cross-sectional data from the post-deployment mental health study of post-9/11 veterans, which enrolled and collected baseline data from 2005 to 2018. We classified veterans as having probable TASD using self-reported measures: traumatic experiences from the traumatic life events questionnaire (TLEQ) and items from the Pittsburgh sleep quality index with Addendum for posttraumatic stress disorder (PTSD) mapped to TASD diagnostic criteria and ascertained mental health diagnoses (PTSD, major depressive disorder [MDD]) via Structured Clinical Interview for DSM-IV. We calculated effect sizes as prevalence ratios (PR) for categorical variables and Hedges' g for continuous variables. Results Our final sample included 3618 veterans (22.7% female). TASD prevalence was 12.1% (95% CI: 11.1% to 13.2%) and sex-stratified prevalence was similar for female and male veterans. Veterans with TASD had a much higher comorbid prevalence of PTSD (PR: 3.72, 95% CI: 3.41 to 4.06) and MDD (PR: 3.93, 95% CI: 3.48 to 4.43). Combat was the highest reported most distressing traumatic experience among veterans with TASD (62.6%). When stratifying by sex, female veterans with TASD had a wider variety of traumatic experiences. Conclusions Our results support the need for improved screening and evaluation for TASD in veterans, which is currently not performed in routine clinical practice.
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Affiliation(s)
- Kenneth A Taylor
- Duke University School of Medicine, Orthopaedic Surgery, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Vincent Mysliwiec
- University of Texas Health Science Center at San Antonio, Department of Psychiatry and Behavioral Sciences, San Antonio, TX, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- VA Health Services Research and Development, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
- Duke University School of Medicine, Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - Ann V Augustine
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Duke University School of Medicine, Neurology, Durham, NC, USA
| | - Christi S Ulmer
- Duke University School of Medicine, Psychiatry and Behavioral Sciences, Durham, NC, USA
- Durham Veterans Affairs (VA) Healthcare System, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA
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26
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Tubbs AS, Taneja K, Ghani SB, Nadorff MR, Drapeau CW, Karp JF, Fernandez FX, Perlis ML, Grandner MA. Sleep continuity, timing, quality, and disorder are associated with suicidal ideation and suicide attempts among college students. J Am Coll Health 2023:1-9. [PMID: 36596225 DOI: 10.1080/07448481.2022.2155828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/12/2022] [Accepted: 10/23/2022] [Indexed: 06/17/2023]
Abstract
Objective: To evaluate sleep continuity, timing, quality, and disorder in relation to suicidal ideation and attempts among college students. Participants: Eight hundred eighty-five undergraduates aged 18-25 in the southwestern United States. Methods: Participants completed questionnaires on sleep, suicide risk, mental health, and substance use. Differences in sleep variables were compared by lifetime and recent suicidal ideation and suicide attempts using covariate-adjusted and stepwise regression models. Results: A total of 363 (41.0%) individuals reported lifetime suicidal ideation, of whom 172 (47.4%) reported suicidal ideation in the last 3 months and 97 (26.7%) had attempted suicide in their lifetime. Sleep disturbances were prevalent among those with lifetime suicidal ideation or a lifetime suicide attempt. Insomnia was identified as the best predictor of recent suicidal ideation, but this relationship did not survive adjustment for covariates. Conclusions: Sleep continuity, quality, and sleep disorders are broadly associated with suicidal thoughts and behaviors among college students.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Krishna Taneja
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Sadia B Ghani
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher W Drapeau
- Department of Health Policy and Management, School of Public Health, Indiana University, Indianapolis, Indiana, USA
- Division of Mental Health and Addiction, Indiana Family and Social Services Administration, Indianapolis, Indiana, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | | | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
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Richardson C, Yuh J, Su J, Forsberg M. Case series: Continued remission of PTSD symptoms after discontinuation of prazosin. Front Psychiatry 2023; 14:1172754. [PMID: 37151970 PMCID: PMC10162405 DOI: 10.3389/fpsyt.2023.1172754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Post-traumatic stress disorder is a debilitating chronic illness that affects 6 out of 100 adults after a severe trauma. The alpha-adrenergic antagonist prazosin, which is prescribed off-label for flashbacks and nightmares due to trauma, is often continued indefinitely due to reports of symptoms returning upon discontinuation. There is no standard guidance for a trial of discontinuation of prazosin due to intolerance or side effects. In this case series, three patients are started on prazosin leading to remission of trauma-related symptoms, and symptoms continue to remit after treatment for an average of about 2 years followed by discontinuation of the medication. There are many similarities in these case reports which serve to provide guidance as to when a trial of prazosin discontinuation may be warranted.
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Valiensi SM, Izbizky GH. [Analysis of causes or reasons that fragment sleep and sleep disorder in pregnant and non-pregnant women]. Rev Fac Cien Med Univ Nac Cordoba 2022; 79:318-26. [PMID: 36542590 DOI: 10.31053/1853.0605.v79.n4.31046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/21/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction During pregnancy, sleep undergoes important changes. The objective was to assess the causes or reasons that fragment sleep and sleep disorders in different women and trimesters of pregnancy, comparing them with those of non-pregnant women (NPW). Methods Cross-sectional study. Anonymous surveys were used to evaluate reasons that fragment sleep and specific questionnaires to evaluate sleep disorders. Results: Pregnant Women (PW)= 320. 1st Trimester of pregnancy (T): n = 106, 2nd. T: n = 104, 3rd T: n = 110. MNE: n = 304. Most frequent reasons that fragmented sleep, statistically significant in PW and were: need to urinate, uncomfortable position, not being able to rotate in bed. As sleep disorders we find: nightmares 44 vs 4.9%; snoring with pauses: 31 vs 3%. Conclusion We found that in the PW studied, most of the causes or reasons analyzed fragmented sleep; they had more sleep disorders such as nightmares, respiratory disorders and periodic leg movements, in that order, compared to the NPW who in turn, presented insomnia, excessive sleepiness and bruxism.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Schwartz S, Clerget A, Perogamvros L. Enhancing imagery rehearsal therapy for nightmares with targeted memory reactivation. Curr Biol 2022; 32:4808-4816.e4. [PMID: 36306786 DOI: 10.1016/j.cub.2022.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022]
Abstract
Nightmare disorder (ND) is characterized by dreams with strong negative emotions occurring during rapid eye movement (REM) sleep. ND is mainly treated by imagery rehearsal therapy (IRT), where the patients are asked to change the negative story line of their nightmare to a more positive one. We here used targeted memory reactivation (TMR) during REM sleep to strengthen IRT-related memories and accelerate remission of ND. Thirty-six patients with ND were asked to perform an initial IRT session and, while they generated a positive outcome of their nightmare, half of the patients were exposed to a sound (TMR group), while no such pairing took place for the other half (control group). During the next 2 weeks, all patients performed IRT every evening at home and were exposed to the sound during REM sleep with a wireless headband, which automatically detected sleep stages. The frequency of nightmares per week at 2 weeks was used as the primary outcome measure. We found that the TMR group had less frequent nightmares and more positive dream emotions than the control group after 2 weeks of IRT and a sustained decrease of nightmares after 3 months. By demonstrating the effectiveness of TMR during sleep to potentiate therapy, these results have clinical implications for the management of ND, with relevance to other psychiatric disorders too. Additionally, these findings show that TMR applied during REM sleep can modulate emotions in dreams.
