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Delage JP, Côté J, Journault WG, Lemyre A, Bastien CH. The relationships between insomnia, nightmares, and dreams: A systematic review. Sleep Med Rev 2024; 75:101931. [PMID: 38733767 DOI: 10.1016/j.smrv.2024.101931] [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: 10/07/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/13/2024]
Abstract
Insomnia and nightmares are both prevalent and debilitating sleep difficulties. The present systematic review aims to document the relationships between insomnia and nightmares in individuals without a concomitant psychopathology. The relationships between insomnia and dreams are also addressed. PsycINFO and Medline were searched for papers published in English or French from 1970 to March 2023. Sixty-seven articles were included for review. Most results support positive relationships between insomnia variables and nightmare variables in individuals with insomnia, individuals with nightmares, the general population, students, children and older adults, and military personnel and veterans. These positive relationships were also apparent in the context of the COVID-19 pandemic. Some psychological interventions, such as Imagery Rehearsal Therapy, might be effective in alleviating both nightmares and insomnia symptoms. Regarding the relationships between insomnia and dreams, compared with controls, the dreams of individuals with insomnia are characterized by more negative contents and affects. The results show that insomnia and nightmares are connected and may be mutually aggravating. A model is proposed to explain how insomnia might increase the likelihood of experiencing nightmares, and how nightmares can in turn lead to sleep loss and nonrestorative sleep.
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Affiliation(s)
- Julia-Pizzamiglio Delage
- École de Psychologie, Université Laval, Québec, QC, Canada; CERVO Brain Research Center, Québec, QC, Canada
| | - Jeannie Côté
- École de Psychologie, Université Laval, Québec, QC, Canada
| | | | - Alexandre Lemyre
- École de Criminologie, Université de Montréal, Montréal, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
| | - Célyne H Bastien
- École de Psychologie, Université Laval, Québec, QC, Canada; CERVO Brain Research Center, Québec, QC, Canada; Research Laboratory on Human Neurophysiology and Sleep, Université Laval, Québec, QC, Canada.
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Gan QW, Yu R, Lian ZR, Yuan YL, Li YP, Zheng LL. Relationship between nightmare distress and depressive symptoms in Chinese emergency department nurses: A cross-sectional study. World J Psychiatry 2023; 13:1087-1095. [PMID: 38186729 PMCID: PMC10768490 DOI: 10.5498/wjp.v13.i12.1087] [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: 07/30/2023] [Revised: 10/14/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Most of the recent research on nightmare distress and depressive symptoms has focused on adolescents and students, with less research on the nurse population. Emergency department nurses are at high risk for nightmare distress and depressive symptoms, but no studies have been conducted to explore the relationship between the two; thus, further investigation is needed. AIM To understand the relationship between nightmare distress and depressive symptoms among emergency department nurses in China. METHODS A convenience sampling method was used to select 280 emergency department nurses from nine provinces, including Jiangxi, Sichuan, Jiangsu, and Shanxi Provinces. The Chinese version of the Nightmare Distress Questionnaire and the Center for Epidemiological Studies Depression Scale (CES-D) were administered. RESULTS Emergency department nurses' nightmare distress scores were positively associated with depressive symptom scores (r = 0.732), depressed affect (r = 0.727), somatic symptoms (r = 0.737), and interpersonal difficulty (r = 0.647). Further multiple linear regression analyses showed that education level, work pressure, self-reported health, and CES-D scores were factors that influenced nightmare distress among Chinese emergency department nurses (P < 0.05). CONCLUSION Nightmare distress is closely associated with depressive symptoms in Chinese emergency department nurses, and early intervention is recommended for professionals with this type of sleep disorder to reduce the occurrence of depressive symptoms.
