Nightmare Frequency Research Articles

Affection deprivation is more aversive than excessive affection: A test of affection exchange theory

AbstractAffection exchange theory predicts that both excessive affection and affection deprivation are associated with poorer health, compared with receiving the level of affectionate communication that one desires. A similar yet‐untested prediction is that affection deprivation is more aversive than excessive affection. This preregistered study tested both hypotheses on a battery of mental and physical health outcomes, including depression, loneliness, stress, physical pain, frequency of nightmares, and sleep quality, using a Census‐matched sample of U.S. American adults (N = 827). As hypothesized, receiving the right amount of affection was associated with more health‐supportive scores on all outcomes than either excessive or deficient affection. Similarly, excessive affection was associated with lower depression, loneliness, stress, and pain, and higher sleep quality, than affection deprivation.

An observatory on changes in dreaming during a pandemic: a living systematic review (part 1).

A 'new' way of dreaming has emerged during the pandemic, enhancing the interest of psychological literature. Indeed, during the years of the spread of coronavirus disease 2019 (COVID-19), many studies have investigated dream-related phenomena and dreaming functions. Considering the constant and rapid emergence of new results on this topic, the main aim of this study was to create an 'observatory' on the short- and long-term consequences of the COVID-19 pandemic on dreaming, by means of a living systematic review. The baseline results are presented, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, to identify and discuss existing studies about dreams and dreaming during the COVID-19 pandemic published until February 2022. Web of Science, Embase, EBSCO, and PubMed were used for the search strategy, yielding 71 eligible papers included in the review. Our results show: (a) a more intense oneiric activity during lockdown; (b) changes in dreaming components (especially dream-recall and nightmare frequency); (c) a particular dreaming scenario ('pandemic dreams'); (d) an alteration of the dreaming-waking-life continuum and a specific function of dreaming as emotional regulator. Findings suggest that monitoring changes in dreaming provides important information about psychological health and could also contribute to the debate on the difficulties of dreaming, as well as sleeping, in particular during and after a period of 'collective trauma'.

Enhancing imagery rehearsal therapy for nightmares with targeted memory reactivation

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 2weeks, 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 2weeks 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 2weeks of IRT and a sustained decrease of nightmares after 3months. 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.

The Relationship between Nightmare Experience and Athletes' Personality Traits and Anxiety.

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.

The role of mindful acceptance and lucid dreaming in nightmare frequency and distress

A theoretical and empirical association between lucid dreaming and mindfulness, as well as lucid dreaming and nightmares has previously been observed; however, the relationship between nightmares and mindfulness has received surprisingly little attention. Here, we present the findings of two studies exploring the relation of nightmare frequency and distress with two components of mindfulness, termed presence and acceptance, as well as lucid dreaming. Study 1 (N = 338) consisted of a low percentage of frequent lucid dreamers whereas Study 2 (N = 187) consisted primarily of frequent lucid dreamers that used lucid dream induction training techniques and meditation. Across studies, nightmare-related variables showed a more robust association with mindful acceptance as opposed to mindful presence. Moreover, individuals with high levels of meditation expertise and practice of lucid dreaming induction techniques reported lower nightmare frequency. Finally, in Study 2, which consisted of frequent lucid dreamers, a positive correlation between lucid dreaming frequency and mindfulness was apparent. The present findings support the notion that wakeful mindfulness is associated with the quality of dreams and extend previous research by suggesting a disentangled role of the two facets of mindfulness in dream variation. This association remains open for experimental manipulation, the result of which could have clinical implications.

The Effectiveness of Dream Analysis in Reducing Idiopathic Nightmares by Hermeneutic Single Case Efficacy Design (HSCED)

Background: Nightmare is a prevalent parasomnia associated with various forms of psychological distress in both clinical and general populations. This study aimed to explain the experiences of a client regarding the effects of nightmares and effectiveness of dream analysis treatment on idiopathic nightmares. Methods: This qualitative study was conducted on a 34-year-old woman who participated in 8 sessions of dream analysis treatment. The client was diagnosed with nightmare disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for nightmare. The hermeneutic method was used to collect and analyze quantitative and qualitative data. This study utilized a simple method for hermeneutic analysis that requires only one person while maintaining research validity. Results: The findings of this study showed the frequency of nightmares decreased during the treatment. The client changed significantly during the treatment, and the dream analysis was responsible for this change. According to Bohart’s grid, there was 72% certainty of change in the client and 87% certainty that improvements were due to therapy. Useful therapeutic factors included analyzing the hidden meaning of nightmares, expressing emotions, self-awareness, and reducing helplessness. Conclusion: The results of the interventions showed that treatment processes made changes in the client that were unexpected and important to her and these changes would not have occurred without the treatment. This method, in addition to exposing the person to the content of the nightmare, leads to the discovery and decoding of the content of the nightmares and understanding of their message to resolve conflicts.