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Affiliation(s)
- Sophie Schwartz
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland
| | - Alice Clerget
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
| | - Lampros Perogamvros
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland; Center for Sleep Medicine, Geneva University Hospitals, 1225 Geneva, Switzerland; Department of Psychiatry, Geneva University Hospitals, 1225 Geneva, Switzerland.
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31
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Verbraecken J. More than sleepiness: prevalence and relevance of nonclassical symptoms of obstructive sleep apnea. Curr Opin Pulm Med 2022; 28:552-558. [PMID: 36101923 PMCID: PMC9553267 DOI: 10.1097/mcp.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the nonclassical symptoms and manifestations occurring in patients with obstructive sleep apnea (OSA), both from a standpoint of prevalence and in terms of clinical relevance. Particular emphasis will be given to nightmares, comorbid insomnia, restless legs syndrome and periodic limb movement disorder, bruxism, morning headache, nocturia, acid reflux, chronic cough and dysphagia. RECENT FINDINGS A review of the recent literature suggests that nonclassical symptoms have a high prevalence, are underestimated, and can interact with quality of life. Although these disturbances may occur together by mere coincidence, they may interact reciprocally. However, the degree of symptoms is not always correlated with OSA severity. SUMMARY OSA is a heterogeneous disease with variable clinical manifestations. This review highlights the need for detailed evaluation of patients with OSA to diagnose other important sleep disorders and clinical manifestations, given their frequent association.
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Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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32
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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 Adv 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mallett R, Sowin L, Raider R, Konkoly KR, Paller KA. Benefits and concerns of seeking and experiencing lucid dreams: benefits are tied to successful induction and dream control. Sleep Adv 2022; 3:zpac027. [PMID: 37193400 PMCID: PMC10104404 DOI: 10.1093/sleepadvances/zpac027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/20/2022] [Indexed: 05/18/2023]
Abstract
Therapies focused on lucid dreaming could be useful for treating various sleep disorders and other conditions. Still, one major roadblock is the paucity of systematic information on the consequences of attempting these sorts of dreams. The current study sought to quantify positive and negative aspects of seeking lucid dreams, describe their phenomenology in detail, and identify features associated with positive or negative experiences. Observational data from a massive lucid-dream discussion forum were analyzed to capture lucid-dreaming themes. Forum posts were independently rated on multiple dimensions hypothesized to contribute to the valence of lucidity-related phenomena. Our results revealed that lucid dreams can end nightmares and prevent their recurrence, but they can also induce harrowing dysphoric dreams. The realization of dreaming (lucidity) and dreams with high-control were both associated with positive experiences. We translated our results into a process model that describes the progression from lucid dream induction to waking benefit, identifying potential areas of concern. Our results and model suggest that negative outcomes primarily result from failed induction attempts or lucid dreams with low dream control, and that successfully inducing high-control lucid dreams poses low risk for negative outcomes. Lucid dreaming has valuable therapeutic and recreational potential, but a better understanding of the risks is required. Our findings provide new insights into possible negative repercussions and how to avoid them in future applications.
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Affiliation(s)
- Remington Mallett
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Laura Sowin
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Rachel Raider
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Karen R Konkoly
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ken A Paller
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Zhou SJ, Wang LL, Wang TT, Wang JQ, Chen JX. Associations between experienced aggression, poor sleep, and suicide risk among Chinese adolescents. Sleep 2022; 45:6542305. [PMID: 35244179 DOI: 10.1093/sleep/zsac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/10/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES The physical and mental health of adolescents is an important study area. This study aims to examine the occurrence of aggression, sleep disturbances, and suicide risk among Chinese adolescents, along with the relationships between these factors. METHODS This is a cross-sectional study conducted through an online survey. Of the original 7011 Chinese adolescent respondents, the analysis included data from 6122 adolescents, aged between 12 and 18 years, from 23 regions, whose average age was 16.12 (±1.44) years, with 48.8% being male. While the chi-square test and t-test were used for analyzing demographic data and continuous variables, respectively, mediation analysis was used to explore the mechanism of experiencing aggression on suicide risk. The respondents' sleep quality, nightmare distress, daytime sleepiness, fatigue, and suicide risk were assessed using the Pittsburgh Sleep Quality Index (PSQI), Nightmare Distress Questionnaire-Chinese version (NDQ-CV), Chinese Adolescent Daytime Sleepiness Scale (CADSS), Multidimensional Fatigue Inventory (MFI-20), and the suicide risk module of the Mini-International Neuropsychiatric Interview (MINI), respectively. Four items were used to assess adolescents' experiences with aggression. RESULTS Of the respondents, 42% reported experiencing aggression by others, especially parental physical maltreatment. Furthermore, 26.9% of adolescents in school, and in particular, 31.8% in senior high school experienced insomnia symptoms. Adolescents who reported experiences of aggression had more severe insomnia symptoms, nightmare distress, fatigue, and a higher risk of suicide when compared with those who did not (all ps < 0.001). Insomnia symptoms, nightmare distress, and fatigue all mediated the relationship between aggression and suicide risk, and there was a chain of mediating effects between these factors [for total indirect effect β = 1.1512, 95% CI (0.9671 to 1.3426), direct effect β = 0.4934, 95% CI (0.1978 to 0.7891), and total effect β = 1.6446, 95% CI (1.3479 to 1.9414)]. CONCLUSIONS Our findings indicate that among adolescents, experiencing aggression is associated with an increased suicide risk. In addition to the direct effect of aggression on suicide risk, insomnia, nightmare distress, and fatigue mediate the relationship between aggression and suicide risk. More attention should be paid to adolescents experiencing aggression, and interventions should be implemented and strengthened.