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Affiliation(s)
- Qing-Wen Gan
- School of Nursing, Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Nursing, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ran Yu
- School of Nursing, Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Nursing, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ze-Rong Lian
- Department of Nursing, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
| | - Yi-Ling Yuan
- School of Nursing, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yuan-Ping Li
- School of Nursing, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Li-Lan Zheng
- Department of Nursing, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Schiess-Jokanovic J, Gösling-Steirer C, Kantor V, Knefel M, Weindl D, Lueger-Schuster B. "My brain freezes and I am blocked again": The subjective experience of post-migration living difficulties influenced by complex posttraumatic stress disorder of Afghan asylum seekers and refugees in Austria. PLoS One 2023; 18:e0288691. [PMID: 37494342 PMCID: PMC10370748 DOI: 10.1371/journal.pone.0288691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/03/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Potentially traumatic experiences and post-migration living difficulties (PMLDs) undoubtedly leave marks on mental health and psychosocial functioning. While PMLDs are recognised as a risk factor for posttraumatic stress disorder and complex posttraumatic stress disorder (described together here as C/PTSD), recent investigations have found that C/PTSD symptoms might also influence the experience of PMLDs. The subjective experience of and coping with PMLDs in the context of C/PTSD symptoms has not yet been explored. METHODS Semi-structured, interpreter-assisted interviews exploring the subjective experience of post-migration living difficulties were conducted with treatment-seeking Afghan refugees and asylum seekers (N = 24) and transcribed verbatim. Participants were screened using the International Trauma Questionnaire (ITQ) and allocated to a C/PTSD group or non-C/PTSD group. We analysed the qualitative interviews using content analysis and then compared the results of the two groups. RESULTS Over half of the participants (58.3%) met the criteria for C/PTSD. While the two groups addressed numerous similar themes, the C/PTSD group more frequently mentioned themes associated with C/PTSD symptoms (e.g., intrusions, avoidance, sleep disturbances, affective dysregulation) that influenced their responses to PMLDs. The non-C/PTSD group more often experienced positive emotions such as gratitude and optimism, and showed more active, solution-oriented behaviour as well as positive self-verbalisation. CONCLUSION To achieve a deeper understanding of PMLDs, post-traumatic psychopathology should be taken into account, as C/PTSD symptoms influence the experience of and coping with PMLDs. The specifics of individual experiences need to be considered in order to promote adaptive coping with PMLDs and to set individual trauma-focused and transdiagnostic treatment targets. In addition, psychological interventions should incorporate psychoeducation to improve the understanding of the impact of C/PTSD on the current experience of PMLDs.
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Affiliation(s)
- Jennifer Schiess-Jokanovic
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Christine Gösling-Steirer
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Viktoria Kantor
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Matthias Knefel
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Dina Weindl
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Brigitte Lueger-Schuster
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
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Sheaves B, Rek S, Freeman D. Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies. Clin Psychol Rev 2023; 100:102241. [PMID: 36566699 PMCID: PMC10933816 DOI: 10.1016/j.cpr.2022.102241] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/11/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Nightmares occur across a wide range of psychiatric disorders, but outside of PTSD presentations are infrequently considered a treatment priority. We aimed to assess evidence for a contributory causal role of nightmares to the occurrence of psychiatric disorders, and vice versa. A systematic review was conducted of longitudinal, experimental, and clinical trial studies. Twenty-four longitudinal, sixteen trials, and no experimental studies were identified. Methodological shortcomings were common, especially the use of single-item nightmare assessment. Thirty-five studies assessed the path from nightmares to psychiatric symptoms. Depression (n = 10 studies), PTSD (n = 10) and anxiety (n = 5) were the most commonly assessed outcomes in trials. Most were not designed to assess the effect of nightmare treatment on psychiatric symptoms. Treating nightmares led to moderate reductions in PTSD and depression, small to moderate reductions in anxiety, and potentially moderate reductions in paranoia. Nightmares increased the risk of later suicide outcomes (n = 10), but two small pilot trials indicated that treating nightmares might potentially prevent recovery of suicidal ideation. PTSD treatment led to large reductions in trauma-related nightmares (n = 3). The limited literature suggests that treating nightmares may be one route to lessening threat-based disorders in particular, suggestive of a causal relationship. Overall, however, nightmares in most disorders are greatly understudied.
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Affiliation(s)
- Bryony Sheaves
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Stephanie Rek
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
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Dumser B, Werner GG, Ehring T, Takano K. Symptom dynamics among nightmare sufferers: An intensive longitudinal study. J Sleep Res 2022; 32:e13776. [PMID: 36351660 DOI: 10.1111/jsr.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
Nightmares are considerably prevalent in the general population and are known to be closely associated with a variety of mental disorders. However, not much is known about the immediate antecedents and consequences of nightmares. Therefore, we used intensive longitudinal assessments to investigate the night-to-night within-person associations between nightmares on the one hand and fear of sleep, somatic as well as cognitive pre-sleep arousal, and sleep quality on the other hand. Young women with regular nightmares (n = 16) maintained a sleep diary for around 30 days; upon awaking, the participants reported on nightmares and sleep quality during the past night as well as the pre-sleep levels of arousal and fear of sleep (which resulted in 461 observations). Participants also wore an actigraph, which provided objective sleep parameters. Multilevel modeling showed that higher levels of fear of sleep and lower subjective sleep quality were significantly associated with higher levels of nightmare distress. Furthermore, we found individual differences in the strength of these associations, which implies that factors proximate to nightmares may vary across individuals. Pre-sleep arousal, however, did not show expected within-person associations with nightmares or fear of sleep. These findings highlight the crucial role of fear of sleep in the etiology of nightmares and sleep disturbances, while pointing to the importance of pursuing individual, personalised models that explain heterogeneity in the process of triggering nightmares.