Nightmare frequency and nightmare distress during the COVID-19 pandemic.

The current study investigated nightmare frequency and distress during the pandemic and associated factors. Participants (n = 1,718) completed a survey, 747 of which were youth. The MADRE dream questionnaire was used to collect self-reported data on nightmare frequency and distress. In addition, personality traits, current stressors, and COVID-related anxiety were also measured. An ordinal regression model was used for statistical analysis, and P < .05 was considered significant. The findings from this study suggest (1) COVID-related anxiety is associated with the frequency of nightmares and the severity of nightmare distress experienced by a person, and (2) findings support the continuity hypothesis, which suggests waking life experiences are related to nightmares and (3) increased COVID-related anxiety contributes independently to nightmare frequency. COVID-related anxiety appeared to be more prevalent within adults (P < .001, effect size = 0.18) compared to youth. Similar results were found for nightmare distress. The risk of nightmares may have increased due to disruptions in mental health and sleep caused by the COVID-19 crisis. These findings may be important in clinician efforts to understand nightmares and the risk of problematic sleep during the pandemic. Remedios A, Marin-Dragu S, Routledge F, etal. Nightmare frequency and nightmare distress during the COVID-19 pandemic. J Clin Sleep Med. 2023;19(1):163-169.

Dreaming and Sleep-Related Metacognitions in Patients with Sleep Disorders.

Sleep-related metacognitions play a role in the etiology of insomnia and are distressing while falling asleep. Although similar concepts, such as thought suppression, have been studied in the context of dreaming, the relationship between sleep-related metacognitions and more negatively toned dreaming due to stressful pre-sleep experiences has yet to be studied. Overall, 919 patients with various sleep disorders completed the Metacognitions Questionnaire-Insomnia (MCQ-I20), Arousal Disposition Scale (APS), and Pre-Sleep Arousal Scale (PSAS) and kept a sleep diary over seven days eliciting dream recall, nightmare frequency, and the emotional tone of their dreams. The regression analysis showed that the MCQ-I20 (small effect size) and the APS (medium effect size) were associated with nightmare frequency and negatively toned dream emotions. These findings suggest that dysfunctional sleep-related metacognitions that are active prior to sleep are also associated with more negatively toned dreaming and more nightmares—even after controlling for trait arousability. It would be very interesting to study where therapeutic strategies, such as metacognitive therapy explicitly targeting sleep-related metacognition, could also be beneficial with regard to dreams (more positive dreams and fewer nightmares).

Nightmare Distress as a Risk Factor for Suicide Among Adolescents with Major Depressive Disorder.

PurposeNightmare is common and is also independently implicated in suicide risk among the adolescent population. Adolescents with major depressive disorder (MDD) are at an increased risk of suicide. Therefore, comorbid nightmares may amplify suicide risk among this clinical population. This study aimed to explore the effects of nightmares on suicide risk among adolescents with MDD.Patients and MethodsSubjects were 499 outpatients aged 12–18 in four large psychiatric hospitals clinic of China, from January 1 to October 31, 2021. Simultaneously, we matched 499 healthy controls according to gender and age. All participants underwent affective state (depressive and anxiety symptoms) and sleep variable (nightmare frequency/distress, insomnia symptoms, and daytime sleepiness) evaluation as well as MDD diagnoses and determination of suicide risk by a fully structured diagnostic clinical interview.ResultsAdolescents with MDD reported a higher incidence of frequent nightmares (at least one night per week) and level of nightmare distress than healthy controls (22.0% vs 6.1%; 28.85 ± 11.92 vs 17.30 ± 5.61). Over half of the patients with suicide risk (51.6%) experienced frequent nightmares compared with approximately one-third of those at a risk for suicide (30.7%). Patients with suicide risk scored scientifically higher on sleep variables, depressive and anxiety symptoms than those without the risk. Further logistic regression analysis indicated that female gender, junior grade, recurrent depressive episode, severe nightmare distress and severe depressive symptoms were independently and significantly associated with suicide risk.ConclusionOur study provided evidence that adolescents with MDD experienced a higher prevalence of frequent nightmares and suffered more nightmare distress. Nightmare distress is an independent risk factor for suicide risk.