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Affiliation(s)
- Shuang-Jiang Zhou
- Sleep Medicine Center, Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Lei-Lei Wang
- Sleep Medicine Center, Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Ting-Ting Wang
- School of Mental Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Jing-Qi Wang
- Binhai Eco-City School-Tianjin Nankai High School, Tianjin, China
| | - Jing-Xu Chen
- Sleep Medicine Center, Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
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Mellman TA, Birku K, Sandhu I, Lavela P, Kobayashi I. Evaluation of suvorexant for trauma-related insomnia. Sleep 2022; 45:zsac068. [PMID: 35554590 DOI: 10.1093/sleep/zsac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/06/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Effective pharmacological treatments for sleep disturbance related to trauma with and without co-occurring posttraumatic stress disorder (PTSD) are needed. There is debate regarding what effects on rapid eye movement sleep (REMS) would be beneficial. Suvorexant is the first dual orexin receptor antagonist (DORA) approved for the treatment of insomnia. In contrast to most psychotropic agents, DORAs can enhance REMS while reducing arousal. We evaluated 6 weeks of suvorexant treatment for trauma-related insomnia in a double-blind, placebo-controlled clinical trial with clinical and polysomnographic evaluation. METHODS Participants with insomnia that followed a traumatic event were recruited from the community. Representation of current, past-only, and never having met criteria for PTSD was similar and most participants had experienced trauma-related nightmares. Participants were randomly assigned to receive suvorexant or placebo, initially at 10 mg and increased to 20 mg after 1 week, if tolerated. Polysomnography was obtained for screening, at baseline, and at 2 weeks of treatment. RESULTS The thirty-seven evaluable participants had significant improvement of PTSD and insomnia symptoms, however, there were no significant interactions with treatment condition. Medication was well tolerated with only one dropout being related to side effects. Within the suvorexant group increased REM segment duration correlated with concurrent PTSD symptom reduction. Nightmares remitted in all of the participants who received suvorexant and all but one of those receiving placebo. CONCLUSIONS A robust placebo response undermined detecting a medication effect. Further evaluation of DORAs for trauma-related insomnia, as well as factors contributing to placebo-response, are warranted.
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Affiliation(s)
- Thomas A Mellman
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Kiya Birku
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Ishaan Sandhu
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Pewu Lavela
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Ihori Kobayashi
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
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Scarpelli S, Alfonsi V, Gorgoni M, De Gennaro L. What about dreams? State of the art and open questions. J Sleep Res 2022; 31:e13609. [PMID: 35417930 PMCID: PMC9539486 DOI: 10.1111/jsr.13609] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023]
Abstract
Several studies have tried to identify the neurobiological bases of dream experiences, nevertheless some questions are still at the centre of the debate. Here, we summarise the main open issues concerning the neuroscientific study of dreaming. After overcoming the rapid eye movement (REM) ‐ non‐REM (NREM) sleep dichotomy, investigations have focussed on the specific functional or structural brain features predicting dream experience. On the one hand, some results underlined that specific trait‐like factors are associated with higher dream recall frequency. On the other hand, the electrophysiological milieu preceding dream report upon awakening is a crucial state‐like factor influencing the subsequent recall. Furthermore, dreaming is strictly related to waking experiences. Based on the continuity hypothesis, some findings reveal that dreaming could be modulated through visual, olfactory, or somatosensory stimulations. Also, it should be considered that the indirect access to dreaming remains an intrinsic limitation. Recent findings have revealed a greater concordance between parasomnia‐like events and dream contents. This means that parasomnia episodes might be an expression of the ongoing mental sleep activity and could represent a viable direct access to dream experience. Finally, we provide a picture on nightmares and emphasise the possible role of oneiric activity in psychotherapy. Overall, further efforts in dream science are needed (a) to develop a uniform protocol to study dream experience, (b) to introduce and integrate advanced techniques to better understand whether dreaming can be manipulated, (c) to clarify the relationship between parasomnia events and dreaming, and (d) to determine the clinical valence of dreams.
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Affiliation(s)
- Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
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Mallet C, Chick CF, Maatoug R, Fossati P, Brunet A, Millet B. Memory reconsolidation impairment using the β-adrenergic receptor blocker propranolol reduces nightmare severity in patients with post-traumatic stress disorder: a preliminary study. J Clin Sleep Med 2022; 18:1847-1855. [PMID: 35404227 DOI: 10.5664/jcsm.10010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Post-traumatic nightmares may exacerbate and perpetuate the daytime symptoms of post-traumatic stress disorder (PTSD) and might represent a therapeutic target. The therapeutic strategy of memory reconsolidation using the β-adrenergic receptor blocker propranolol associated with re-exposure psychotherapy is a promising treatment in PTSD patients. Previous studies have established this therapy is effective in reducing overall clinician-assessed PTSD symptoms but to date no previous study has specifically focused on posttraumatic nightmares in this therapy. This study provides a preliminary assessment of the evolution of nightmares severity during this therapy protocol, compared with the decrease of the other PTSD symptoms. It evaluates the incidence of side effects and examines the relative effects on posttraumatic nightmares. METHODS Patients were recruited as part of the Paris Mémoire Vive study. Data were collected using a prospective longitudinal design including one baseline visit, six therapeutic visits, and two follow-up visits. During the six therapeutic visits, propranolol was administered orally 60 to 75 minutes prior to the psychotherapeutic session. RESULTS On average, nightmare severity decreased from "severe" to "mild" during the protocol and remained stable two months after the last session. Whereas 85% of patients reported nightmares at baseline, only 50% still had them after the protocol. The protocol was generally well tolerated and, did not increase nightmare severity for any patient in the study. CONCLUSIONS Memory reconsolidation therapy with propranolol seems promising in reducing nightmare severity, up to and including remission. However, research using a randomized controlled design, and assessing maintenance of nightmare extinction, is warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Using Reconsolidation Blockade to Treat Trauma Related Disorders After Paris Attacks: An Effectiveness Study (PARIS-MEM); Identifier: NCT02789982; URL: https://www.clinicaltrials.gov/ct2/show/NCT02789982.
