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Study Objectives: To identify risk factors for experiencing nightmares among the Finnish general
adult population. The study aimed to both test whether previously reported correlates of frequent
nightmares could be reproduced in a large population sample and to explore previously unreported
associations.
Design: Two independent cross-sectional pop...
Context in source publication
Context 1
... duration had a clear U-shaped association with night- mare frequency, as can be seen from Figure 1, but the effect size of this association was small (χ 2 , P < 0.001; Cramer V, 0.070). The evening chronotype was associated with night- mares in women: 7.5% of female evening types reported fre- quent nightmares compared with only 2.7% reported by female morning types (χ 2 , P < 0.001; Cramer V 0.067) but the effect size of this association was small. ...
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Objective:
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Citations
... While the risk factors behind nightmares are not well understood, nightmares can be caused by negative experiences and fear, such as traumatic events, as observed in war veterans with PTSD [3]. Our earlier epidemiological studies and those by others have shown that both sleep problems and severe sleep disorders, such as insomnia and narcolepsy, are associated with nightmares [4][5][6][7]. Furthermore, we have previously shown a familial aggregation between nightmares and psychiatric traits, and alcohol use in general [2]. ...
... Given that nightmares are heritable, we used a genome-wide association study design (GWAS) in 45,255 individuals with a self-reported frequency of nightmares to elucidate the underlying biology as well as shared mechanisms and links with psychiatric diseases. As our cohorts also included individual alcohol consumption information, we decided to perform a sensitivity analysis where we removed individuals with significant alcohol consumption as it may influence nightmare incidence [6,13]. ...
... Analyses were adjusted for relevant covariates comprising age, gender, and identity by descent-calculated genetic correlation matrix with the top 10 principal components, the survey year, genotyping chip, and the cohort for each Finrisk sub cohort. In addition, individuals who were intoxicated once or more often per month were removed from the secondary analysis, because frequent heavy use of alcohol has been previously found to increase the risk of frequent nightmares [6]. ...
Nightmares are vivid, extended, and emotionally negative or negative dreams that awaken the dreamer. While sporadic nightmares and bad dreams are common and generally harmless, frequent nightmares often reflect underlying pathologies of emotional regulation. Indeed, insomnia, depression, anxiety, or alcohol use have been associated with nightmares in epidemiological and clinical studies. However, the connection between nightmares and their comorbidities are poorly understood. Our goal was to examine the genetic risk factors for nightmares and estimate correlation or causality between nightmares and comorbidities. We performed a genome-wide association study (GWAS) in 45,255 individuals using a questionnaire-based assessment on the frequency of nightmares during the past month and genome-wide genotyping data. While the GWAS did not reveal individual risk variants, heritability was estimated at 5%. In addition, the genetic correlation analysis showed a robust correlation (rg > 0.4) of nightmares with anxiety (rg = 0.671, p = 7.507e−06), depressive (rg = 0.562, p = 1.282e−07) and posttraumatic stress disorders (rg = 0.4083, p = 0.0152), and personality trait neuroticism (rg = 0.667, p = 4.516e−07). Furthermore, Mendelian randomization suggested causality from insomnia to nightmares (beta = 0.027, p = 0.0002). Our findings suggest that nightmares share genetic background with psychiatric traits and that insomnia may increase an individual’s liability to experience frequent nightmares. Given the significant correlations with psychiatric and psychological traits, it is essential to grow awareness of how nightmares affect health and disease and systematically collect information about nightmares, especially from clinical samples and larger cohorts.
... the pre-pandemic sample participants had been screened for excellent sleep quality. Depressive symptoms and poorer sleep quality, especially insomnia symptoms, have been associated with nightmares (e.g., Sandman et al., 2015) which are paradigm cases of threat simulation dreams. However, the sleep quality in the pandemic sample was also generally good and the samples did not differ in the satisfaction or quality of life. ...