Nightmare frequency and nightmare distress: Relationship to the big five personality factors and sensory-processing sensitivity.

Nightmare frequency and nightmare distress: Relationship to the big five personality factors and sensory-processing sensitivity.

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.

PurposeThe 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 MethodsFor 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).ResultsThe 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.ConclusionOur 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.

COVID-19 nightmare response and stress: A new Mexico sample based survey

Studies conducted during the COVID-19 Pandemic have reported increased rates of mental illnesses including depression, anxiety, and post-traumatic stress disorder (PTSD) [1]. A common symptom of mental illness is change in Rapid Eye Movement (REM) sleep, the phase of sleep associated with dreaming and nightmares. The COVID-19 pandemic offers a unique opportunity to evaluate the effects of systemic stress on nightmares.In this study, we investigate whether the COVID-19 pandemic affects nightmare frequency and content using a web-based survey within the state of New Mexico. The survey returned 197 responses showing an increase in the quantity of both bad dreams and nightmares. Furthermore, significant changes in nightmare themes were reported compared to relative rates prior to the pandemic (RR 1,42, p < 0.01; RR 5, p < 0.001). This novel data supports that increased stress from the COVID-19 pandemic has altered dream and nightmare content and frequency.

Schizotypy unfolding into the night? Schizotypal traits and daytime psychotic-like experiences predict negative and salient dreams

Symptoms of insomnia and frequent nightmares are prevalent in psychotic disorders, and are associated with psychotic-like experiences (PLEs) in the non-clinical population. Whereas the role of impaired sleep in psychosis was extensively examined by longitudinal and interventional approaches, studies on the association between psychosis and dream quality are scarce, and mainly cross-sectional. We conducted a three-week long prospective study in a group of healthy adults (N = 55), assessed schizotypal traits, daily PLEs, and the emotional quality of dreams recalled in the morning (N = 490). We extracted the latent factors of schizotypal traits and dream emotions, and examined the predictive value of trait-and state-like variables on day-to-day reports of PLEs and dream quality. PLEs reported in the evening predicted emotionally more negative and salient dream reports the following morning. On the other hand, the quality of dreams were not predictive of PLEs reported later during the day. Schizotypal personality traits were differentially associated with dream quality: Introvertive Anhedonia, Cognitive Disorganization, and General-Disorganized schizotypy were linked to more negative dream valence, whereas Unusual Experiences were associated with more salient dreams. Our findings highlight the relevance of the multidimensional nature of schizotypal traits, the role of different facets of schizotypy in daytime and nocturnal mental experiences, and the day-to-day associations between PLEs and dream affect. General scientific summaries (GSS)The aim of the study was to examine the temporal associations between psychotic-like experiences and dream emotions, taking into account the trait factors of schizotypy. Psychotic-like experiences during the evening hours predicted reporting more negative and salient dreams the following morning, and schizotypal personality traits were differentially associated with the dimensions of dream emotions.

Sleep in Paralympic athletes and its relationship with injuries and illnesses

ObjectivesTo evaluate sleep characteristics and investigate the relationship of sleep with injuries and illnesses in Paralympic athletes. DesignCross-sectional. SettingSports Training Center. Participants20 Paralympic athletes of athletics, swimming, and powerlifting. OutcomesInjury and illnesses were recorded during the sports season through the Oslo Sports Trauma Research Center questionnaire (OSTRC-BR). Sleep-wake pattern was monitored for 2 weeks using actigraphy. Chronotype, sleep quality, sleep behavior, and sleep complaints were cross-sectionally collected. ResultsPoor sleep quality and poor sleep behavior were highly prevalent. The mean total sleep time was 6.57 ± 49.91. Duration of naps (r= −0.46; p=0.04) was associated with occurrence of health problems; frequency of insomnia (r= 0.51; p= 0.02), Pittsburgh Sleep Quality Index score (r= 0.45; p=0.04), and frequency of awakenings at night (r= 0.58; p= 0.01) were associated with severity of health problems; frequency of movements during sleep was associated with OSTRC-BR cumulative score (r= 0.58; p=0.00); and frequency of nightmares was associated with OSTRC mean score. ConclusionsParalympic athletes tend to report poor sleep quality, have poor sleep behavior and sleep less than the recommended. Insomnia symptoms, awakenings at night, movements during sleep and poor sleep quality were associated with the occurrence and/or severity of health problems.