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Affiliation(s)
- Claire Mallet
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Paris, France
| | - Christina F Chick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Redwan Maatoug
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France
| | - Philippe Fossati
- Institut du Cerveau, (ICM), UM75, CNRS UMR 7225, Inserm U1127 & Service de Psychiatrie Adultes, APHP Sorbonne Université, Sorbonne Université, Paris, France
| | - Alain Brunet
- Douglas Institute Research Center, and the Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Bruno Millet
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France
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Ranney RM, Gloria R, Metzler TJ, Huggins J, Neylan TC, Maguen S. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans. J Clin Sleep Med 2022; 18:1831-1839. [PMID: 35393934 DOI: 10.5664/jcsm.10002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Trauma-related nightmares are highly prevalent among veterans and are associated with higher severity insomnia and PTSD. Cognitive behavioral therapy for insomnia (CBT-I, typically 6-8 sessions) has been shown to reduce trauma-related nightmares. Brief behavioral treatment for insomnia (BBTI, 4 sessions) has been found to be comparable to CBT-I in decreasing insomnia severity; however, the effects of BBTI on nightmares have not been investigated. The current study tested the effects of BBTI on both trauma-related nightmares and non-trauma-related bad dreams using an active control group, progressive muscle relaxation therapy (PMRT). Additionally, we tested whether baseline trauma-related nightmare frequency and baseline non-trauma-related bad dream frequency moderated changes in insomnia severity. METHODS Participants were 91 military veterans with insomnia disorder randomized to BBTI or PMRT. Participants reported insomnia severity on the Insomnia Severity Index and reported trauma-related nightmare frequency and non-trauma-related bad dream frequency on the Pittsburgh Sleep Quality Index--PTSD Addendum. RESULTS We found that BBTI significantly reduced trauma-related nightmares from baseline to post-treatment while PMRT did not. However, reductions in trauma-related nightmares were not maintained at six month follow up. Neither BBTI nor PMRT reduced non-trauma-related bad dreams from baseline to post-treatment. We also found that neither baseline trauma-related nightmare frequency nor baseline non-trauma-related bad dream frequency moderated changes in insomnia symptom severity. CONCLUSIONS Findings from the current study suggest that BBTI may help to reduce trauma-related nightmares. Further research is needed to better understand potential mechanisms underlying how improved sleep may reduce trauma-related nightmares. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Brief Behavioral Insomnia Treatment Study (BBTI); Identifier: NCT02571452; URL: https://clinicaltrials.gov/ct2/show/NCT02571452.
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Affiliation(s)
- Rachel M Ranney
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Rebecca Gloria
- Veterans Affairs San Francisco Health Care System, San Francisco, CA
| | - Thomas J Metzler
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Joy Huggins
- Veterans Affairs San Francisco Health Care System, San Francisco, CA
| | - Thomas C Neylan
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Shira Maguen
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
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39
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Possemato K, Silander N, Bellete N, Emery JB, De Stefano L, Pigeon W. Characteristics of Posttraumatic Nightmares and Their Relationship to PTSD Severity Among Combat Veterans With PTSD and Hazardous Alcohol Use. J Nerv Ment Dis 2022; 210:223-226. [PMID: 35199661 PMCID: PMC8887778 DOI: 10.1097/nmd.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Although nightmares are known to predict the clinical course of posttraumatic stress disorder (PTSD), research on the relationship between specific nightmare characteristics and PTSD severity is sparse. This study conducted a secondary analysis to explore how five nightmare characteristics are cross-sectionally related to PTSD severity in 76 combat veterans with PTSD and at-risk alcohol use. Consistent with emotional processing theory, we hypothesized that more replicative, threatening, realistic, and easily recalled nightmares would be associated with more severe PTSD, whereas those with greater symbolism would predict lower PTSD severity. Nightmares narratives were audio-recorded and rated by multiple coders. Multiple analyses of variance explored the relationship between nightmare characteristics and PTSD clinical indicators. Most nightmares were realistic, easily recalled, and involved significant threat. Greater realism and replication were associated with greater PTSD severity. Realistic and replicative nightmares may be markers of more severe PTSD and may indicate that less emotional processing of the trauma has occurred.