Previous research indicates that the COVID-19 pandemic has affected dreaming negatively. We compared 1132 dreams collected with prospective two-week dream diary during the pandemic to
166 dreams collected before the pandemic. We hypothesized that the pandemic would increase the number of threatening events, threats related to diseases, and the severity of threats. We also hypothesized that dreams that include direct references to the pandemic will include more threatening events, more disease-related threats, and more severe threats. In contradiction with our hypotheses, results showed no differences between pandemic and pre-pandemic samples in the number of threats, threats related to diseases, or severe threats. However, dreams with direct references to the pandemic had more threats, disease-related threats, and severe threats. Our results thus do not suggest a significant overall increase in nightmarish or threatening dream content during the pandemic but show a more profound effect on a minority of dreams.
... While irregular nightmares are common in the population, frequent nightmares (i.e., at least one or more nightmares per week) may in contrast reflect an underlying psychopathology suggestive of heightened mental health risks [4]. Differences in the criteria adopted for frequent nightmares and the populations sampled have yielded extensive variations in the prevalence reported across studies [4,5]. For instance, a large study of the Finnish general adult population has reported a prevalence of 3.9% for "often" having nightmares during the past 30 days [5], while another epidemiological study of parents in Hong Kong has reported a prevalence of 5.1% for frequent nightmares (defined as at least once per week) [4]. ...
... Differences in the criteria adopted for frequent nightmares and the populations sampled have yielded extensive variations in the prevalence reported across studies [4,5]. For instance, a large study of the Finnish general adult population has reported a prevalence of 3.9% for "often" having nightmares during the past 30 days [5], while another epidemiological study of parents in Hong Kong has reported a prevalence of 5.1% for frequent nightmares (defined as at least once per week) [4]. Meanwhile, focusing specifically on young adults, the prevalence of frequent nightmares has also recently been reported to be 7.9% among middle and high school students in mainland China [6]. ...
... The majority of existing studies examining the associations between nightmares and mental health, however, have largely been based on either student [6,17,18] or clinical populations [19,20]. The assessment of mental health states in these studies has also been based largely on self-rated mood symptom measures [5,6,17,21], with few having examined the role of nightmares in probable depressive and anxiety disorders using interviewerrated diagnostic tools [4]. There is also a scarcity of longitudinal studies examining the influences of frequent nightmares on long-term outcomes, which would be necessary for determining their implications on not only current but also future mental health risks. ...
Study Objectives
No study has yet examined the prevalence of frequent nightmares in representative youth populations in Asia and how they may contribute to future mental health risks. We aimed to fill this gap using data from a large-scale household-based youth sample in Hong Kong.
Methods
Participants were consecutively recruited from a large-scale epidemiological youth mental health study in Hong Kong (n=3,132). A subset of participants were invited for a follow-up assessment after 1 year (n=1,154 in the final analyses). Frequent nightmares (≥1/week during the past month) were assessed using an item from the Pittsburgh Sleep Quality Index. Univariate analyses and multivariable logistic regression models were applied to examine the contribution of frequent nightmares at baseline to moderate-to-severe depressive and anxiety symptoms, post-traumatic stress disorder symptoms, and 30-day major depressive episode (MDE) or generalised anxiety disorder (GAD), both at baseline and follow-up. The long-term functional implications of frequent nightmares were also examined.
Results
The prevalence of frequent nightmares was 16.3%. Females were more likely to experience frequent nightmares (20.4%) compared to males (12.1%), p<0.001. Baseline frequent nightmares were significantly associated with all four mental health outcomes at 1 year. Notably, their prospective associations with depressive and anxiety symptoms and 30-day MDE/GAD remained significant even after adjusting for external stressors, resilience, and sociodemographic characteristics. Frequent nightmares were also significantly associated with both current and 1-year functional impairments.
Conclusions
Frequent nightmares have significant long-term implications on mental health and functioning. Identifying young adults with frequent nightmares can improve early risk detection and intervention in the population.
