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Nightmares
Last edited |
10/22/2008
Epidemiological data on the
incidence of nightmares in adults or in subjects with psychological difficulties
is scarce, yet this information would be of great interest
Nightmares have been
reported to occur in a large percentage of the population following an
intensely frightening or highly emotional experience
(Hefez et al., 1987; Ross et al., 1989).
They may also exist as
recurrent episodes, and certain subgroups have been investigated thoroughly
(concentration camp survivors, Viet Nam war veterans, bus or airplane hijack
victims, etc.) (Grinker et al., 1945; Ross et al., 1989).
Studies have suggested that,
depending on their frequency and on the psychological profile of the subject,
nightmares may have a negative disturbing impact on the subject’s daytime
behavior and on his/her relations with the surrounding environment, and could be
the basis of a neuropsychiatric syndrome (Levin et al., 1991; Hudson et al.,
1991).
Research
We questioned the prevalence of
nightmares and investigated the possible association with psychopathology and
altered daytime functioning for subjects with insomnia as part of a large
general population survey concerning sleep disorders.
We hypothesized that insomnia nightmare sufferers experienced more difficulties
in daytime functioning and were more likely to have psychiatric disorders than
insomnia subjects without nightmares.
A representative sample of
5622 subjects, between 15
and 96 years of age, from the non-institutionalized general population of
France, were interviewed by telephone concerning their sleeping habits and
sleep disorders.
The interviews were conducted using the Sleep-EVAL
System.
Questions investigated nightmares, based on the DSM-IV definition,
psychopathological traits, and included 12 other groups of information,
including sociodemographics, sleep/wake schedule, daytime functioning,
psychiatric and medical history, and drug intake.
The data from 1049 subjects
suffering from insomnia were considered for this analysis.
Bivariate analyses,
logistic regression analysis using the method of indicator contrasts for the
investigation of independent variables, and calculation of significant odds
ratios were performed.
Results
Nightmares were reported in
18.3% of the surveyed insomniac population and were two times higher in women
than in men.
The following factors were found
to be significantly associated with nightmares:
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Sleep with many
awakenings,
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abnormally
long sleep onset,
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daytime
memory impairment following poor nocturnal sleep,
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daytime
anxiety following poor nocturnal sleep,
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and
being a woman.
There was a
strong association
between the report of nightmares in women and the presence of either a
Depressive Disorder, Anxiety Disorder or both disorders together.
When the effects of major psychiatric disorders were controlled for,
nightmares were significantly associated with being a woman, feeling depressed
after a poor night’s sleep and complaining of a long sleep latency.
Nightmares can lead to a
negative conditioning toward sleep and to chronic sleep complaints.
Considering the frequency of
nightmares in an adult insomniac population, and the significant relationship
between nightmares and certain subgroups, nightmares should receive more
attention in patients, especially women complaining of disrupted sleep as high
rates of psychiatric disorders were found in this specific group.
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Sleep-EVAL
Research