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Affiliation(s)
- Kyle Possemato
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - Nina Silander
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - Nardos Bellete
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - J. Bronte Emery
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - Leigha De Stefano
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - Wilfred Pigeon
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
- Center of Excellence for Suicide Prevention, Canandaigua Veterans Affairs Medical Center, Canandaigua, NY
- Sleep & Neurophysiology Research Laboratory, University of Rochester Medical Center, Rochester, NY
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40
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Miles SR, Pruiksma KE, Slavish D, Dietch JR, Wardle-Pinkston S, Litz BT, Rodgers M, Nicholson KL, Young-McCaughan S, Dondanville KA, Nakase-Richardson R, Mintz J, Keane TM, Peterson AL, Resick PA, Taylor DJ. Sleep disorder symptoms are associated with greater posttraumatic stress and anger symptoms in U.S. army service members seeking treatment for PTSD. J Clin Sleep Med 2022; 18:1617-1627. [PMID: 35197191 DOI: 10.5664/jcsm.9926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Characterize associations between sleep impairments and posttraumatic stress disorder (PTSD) symptoms, including anger, in service members seeking treatment for PTSD. METHODS Ninety-three US Army personnel recruited into a PTSD treatment study completed the baseline assessment. State of the science sleep measurements included (1) retrospective, self-reported insomnia, (2) prospective sleep diaries assessing sleep patterns and nightmares, and (3) polysomnography (PSG) measured sleep architecture and obstructive sleep apnea-hypopnea (OSAH) severity. Dependent variables included self-report measures of PTSD severity and anger severity. Pearson correlations and multiple linear regression analyses examined if sleep symptoms, not generally measured in PTSD populations, were associated with PTSD and anger severity. RESULTS All participants met PTSD, insomnia, and nightmare diagnostic criteria. Mean sleep efficiency = 70%, total sleep time = 5.5 hours, obstructive sleep apnea/hypopnea (OSAH index ≥ 5) = 53%, and clinically significant anger = 85%. PTSD severity was associated with insomnia severity (β =.58), nightmare severity (β = .24), nightmare frequency (β = .31), and time spent in Stage 1 sleep (β = .27, all p < .05). Anger severity was associated with insomnia severity (β =37), nightmare severity (β = .28), and OSAH during rapid eye movement (β = .31, all p < .05). CONCLUSIONS Insomnia and nightmares were related to PTSD and anger severity, and OSAH was related to anger. Better assessment and evidence-based treatment of these comorbid sleep impairments in service members with PTSD and significant anger, should result in better PTSD, anger, and quality of life outcomes. CLINICAL TRIALS REGISTRATION Registry: ClinicalTrials.gov; Name: Treatment of Comorbid Sleep Disorders and Post Traumatic Stress Disorder; Identifier: NCT02773693; URL: https://clinicaltrials.gov/ct2/show/NCT02773693.
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Affiliation(s)
- Shannon R Miles
- James A. Haley Veterans' Hospital, Tampa, FL.,Division of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Danica Slavish
- Department of Psychology, University of North Texas, Denton, TX
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR
| | | | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA.,Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | | | | | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Risa Nakase-Richardson
- James A. Haley Veterans' Hospital, Tampa, FL.,Division of Pulmonary and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, MA.,Behavioral Science Division, National Center for PTSD at VA Boston Healthcare System, Boston, MA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX
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41
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Alghamdi AA, Alafif NO, BaHammam AS, Almuammar M, Alharbi NS, Alhefdhi NA, Al-Musharaf S, Al Ghamdi KS, AlYousif GF, Al Muhanna NF. Nightmares' Pattern and Predictors among a Saudi University Students during COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:ijerph19031776. [PMID: 35162799 PMCID: PMC8835620 DOI: 10.3390/ijerph19031776] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 12/16/2022]
Abstract
Purpose: During the coronavirus disease 2019 (COVID-19) pandemic quarantine, university students were under various types of stressors, including the exams period, which might have affected their quality and quantity of sleep, and consequently, their quality of life. This study aimed to investigate the pattern and predictors of nightmares among university students and coinvestigate the presence of other types of sleep disturbances, mental disorders, and quarantine-related stressors. Methods: This cross-sectional study included 368 university students who answered a self-completed questionnaire covering their sociodemographic features, nightmare indicators, and associated quarantine stressors. Additionally, sleep disturbances were measured using the Generalized Sleep Disturbance Scale (GSDS), anxiety using the Generalized Anxiety Disorder 2 scale, and depression using the Patient Health Questionnaire-2. Results: The participants’ mean age was 20.4 ± 1.6 years, and male participants represented 35.9% of the sample. Nightmares were experienced by 117 (31.8%) of the participants, of whom 44.4% had new-onset nightmares. The mean GSDS was 45.0 ± 14.9 (min. = 12, max. = 130). This value is associated with elevated odds of the following outcomes: the presence of nightmares (odds ratio [OR] = 1.8; confidence interval [CI] 95% = 1.1–3.0); new-onset nightmares at the time of pandemic (OR = 2.6; CI 95% = 1.3–5.5); and anxiety (OR = 1.74; CI 95% = 1.0–2.9). The presence of nightmares elevated the score of GSDS by 11.3 points (S.E. = 1.6, p < 0.001), elevated the odds of anxiety by 4.1 (CI 95% = 2.5–6.8), and depression by 2.1 (CI 95% = 1.3–3.4). Conclusions: Stressors resulting from both the exams period and the fact that it was conducted during COVID-19 quarantine increased the rate and affected the pattern of nightmares. These stressors also led to other sleep disturbances and mental disorders that were significantly more prevalent among females.
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Affiliation(s)
- Amal A. Alghamdi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia; (A.A.A.); (G.F.A.)
| | - Nora O. Alafif
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 10219, Saudi Arabia; (M.A.); (N.S.A.); (N.A.A.); (S.A.-M.)
- Correspondence:
| | - Ahmed S. BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia;
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh 11362, Saudi Arabia
| | - May Almuammar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 10219, Saudi Arabia; (M.A.); (N.S.A.); (N.A.A.); (S.A.-M.)
| | - Najd S. Alharbi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 10219, Saudi Arabia; (M.A.); (N.S.A.); (N.A.A.); (S.A.-M.)
| | - Nouf A. Alhefdhi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 10219, Saudi Arabia; (M.A.); (N.S.A.); (N.A.A.); (S.A.-M.)
| | - Sara Al-Musharaf
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 10219, Saudi Arabia; (M.A.); (N.S.A.); (N.A.A.); (S.A.-M.)
| | - Kholoud S. Al Ghamdi
- Department of Physiology, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Ghada F. AlYousif
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia; (A.A.A.); (G.F.A.)