The autonomic activity of nightmare sufferers during sleep and emotion-evoking picture viewing

IntroductionIn nightmare disorder, dysfunctional emotion regulation goes along with poor subjective sleep quality, which is characterised by pathophysiological features such as abnormal arousal processes and sympathetic influences. Dysfunctional parasympathetic regulation, especially before and during REM phases, is assumed to alter heart rate (HR) and its variability (HRV) of frequent nightmare recallers.ObjectivesWe hypothesised that cardiac variability is attenuated in participants experiencing frequent nightmares as opposed to healthy control subjects during less deep sleep stages and an emotion-evoking picture-rating task.MethodsBased on the second-nights’ polysomnographic recordings of 24 nightmare disordered (NM) and 30 control (CTL) subjects, we examined HRV during pre-REM, REM, post-REM and slow wave sleep periods, separately. Additionally, ECG recordings of wakeful periods such as resting state before sleep onset and an emotional picture-rating task were also analysed.ResultsAccording to our results, a significant difference was found in the HR of the NM and CTL groups in the nocturnal segments but not during resting wakefulness before sleep onset, suggesting autonomic dysregulation, specifically during sleep in nightmare disorder. However, despite the accelerated HR of NM subjects at night, they did not exhibit lower HRV. Regarding the emotional task, we also found a contrast between the NM and CTL subjects’ HR and HRV, which might indicate altered processes of emotion regulation in nightmare disorder, but the two groups’ subjective picture ratings did not differ.ConclusionsIn summary, our study suggests that there might be some trait-like autonomic changes during sleep, but also state-like autonomic responses to emotion-evoking pictures in nightmare disorder.DisclosureNo significant relationships.

Bad dreams and bad sleep: Relationships between nightmare frequency, insomnia, and nightmare proneness.

Bad dreams and bad sleep: Relationships between nightmare frequency, insomnia, and nightmare proneness.

Interrelations between insomnia, dreaming, and schizotypy in the general population: A network model

IntroductionInsomnia and Nightmare disorder are the two most common comorbid sleep disturbances in psychotic conditions. However, insomnia and psychotic symptoms are umbrella terms that hide the heterogeneity of these concepts. Several studies have found that worsening sleep quality is associated with the strengthening of psychotic symptoms. Until now, there was less interest in the relationship between the specific insomnia symptoms (trouble with falling asleep, fragmented sleep, early awakenings, daytime consequences) and the specific dimensions of schizotypy (disorganization, unusual perceptual experiences, anhedonia, and impulsive nonconformity).ObjectivesThe study aimed to depict the network structure of insomnia, dreaming features (dream recall/bad dream/nightmare frequency), and schizotypy dimensions.MethodsExploratory network analysis was conducted on cross-sectional data of the general population (N=1419, 77 % female). We modeled the interrelations between insomnia symptoms (Athens Insomnia Scale), dreaming features (the frequency of dream recall/bad dreams/nightmares), and the dimensions of schizotypy (OLIFE-S).Resultsshow a highly connected network with strong stability. The nodes of schizotypy, insomnia, and dream feature perfectly correspond to their own clusters, but the nodes were also densely connected between the three clusters. Disorganization, frequent awakenings, and nightmares are the most central nodes of the clusters. The node of frequent nightmares seems to be the bridge symptom in this network which connects unusual experiences dimension and frequent awakenings.ConclusionsThese results suggest that specific dimensions of schizotypy and specific sleep complaints are differently connected. However further research is needed to investigate the finer details of these heterogenic phenomena.DisclosureNo significant relationships.

