Abstract
Sleep disruption is commonly associated with psychotic experiences. While sparse, the literature to date highlights nightmares and related distress as prominent risk factors for psychosis in students. We aimed to further explore the relationship between specific nightmare symptoms and psychotic experiences in university students while examining the mediating role of emotion dysregulation. A sample (N = 1273) of student respondents from UK universities completed measures of psychotic experiences, nightmare disorder symptomology and emotion dysregulation. Psychotic experiences were significantly more prevalent in students reporting nightmares (n = 757) relative to those who did not (n = 516). Hierarchical linear regression analysis showed that psychotic experiences were significantly associated (Adjusted R2 = 32.4%) with perceived nightmare intensity, consequences and resulting awakenings, and with emotion regulation difficulties. Furthermore, multiple mediation analysis showed that the association between psychotic experiences and nightmare factors was mediated by emotion regulation difficulties. Adaptive regulation of dream content during rapid eye-movement sleep has previously been demonstrated to attenuate surges in affective arousal by controlling the intensity and variability of emotional content. Difficulties in emotion regulation may partially explain the experience of more intense and disruptive nightmares among individuals with psychotic experiences. Emotion regulation may represent an important control mechanism that safeguards dream content and sleep quality.
Highlights
Disturbed sleep plays a crucial role in predicting the development of first-onset psychosis and paranoid thinking[1,2]
All the emotion dysregulation dimensions but goals were significantly associated with psychotic experiences
The primary purpose of this study was to evaluate the relationship between nightmare symptoms and psychotic experiences in university students, and to examine the mediating role of npj Schizophrenia (2020) 15
Summary
Disturbed sleep plays a crucial role in predicting the development of first-onset psychosis and paranoid thinking[1,2]. Abnormalities in objective sleep continuity (i.e. increased sleep onset latency and fragmentation) and circadian rhythm disruption are commonly reported in people experiencing psychosis[2,3,4]. Sleep disruption at disorder level (i.e. insomnia and obstructive sleep apnoea) has been evidenced in this population[4,5,6]. While persistent reports of childhood nightmares appear to predict future psychotic experiences in young adulthood[2], the role of nightmares in relation to psychotic experiences in young adults has received little attention until recently[7,8]. Weekly nightmares present at a rate of up to 6%10,11.
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