| | - Norah F. Al Muhanna
- Psychiatry Department, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
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42
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Barbeau K, Lafrenière A, Ben Massaoud H, Campbell E, De Koninck J. Dissociated Effects of Age and Recent Troubling Experiences on Nightmares, Threats and Negative Emotions in Dreams. Front Psychiatry 2022; 13:770380. [PMID: 35308880 PMCID: PMC8927059 DOI: 10.3389/fpsyt.2022.770380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022] Open
Abstract
Several studies have highlighted associations between adverse life events and the dysphoric character of dream experiences. This degree of continuity between waking-life and dream content seems partly attributed to the emotional and personal attachment linked to the incorporated waking experiences. Numerous changes in the processing of emotion-related stimuli are also reported across different human developmental stages. Therefore, we were interested in testing whether age would modulate the impact of recent troubling experiences on dream characteristics. Two hundred sixty participants, evenly distributed in five developmental stages, matched for gender and their exposure to a troubling experience, were selected from a large sample collected for a previous normative study of dreams of Canadians. Participants completed a dream questionnaire from which independent judges subsequently scored the dreams. We observed no interactions between the experience of troubling events and age. However, individuals who experienced a recent troubling event reported a higher frequency of nightmares and their dreams were more emotionally negative. Participants who experienced a moderately severe troubling event were also more likely to experience a dream whose maximal threat severity was of moderate intensity. Adolescents and young adults had dreams with a higher level of oneiric threats compared to older adults (>40 years old). Young adults also reported a higher frequency of nightmares compared to older adults. Our findings have implications for modern dream theories. They also suggest that dysphoric dreams might serve as potential proxies of mental health status and developmental stages. Future studies are now needed to explore the implications of these findings for psychological adaptation.
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Affiliation(s)
- Kheana Barbeau
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Emma Campbell
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
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43
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Holzinger B, Nierwetberg F, Chung F, Bolstad CJ, Bjorvatn B, Chan NY, Dauvilliers Y, Espie CA, Han F, Inoue Y, Leger D, Macêdo T, Matsui K, Merikanto I, Morin CM, Mota-Rolim SA, Partinen M, Plazzi G, Penzel T, Sieminski M, Wing YK, Scarpelli S, Nadorff MR, De Gennaro L. Has the COVID-19 Pandemic Traumatized Us Collectively? The Impact of the COVID-19 Pandemic on Mental Health and Sleep Factors via Traumatization: A Multinational Survey. Nat Sci Sleep 2022; 14:1469-1483. [PMID: 36052103 PMCID: PMC9426865 DOI: 10.2147/nss.s368147] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The COVID-19 pandemic affects mental health and sleep, resulting in frequent nightmares. Therefore, identifying factors associated with nightmare frequency is important, as it can indicate mental health issues. The study aimed to investigate increases in nightmare frequency comparing the pre-pandemic and pandemic period, and identify its risk factors. Further, the mediating role of post-traumatic stress disorder symptoms between the pandemic and nightmares is explored. PATIENTS AND METHODS For this cross-sectional survey data were obtained via self-rating online survey (ICOSS: details in Partinen et al, 2021), which was open to anyone older than 18 years. The final volunteer sample consisted of 15,292 participants, divided according to their nightmare frequency (high: ≥1-2 nights/week; low: <1-2 nights/week). A total of 9100 participants were excluded if answers on variables of interest were missing or receiving rewards for participation. Chi-square tests identified changes of nightmare frequency. Predictors of high nightmare frequency were assessed using logistic regression and presented as Odds Ratios. Post-hoc mediation models were used to investigate the role of post-traumatic stress symptoms (PTSS). RESULTS The mean age was 41.63 (SD=16.55) with 64.05% females. High nightmare frequency increased significantly from 13.24% to 22.35% during the pandemic. Factors associated with it included self-reported PTSS (OR=2.11), other mental disorders and various sleep disorders or problems. Financial burden due to the pandemic, confinement, having had COVID-19, and work situation during the pandemic were associated with nightmare frequency, those relations were partly mediated through PTSS. CONCLUSION Our results display the pandemic influence on nightmare frequency, which in turn connects to multiple mental health and sleep factors. These relations were partly mediated through PTSS. The COVID-19 pandemic appears to have caused traumatization of a substantial proportion of society. Health care workers should consider nightmares in their screening routines, as it might indicate PTSS and/or other mental and sleep disorders.
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Affiliation(s)
- Brigitte Holzinger
- Institute for Consciousness and Dream Research, Vienna, Austria.,Medical University Vienna, Postgraduate Master ULG Sleep Coaching, Vienna, Austria
| | | | - Frances Chung
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INM, Univ Montpellier, INSERM, Montpellier, France
| | - Colin A Espie
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute (SCNi), University of Oxford, Oxford, UK
| | - Fang Han
- Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | | | - Damien Leger
- Université de Paris, APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Tainá Macêdo
- Department of Psychology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Kentaro Matsui
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Ilona Merikanto
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Charles M Morin
- École de Psychologie, Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval, Québec, QC, Canada
| | - Sérgio A Mota-Rolim
- Brain Institute, Physiology and Behavior Department, and Onofre Lopes University Hospital - Federal University of Rio Grande do Norte, Natal, Brazil
| | - Markku Partinen
- Helsinki Sleep Clinic, Terveystalo Healthcare, and Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Thomas Penzel
- Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mariusz Sieminski
- Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China
| | - Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Michael R Nadorff
- Mississippi State University, Mississippi State, MS, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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45
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Faccini J, Joshi V, Graziani P, Del-Monte J. Non-Constructive Ruminations, Insomnia and Nightmares: Trio of Vulnerabilities to Suicide Risk. Nat Sci Sleep 2022; 14:433-441. [PMID: 35321356 PMCID: PMC8935486 DOI: 10.2147/nss.s339567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/19/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Nightmare distress, nightmare frequency and anxiety are related to suicidal risk. Ruminations are a factor maximizing the risk of suicide. Research has identified two types of ruminations: constructive ruminations and non-constructive ruminations. As per our knowledge, no study has verified the links between non-constructive ruminations and sleep disorders and their role in the development of suicidal risk. We aimed to highlight the impact of non-constructive ruminations on nightmares, anxiety and insomnia in the development of suicidal risk. METHODS A total of 429 French participants responded to an anonymous online survey using the Qualtrics® software. To assess variables, we used the Mini Cambridge-Exeter Repetitive Thought Scale, the Suicide Behaviors Questionnaire-Revised, the Nightmare Distress Questionnaire, the Beck Anxiety Inventory, and the Sleep Condition Indicator. Nightmare frequency was assessed by subjective evaluation through a question. We tested the possible effects of confounding variables such as age, gender, marital status and depression (Beck Depression Inventory-II). RESULTS Nightmare frequency was found to mediate the link between anxiety and suicidal risk (32.9%). Nightmare distress (37%) and non-constructive thoughts (48%) were also seen to mediate this link. Additionally, we found a moderating effect of insomnia on the link between non-constructive ruminations and suicidal risk (Z = 7.42, p < 0.001). CONCLUSION Our results showed that the frequency of nightmares, distress and non-constructive ruminations are closely related to suicidal risk. The interoperability between these elements and insomnia has thus been newly explored. The processes related to nightmares and suicidal risk as well as the underlying cognitive processes between sleep disorders and suicidal risk have been shed light upon.