... We generated 10 datasets with predicted missing values through a Markov Chain Monte Carlo procedure in which all available variables were entered regardless of their temporal relations (Schaefer, 1997). Multivariable-adjusted models were run on each imputed dataset and the estimates were combined across models using Rubin's rules (Rubin, 1987). ...
... Different mechanisms could explain an association between long sleep duration and the development of behavior problems. Nightmares could be one of them; sleeping ≥9 hr is associated with nightmares (Munezawa et al., 2011;Sandman et al., 2015) which, in turn, are related to both internalizing and externalizing problems (Li et al., 2011). Medical conditions such as asthma and allergies may be associated with sleeping above recommendations (Koinis-Mitchell et al., 2012). ...
We examined the associations of middle childhood and adolescence nighttime sleep duration with adolescence internalizing and externalizing behavior problems per the Youth Self-Report (YSR) and the Child Behavior Checklist (CBCL) questionnaires, in a cohort of 889 Colombian schoolchildren. We estimated adjusted differences with 95% confidence intervals (CI) in mean behavior problem t -scores in standardized units between recommended sleep duration categories and as a continuous exposure using multiple linear regression and restricted cubic spline models, respectively. Compared with sleep duration within recommendations, middle childhood sleep above recommendations was related to 4.6 (95% CI: 1.6, 7.6; p = .004) and 5.4 (95% CI: 1.2, 9.7; p = .01) adjusted units higher YSR and CBCL externalizing problem scores, respectively. In continuous exposure analyses, this association seemed restricted to children aged ≥11 years. Longer sleep, both in categories and as a continuous exposure, was also associated with increased CBCL internalizing problems. Results did not differ by sex or weekend/weekday sleep. Sleeping under recommendations in middle childhood was not significantly related to behavior problems; nevertheless, shorter sleep in adolescence, in both categorical and continuous scales, was significantly related to behavior problems. In conclusion, behavior problems in adolescence are associated with longer sleep in middle childhood and shorter sleep in adolescence.
... Nightmares often result in waking with rapid orientation and alertness, which not only affects the quality of sleep but also damages the daily function and health of the individual [4]. For example, there are increased negative emotions and self-harming behaviors [5] as well as reduced life satisfaction and work efficiency [6]. A longitudinal study found that individuals with lower levels of psychological well-being were more likely to report negative dreams [7], suggesting that health-related psychological factors may play an important role in causing nightmares. ...
Objective:
Frequent nightmare behavior or deep nightmare experiences may harm the physical and mental health and performance of athletes. This study explores the nightmare experiences of athletes, and includes non-athletes with similar experiences for comparison.
Methods:
The Nightmare Experience Questionnaire (NEQ); Zuckerman-Kuhlman-Aluja Personality Questionnaire, Shortened Form (ZKA-PQ/SF); and Self-Rating Anxiety Scale (SAS) were used. The subjects were 187 athletes (mean age = 20.44 years, SD = 0.85; 91 females, 96 males) and 90 non-athletes (mean age = 20.34 years, SD = 1.65; 52 females, 38 males) who reported having nightmares.
Results:
A total of 87 athletes (46.5%) reported having nightmare experiences. The athlete nightmare group scored significantly higher in neuroticism than the non-nightmare group, and their anxiety scores were significantly higher than those of non-athletes, who scored higher in aggressiveness, neuroticism, and sensation seeking. Moreover, anxiety, neuroticism, and sensation seeking positively predicted athletes' nightmare experiences.
Conclusions:
Personality traits and anxiety levels can be effectively applied to predict athletes' nightmare experiences.