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Affiliation(s)
- Britta Dumser
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, LMU Munich Munich Germany
| | - Gabriela G. Werner
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, LMU Munich Munich Germany
| | - Thomas Ehring
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, LMU Munich Munich Germany
| | - Keisuke Takano
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, LMU Munich Munich Germany
- Human Informatics and Interaction Research Institute (HIIRI), National Institute of Advanced Industrial Science and Technology (AIST) Tokyo Japan
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Liu Y, Zhang Q, Jiang F, Zhong H, Huang L, Zhang Y, Chen H. Association between sleep disturbance and mental health of healthcare workers: A systematic review and meta-analysis. Front Psychiatry 2022; 13:919176. [PMID: 35966483 PMCID: PMC9372625 DOI: 10.3389/fpsyt.2022.919176] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Sleep disturbance and mental health are challenges for healthcare workers (HCWs). Especially during the COVID-19 pandemic, they experienced more severe sleep and mental health problems. However, the association between sleep disturbance and the mental health of HCWs is still controversial. This study aimed to systematically review the relationship by conducting a systematic review and meta-analysis. METHOD Two researchers retrieved the literature from Web of Science, PubMed, EMBASE, CINAHL, Psyclnfo, and Cochrane Library from the establishment of the databases until November 20, 2021. We used the New Castle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality (AHRQ) to evaluate the risk of bias in prospective research and cross-sectional research, respectively. The major exposure was HCWs' sleep disturbance, and the major outcome was mental health. The correlation coefficients (r), regression coefficients (β) and odds ratios (OR) of the included studies were integrated. RESULT Fifty-nine studies were included for qualitative analysis, of which 30 studies could be combined and entered into quantitative analysis. There were 23 studies during the COVID-19 pandemic among the 59 included studies. The results of the meta-analysis showed that the correlation coefficient between sleep disturbance and mental health was 0.43 (95% CI: 0.39-0.47). HCWs with sleep disturbance had a 3.74 (95% CI: 2.76-5.07) times higher risk of mental health problems than those without sleep disturbance. The correlation coefficient during the COVID-19 epidemic was 0.45 (95% CI: 0.37-0.53), while it was 0.40 (95% CI: 0.36-0.44) during the non-epidemic period. Subgroup analysis compared the OR results in epidemic and non-epidemic periods of COVID-19, which were 4.48 (95% CI: 2.75-5.07) and 3.74 (95% CI: 2.74-7.32), respectively. CONCLUSION Sleep disturbance and mental health problems were positively correlated among HCWs. Particularly in the COVID-19 pandemic, more attention should be given to this issue.