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Affiliation(s)
- Julie Faccini
- University of Nîmes, LSP Laboratory, Aix-Marseille University, Marseille, France
| | - Vrutti Joshi
- University of Nîmes, LSP Laboratory, Aix-Marseille University, Marseille, France
| | - Pierluigi Graziani
- University of Nîmes, LSP Laboratory, Aix-Marseille University, Marseille, France
| | - Jonathan Del-Monte
- University of Nîmes, LSP Laboratory, Aix-Marseille University, Marseille, France
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46
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Khazaie H, Khazaie S, Zakiei A, Dürsteler KM, Brühl AB, Brand S, Sadeghi-Bahmani D. When Non-Suicidal Self-Injury Predicts Non-Suicidal Self-Injury and Poor Sleep-Results from a Larger Cross-Sectional and Quasi-Longitudinal Study. Int J Environ Res Public Health 2021; 18:ijerph182413011. [PMID: 34948620 PMCID: PMC8701371 DOI: 10.3390/ijerph182413011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023]
Abstract
Poor sleep is associated with a higher risk of non-suicidal self-injury (NSSI) as a proxy of unfavorable emotion regulation. In the present study, we tested the hypothesis that past non-suicidal self-injury was associated with current non-suicidal self-injury and with current subjective sleep patterns. To this end, a larger sample of young adults were assessed. A total of 2374 adults (mean age: 27.58 years; 39.6% females) completed a series of self-rating questionnaires covering sociodemographic information, past and current NSSIs, suicide attempts, and current sleep patterns, including experiencing nightmares. Past NSSIs predicted current NSSIs. Current sleep patterns had a modest impact on the association between past and current NSSIs. Compared to male participants, female participants did not report more sleep complaints or more current NSSIs, but more past NSSIs. Past NSSIs predicted the occurrences of nightmares and suicide attempts. The best predictor of current NSSI was the remembered past NSSI, while current poor sleep was only modestly associated with current NSSI. Further indicators of current NSSI and poor sleep were suicide attempts and nightmares within the last six months. Overall, it appears that poor emotion regulation should be considered as underlying factor to trigger and maintain non-suicidal self-injury-related behavior and poor sleep. Further, unlike previous studies, which focused on the possible influence of sleep patterns on NSSIs, the aim of the present study paradigm was to investigate NSSIs on sleep patterns.
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Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (H.K.); (A.Z.); (D.S.-B.)
| | - Sepideh Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (H.K.); (A.Z.); (D.S.-B.)
- Correspondence: (S.K.); (S.B.)
| | - Ali Zakiei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (H.K.); (A.Z.); (D.S.-B.)
| | - Kenneth M. Dürsteler
- Psychiatric Clinics, Division of Substance Use Disorders Basel, University of Basel, 4002 Basel, Switzerland;
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001 Zurich, Switzerland
| | - Annette Beatrix Brühl
- Center of Affective, Stress and Sleep Disorders, Psychiatric Hospital, University of Basel, 4002 Basel, Switzerland;
| | - Serge Brand
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (H.K.); (A.Z.); (D.S.-B.)
- Center of Affective, Stress and Sleep Disorders, Psychiatric Hospital, University of Basel, 4002 Basel, Switzerland;
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran
- Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, University of Basel, 4052 Basel, Switzerland
- School of Medicine, Tehran University of Medical Sciences, Tehran 1417466191, Iran
- Correspondence: (S.K.); (S.B.)
| | - Dena Sadeghi-Bahmani
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (H.K.); (A.Z.); (D.S.-B.)
- Center of Affective, Stress and Sleep Disorders, Psychiatric Hospital, University of Basel, 4002 Basel, Switzerland;
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
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47
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Garcia O, Slavish DC, Dietch JR, Messman BA, Contractor AA, Haynes PL, Pruiksma KE, Kelly K, Ruggero C, Taylor DJ. What goes around comes around: Nightmares and daily stress are bidirectionally associated in nurses. Stress Health 2021; 37:1035-1042. [PMID: 33749112 PMCID: PMC11002978 DOI: 10.1002/smi.3048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/17/2021] [Accepted: 03/14/2021] [Indexed: 01/14/2023]
Abstract
Nurses may experience frequent nightmares due to stressful work environments. Nightmares may also exacerbate stress among nurses, although this has yet to be tested empirically. We examined daily bidirectional associations between stress severity and nightmares, and moderation by post-traumatic stress disorder (PTSD) symptoms. 392 nurses (92% female; 78% White) completed 14 days of sleep diaries to assess previous-day stress severity and nightmare occurrence and severity. PTSD symptoms were assessed at baseline. Multilevel models were used to examine bidirectional, within-person associations between daily stress and nightmares, and cross-level moderation by baseline PTSD symptoms. 47.2% of nurses reported at least one nightmare across the two weeks. Days with greater stress were associated with higher odds of experiencing a nightmare (OR = 1.22, p = 0.001), as well as greater nightmare severity (b = 0.09, p = 0.033). Nightmare occurrence was associated with greater next-day stress severity (b = 0.15, p < 0.001). Daily stress and nightmare associations were similar for those with and without PTSD symptoms. Nightmares and stress may occur in a bidirectional fashion. Nurses face intense occupational demands and frequent exposure to potentially traumatic events. Studies should explore whether targeting nightmares and stress may improve nurses' health and well-being.