... During the early stages of the pandemic, individuals with insomnia reported higher dream recall frequency, bizarreness, negative emotional tone and more frightening nightmare content compared with good sleepers (Fränkl et al., 2021;Gorgoni et al., 2021;Kennedy et al., 2021). Pre-pandemic literature suggests that individuals with insomnia experience more nightmares, with more negatively toned, bizarre and health-related dreams than good sleepers (Feige et al., 2018;Ohayon, Morselli, & Guilleminault, 1997;Sandman et al., 2015, & Schredl, 2009Schredl, Schäfer, Weber, & Heuser, 2015). Individuals with insomnia experience more dreams related to waking life stressors than good sleepers, likely reflecting their increased perception of, and rumination about, daily stressors (Fernández-Mendoza et al., 2010;Schredl et al., 1998). ...
Dreaming and insomnia are important markers of distress in times of crisis. Here, we present a longitudinal, mixed‐methods study examining changes in dreaming between individuals with and without insomnia symptoms and their relationship to mental health during the COVID‐19 pandemic. A global survey examining insomnia symptoms, dreams and mental health was launched in April 2020 and followed participants over 12 months. Of 2214 participants, 1009 (45%) reported dream changes at baseline. A higher proportion of participants with new‐onset insomnia reported dream changes (55%) than those with pre‐existing insomnia (45%) or good sleepers (36%). Overall, thematic analysis identified key dream change themes of increased dream activity, with participants dreaming vividly, in high‐definition, and with a strong negative charge. Themes around survival, adjusting to pandemic life, meaning‐making and poor sleep quality were also noted. Linguistic Inquiry Word Count showed that individuals with insomnia used more negative words to describe their dream changes than good sleepers. Specifically, the new‐onset insomnia group used more anxious and death‐related words than those who slept well. Notably, all groups experienced a significant reduction in dream activity by 3‐month follow‐up. Lastly, dream changes were associated with worse mental health symptoms over time, and this effect was more pronounced in individuals with insomnia. Our results highlight that insomnia symptoms, especially new‐onset insomnia, are associated with more negative dream changes during collective stressful events, potentially compounding daytime distress and mental health symptoms over time. During times of crisis, dreaming and insomnia may reveal an important target for mental health interventions.
... Across several studies nightmares have been linked to insomnia. For example, in two large community samples, 17-18% of individuals with frequent insomnia also had frequent nightmares (Ohayon et al., 1997;Sandman et al., 2015). Further, nightmares correlated with all of Li et al.'s (2010) indices of insomnia: difficulty maintaining sleep, difficulty initiating sleep, restless sleep, and early morning awakenings. ...
... However, nightmare frequency had little effect on the relationship between nightmare proneness and early morning wakenings. The results were consistent with previous findings of a relationship between insomnia and nightmare frequency (Li et al., 2010;Ohayon et al., 1997;Sandman et al., 2015), that both nightmares and insomnia were related to hyperarousal (Coren, 1988;de Zambotti et al., 2019;Levin & Nielsen, 2007;Riemann et al., 2010;Van Someren, 2021) and that nightmare proneness related to insomnia and nightmare frequency (Kelly, 2018). ...
... Additional research could examine possible effects of nightmare intensity and nightmare distress and their interaction with nightmare proneness on the relationship between nightmares and insomnia. Finally, consistent with previous work (Li et al., 2010;Ohayon et al., 1997;Sandman et al., 2015), the current study did not include a definition of nightmares or the waking criteria in order to prevent conflating waking from nightmares and insomnia. However, it would be interesting specifically compare how applying the waking criterion versus not affects the relationship between nightmares and insomnia. ...
Previous research consistently found a relationship between nightmares and insomnia. The aim of the current study was to investigate how nightmare proneness, a disposition to experience frequent nightmares partly reflecting hyperarousal, might influence this relationship among 339 university students. After controlling for gender, neuroticism, and negative response bias, mediation models found that nightmare proneness had direct relationships with insomnia markers. Nightmare frequency partially mediated nightmare proneness for difficulty initiating sleep, maintaining sleep, and returning to sleep after waking but not early morning wakenings. The results suggested that nightmare proneness directly influences insomnia markers outside of nightmare frequency, neuroticism, negative responding, and gender and partly influences difficulty initiating sleep, maintaining sleep, and returning to sleep after waking through nightmare occurrences. The findings provide additional evidence for a relationship between nightmares and insomnia and suggest that nightmare proneness could be a factor in this relationship. Suggestions for future research are offered.