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Affiliation(s)
- Ying Liu
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Qin Zhang
- Department of Postgraduate Students, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Fugui Jiang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Hua Zhong
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Lei Huang
- Department of Environmental Health and Occupational Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,Department of Occupational Hazard Assessment, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
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Solomonova E, Picard-Deland C, Rapoport IL, Pennestri MH, Saad M, Kendzerska T, Veissiere SPL, Godbout R, Edwards JD, Quilty L, Robillard R. Stuck in a lockdown: Dreams, bad dreams, nightmares, and their relationship to stress, depression and anxiety during the COVID-19 pandemic. PLoS One 2021; 16:e0259040. [PMID: 34818346 PMCID: PMC8612516 DOI: 10.1371/journal.pone.0259040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND An upsurge in dream and nightmare frequency has been noted since the beginning of the COVID-19 pandemic and research shows increases in levels of stress, depression and anxiety during this time. Growing evidence suggests that dream content has a bi-directional relationship with psychopathology, and that dreams react to new, personally significant and emotional experiences. The first lockdown experience was an acute event, characterized by a combination of several unprecedent factors (new pandemic, threat of disease, global uncertainty, the experience of social isolation and exposure to stressful information) that resulted in a large-scale disruption of life routines. This study aimed at investigating changes in dream, bad dream and nightmare recall; most prevalent dream themes; and the relationship between dreams, bad dreams, nightmares and symptoms of stress, depression and anxiety during the first COVID-19 lockdown (April-May 2020) through a national online survey. METHODS 968 participants completed an online survey. Dream themes were measured using the Typical Dreams Questionnaire; stress levels were measured by the Cohen's Perceived Stress Scale; symptoms of anxiety were assessed by Generalized Anxiety Disorder (GAD-7) scale; and symptoms of depression were assessed using the Quick Inventory of Depressive Symptomatology. RESULTS 34% (328) of participants reported increased dream recall during the lockdown. The most common dream themes were centered around the topics of 1) inefficacy (e.g., trying again and again, arriving late), 2) human threat (e.g., being chased, attacked); 3) death; and 4) pandemic imagery (e.g., being separated from loved ones, being sick). Dream, bad dream and nightmare frequency was highest in individuals with moderate to severe stress levels. Frequency of bad dreams, nightmares, and dreams about the pandemic, inefficacy, and death were associated with higher levels of stress, as well as with greater symptoms of depression and anxiety. CONCLUSIONS Results support theories of dream formation, environmental susceptibility and stress reactivity. Dream content during the lockdown broadly reflected existential concerns and was associated with increased symptoms of mental health indices.
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Affiliation(s)
- Elizaveta Solomonova
- Neurophilosophy Lab, McGill University, Montreal, Canada
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, Culture, Mind and Brain research group, McGill University, Montreal, Canada
| | - Claudia Picard-Deland
- Dream and Nightmare Laboratory, Center for Advanced Research in Sleep Medicine, Montreal, Canada
- Department of Neuroscience, University of Montreal, Montreal, Canada
| | | | - Marie-Hélène Pennestri
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
- Sleep Laboratory and Clinic, Hôpital en Santé Mentale Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
| | - Mysa Saad
- The Royal’s Institute of Mental Health Research, Ottawa, Canada
| | - Tetyana Kendzerska
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Samuel Paul Louis Veissiere
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, Culture, Mind and Brain research group, McGill University, Montreal, Canada
| | - Roger Godbout
- Sleep Laboratory and Clinic, Hôpital en Santé Mentale Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
- Department of Psychiatry, University of Montreal, Montreal, Canada
| | - Jodi D. Edwards
- University of Ottawa Heart Institute, Ottawa, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Lena Quilty
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Rebecca Robillard
- The Royal’s Institute of Mental Health Research, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
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Abstract
The discrepancy between natural sleep-wake rhythm and actual sleep times in shift workers can cause sleep loss and negative daytime consequences. Irregular shift schedules do not follow a fixed structure and change frequently, which makes them particularly harmful and makes affected individuals more susceptible to insomnia. The present study compares insomnia symptoms of non-shift workers, regular shift workers, and irregular shift workers and takes into account the moderating role of the Big Five personality traits and levels of perfectionism. Employees of an Austrian railway company completed an online survey assessing shift schedules, sleep quality and duration, daytime sleepiness, and personality traits. A total of 305 participants, of whom 111 were non-shift workers, 60 regular shift workers, and 134 irregular shift workers, made up the final sample. Irregular shift workers achieved significantly worse scores than one or both of the other groups in time in bed, total sleep time, sleep efficiency, sleep duration, sleep quality, sleep latency, and the number of awakenings. However, the values of the irregular shifts workers are still in the average range and do not indicate clinical insomnia. Participants working regular shifts reported the best sleep quality and longest sleep duration and showed the least nocturnal awakenings, possibly due to higher conscientiousness- and lower neuroticism scores in this group. Agreeableness increased the effect of work schedule on total sleep time while decreasing its effect on the amount of sleep medication taken. Perfectionism increased the effect of work schedule on time in bed and total sleep time. Generalization of results is limited due to the high percentage of males in the sample and using self-report measures only.
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Affiliation(s)
- Brigitte Holzinger
- Institute for Consciousness and Dream Research, Vienna, Austria.,Sleep Coaching Programme, Medical University, Vienna, Austria
| | - Lucille Mayer
- Institute for Consciousness and Dream Research, Vienna, Austria
| | - Gerhard Klösch
- Institute for Consciousness and Dream Research, Vienna, Austria.,Sleep Coaching Programme, Medical University, Vienna, Austria.,Department of Neurology, Medical University of Vienna, Vienna, Austria
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