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Affiliation(s)
- Odalis Garcia
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Jessica R Dietch
- Department of Psychology, Oregon State University, Corvallis, Oregon, USA
| | - Brett A Messman
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | | | - Patricia L Haynes
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
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48
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Abstract
The COVID-19 pandemic has affected the sleep and dreams of many individuals. Some have experienced improvements, while others have had more complaints. The changes to daily life such as working from home and spending more time indoors in confinement may have disturbed the circadian rhythms of some individuals. There were many reports of a shift towards a later bedtime during the pandemic, with several studies showing that in general, females experienced worse sleep than males, including more nighttime awakenings and nightmares. Increased dream and nightmare frequency during the pandemic has been shown in multiple studies. It has been postulated that because dreams are often guided by the dominant emotional state, that dreams and nightmares related to pandemic themes are a result of specific stressors related to COVID-19. Those experiencing unwanted sleep disturbances and nightmares could stand to benefit from mindfulness and relaxation practices that can ease stress and anxiety before bedtime. Striving to maintain a regular sleep schedule and enhance exposure to daylight-particularly during the first half of the day-may also be helpful.
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49
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Holzinger B, Nierwetberg F, Klösch G. Case Report: Why Sleep and Dream Related Psychological Treatments, Such as Sleepcoaching (According to Holzinger&Klösch) and CBT-I Should Be Implemented in Treatment Concepts in the Public Health System-Description of the Nightmare Treatment Process in the Context of PTSD. Front Psychol 2021; 12:733911. [PMID: 34764915 PMCID: PMC8576602 DOI: 10.3389/fpsyg.2021.733911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
In this case report, we explain the story of a woman diagnosed with severe PTSD, suffering from recurrent nightmares involving a traumatizing event. She participated in 6 week lucid dreaming training to help her reduce her nightmare frequency. Our descriptions include her dream reports as well as the results of the psychological assessment conducted. In only 6 weeks, she was able to begin to change her dream plots and to improve several of the psychological measures. In this case, we stated that paying more attention to sleep and, especially nightmares, not only in patients with PTSD, should be standard in treatment processes for psychiatric disorders. We, therefore, underpin our case with literature that explains the benefits of treatments, specifically for sleep problems that do not involve medication.
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Affiliation(s)
- Brigitte Holzinger
- Institute for Consciousness and Dream Research, Vienna, Austria
- Certificate Program Sleep Coaching, Medical University of Vienna, Vienna, Austria
| | | | - Gerhard Klösch
- Institute for Consciousness and Dream Research, Vienna, Austria
- Certificate Program Sleep Coaching, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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50
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Scarpelli S, Alfonsi V, Gorgoni M, Musetti A, Filosa M, Quattropani MC, Lenzo V, Vegni E, Borghi L, Margherita G, Freda MF, Saita E, Cattivelli R, Castelnuovo G, Manari T, Plazzi G, De Gennaro L, Franceschini C. Dreams and Nightmares during the First and Second Wave of the COVID-19 Infection: A Longitudinal Study. Brain Sci 2021; 11:brainsci11111375. [PMID: 34827374 PMCID: PMC8615577 DOI: 10.3390/brainsci11111375] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 02/05/2023] Open
Abstract
Recent literature shows that the Coronovirus-19 (COVID-19) pandemic has provoked significant changes in dreaming. The current study intends to provide an update about dream variable changes during the second wave of COVID-19. A total of 611 participants completed a web survey from December 2020 to January 2021. Statistical comparisons showed that subjects had lower dream-recall frequency, nightmare frequency, lucid-dream frequency, emotional intensity, and nightmare distress during the second than the first wave of the pandemic. Dreams had a higher negative tone during the second than first wave. We revealed significant differences concerning post-traumatic growth, sleep-related post-traumatic stress disorder (PTSD) symptoms and sleep measures between groups obtained as a function of the changes in the oneiric frequency between the first and second waves. We also found significant correlations between qualitative/emotional dream features and COVID-19-related factors (job change, forced quarantine, having COVID-19 infected relatives/friends, or asking for mental health help). Overall, we found that the second wave affected fewer quantitative features of dream activity and there was less emotional intensity. Moreover, we confirmed the relationship between nightmares and the high risk of PTSD when subjects were grouped as a function of the increasing/decreasing frequency. Finally, our findings are partly coherent with the continuity hypothesis between oneiric and waking experiences.
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Affiliation(s)
- Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (V.A.); (M.G.); (L.D.G.)
- Correspondence:
| | - Valentina Alfonsi
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (V.A.); (M.G.); (L.D.G.)
| | - Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (V.A.); (M.G.); (L.D.G.)
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, 43125 Parma, Italy; (A.M.); (T.M.)
| | - Maria Filosa
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.F.); (C.F.)
| | - Maria C. Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, “Dante Alighieri” University for Foreigners of Reggio Calabria, 89125 Reggio Calabria, Italy;
| | - Elena Vegni
- Department of Health Sciences, University of Milan, 20146 Milan, Italy; (E.V.); (L.B.)
| | - Lidia Borghi
- Department of Health Sciences, University of Milan, 20146 Milan, Italy; (E.V.); (L.B.)
| | - Giorgia Margherita
- Department of Humanistic Studies, Federico II University, 80138 Naples, Italy; (G.M.); (M.F.F.)
| | - Maria Francesca Freda
- Department of Humanistic Studies, Federico II University, 80138 Naples, Italy; (G.M.); (M.F.F.)
| | - Emanuela Saita
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.S.); (R.C.); (G.C.)
| | - Roberto Cattivelli
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.S.); (R.C.); (G.C.)
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 28824 Verbania, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.S.); (R.C.); (G.C.)
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 28824 Verbania, Italy
| | - Tommaso Manari
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, 43125 Parma, Italy; (A.M.); (T.M.)
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (V.A.); (M.G.); (L.D.G.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Christian Franceschini
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.F.); (C.F.)
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