... As described above, there is empirical evidence on the relationship between psychological distress and sleep disturbances (e.g. 27,61 ). In order to measure somatization, depression and anxiety in the preceding week we used the short version of the Brief Symptom Inventory . ...
Purpose
Child maltreatment may be linked with long-term sleeping disorders and limited coping with stress. Yet, the potential relationships are only marginally studied.
Patients and Methods
Based on a sample of young adults (n = 312) this study aims at exploring the effects of child maltreatment and the experience of threat to personal safety and life in childhood on sleep disturbances in early adulthood. Data were collected at the two study sites, Ulm University and Bielefeld University, by an online survey. For both risk factors, child maltreatment and the experience of threat to personal safety and life in childhood, a direct impact on sleep disturbances and an indirect path via psychological distress were tested using Structural Equation Modelling (SEM).
Results
In these models, the direct path to sleep disturbances turned out to be significant for the experience of threat to personal safety and life (Path C: b = 0.18, p = 0.013), but not for child maltreatment (Path C: b = 0.05, p = 0.491). However, the current level of psychological distress was found to have a mediating effect on sleep disturbances for both risk factors, thereby confirming indirect significant effects.
Conclusion
Considering that the etiological pathway of child maltreatment on sleeping disturbances is mediated via psychological distress, this provides a venue to test in future research whether stress reduction interventions can reduce the negative consequences of child maltreatment on sleep disorders.
... Marine Ambar Akkaoui, MD , 1,2 Marie-Pia D'ortho, MD, PhD, 3,4 Raphael Gourevitch, MD, PhD, 1 Alexandra Pham-Scottez, MD, PhD, 1 Patricia Benhamou, MD, 5 ...
... Frequent nightmares are also associated with poor sleep quality (Li et al., 2010;Sandman et al., 2015;Schredl, 2009). Accordingly, a growing number of studies indicate that nightmare sufferers compared to matched controls exhibit altered sleep physiology, such as increased microarousals Simor et al., 2013a), altered sleep spindle activity (Picard-Deland et al., 2018), and increased highfrequency power in non-rapid-eye-movement (NREM) sleep (Blaskovich et al., 2020;Marquis et al., 2017), abnormal motor activity (Germain and Nielsen, 2003), and indices of impaired parasympathetic regulation during different sleep stages (Nielsen et al., 2010;Simor et al., 2014). ...
Frequent nightmares are highly prevalent and constitute a risk factor for a wide range of psychopathological conditions. Despite its prevalence and clinical relevance however, the pathophysiological mechanisms of nightmares are poorly understood. A recent study (Perogamvros et, al 2019) examined the heart beat evoked potential (HEP) in a small group of nightmare sufferers (N = 11) and matched healthy controls (N =11) and observed markedly different (Hedges’ g = 1.42 [0.62 - 2.22]) HEP response across the groups during Rapid Eye Movement (REM) sleep. Moreover, the HEP correlated with depression scores in the nightmare group only. The authors concluded that the HEP in REM sleep could be used as a trait-like biomarker reflecting pathological emotional-and sleep regulation in nightmare disorder. To replicate the above study, we performed the same analyses of HEPs in two separate, and larger databases comprising the polysomnographic recordings of nightmare sufferers and matched controls (NStudy 1 = 39 ; NStudy 2 = 41). In contrast to the original findings, we did not observe significant differences in HEP across the two groups in either of the two databases. Moreover, we found no associations between depression scores and HEP amplitudes in the relevant spatiotemporal cluster. Our data cast doubts on the utility of HEP as a biomarker in the diagnostic and treatment procedures of nightmare disorder and suggests that the interpretation of HEP as a marker of impaired arousal and emotional processing during REM sleep is premature and requires further validation.