0676 Increased Depression Symptoms are Associated with Higher Nightmare Frequency within the Wisconsin Sleep Cohort

Abstract Introduction Nightmare frequency has been suggested as a strong clinical indicator of psychiatric disorders. Additionally, frequent nightmares are a possible underrepresented outcome of depression. As nightmares may increase the risk of negative health outcomes, such as suicide attempts, understanding possible sources of nightmare frequency is imperative. This study sought to examine the association between depression and anxiety on the incidence of high frequency of nightmares. Methods Using cross-sectional and longitudinal data from the Wisconsin Sleep Cohort, accessed through the National Sleep Research Resource, we conducted an analysis of demographics, co-occurring sleep disturbances, and mental health measures of participants experiencing ordinal frequencies of nightmares. The study sample included 758 Wisconsin state employees with a baseline and follow-up assessment (mean 4.46 years between visits; standard deviation 1.7). All participants were screened for depression and anxiety symptoms using the Zung Depression Scale (SDS), and the State-Trait Anxiety Inventory. Sleep disturbances, medication use, nightmares and insomnia were based on self-report. Nightmare frequency was categorized as high (≥2 per month) and low (&amp;lt;2 per month). Logistic regression was used to determine the association of baseline anxiety and depression scales (in the same model) with incidence of high nightmare frequency at follow-up, adjusted by age, sex, body mass index, hypertension medications, use of narcotics and caffeine. Results After adjusting for covariates, SDS scores at baseline were associated with an increased incidence of higher frequency of nightmares at follow-up (OR=1.05; 95%CI=1.01-1.10, p = 0.026), while anxiety at baseline was not (OR=1.03; 95%CI=0.99-1.07; p = 0.165). An increase in one unit of the SDS was associated with a 5% increase in the odds of presenting higher frequency nightmares at follow-up. Conclusion Participants with higher SDS scores had higher incidence of high frequency of nightmares upon follow up, however, those with anxiety did not. Further research should be targeted at gaining better understanding of the role of psychiatric conditions on the onset of nightmares. Support (If Any) NIH NHLBI (R01HL62252), NIA (R01AG036838, R01AG058680), and National Center for Research Resources (1UL1RR025011). The National Sleep Research Resource was supported by NIH-NHLBI (R24 HL114473, 75N92019R002).

0670 The role of social vigilance and hindrance-challenge stress in predicting nightmares among nurses

Abstract Introduction Increased exposure and reactivity to daytime stressors may heighten the frequency and severity of nightmares. Although research has examined the role of personality traits such as neuroticism in nightmares, it is unknown if other hypervigilance-related characteristics predict nightmares. Social vigilance, or monitoring one’s social environment for potential threats, is one factor that may influence stress reactivity and sleep. Nurses are one population who may be particularly susceptible to social vigilance and nightmares given their stressful work environments. The current study had two aims: 1) to examine the association between social vigilance and nightmares (assessed via retrospective questionnaire and via daily sleep diaries), and 2) to examine if perceived job stress strengthened the association between social vigilance and nightmares. Methods Participants were 464 nurses (mean age = 39.03 years, SD = 11.07 years, 91% female) recruited from two Dallas-area hospitals. At baseline, nurses completed the Social Vigilance Questionnaire (SVQ), the Nightmare Disorder Index (NDI; a newly validated scale measuring past-month nightmare frequency and severity), and the Challenge- and Hindrance-Related Self-Reported Stress Scale (CHRSS). Nurses then completed 14 days of sleep diaries to assess daily nightmare frequency, which were then summed across the 14 days. Multiple linear regression models were run to assess main effects of social vigilance and hindrance or challenge stress, as well as their interactions, on nightmares. Results Greater social vigilance (β = 0.10, p = 0.041) and greater hindrance stress (β = 0.13, p = 0.031) each predicted more nightmare symptoms as measured by the NDI, but not nightmare frequency as measured by the daily surveys. Only greater hindrance stress predicted greater daily nightmare frequency as measured by the daily surveys (β = 0.14, p = 0.015). Social vigilance did not interact with either hindrance or challenge stress to predict nightmares. Conclusion Results indicate nurses who report higher levels of social vigilance or hindrance stress at work experience more nightmare symptoms. Although more research is needed, supporting nurses who report high levels of stress and vigilance may help reduce their arousal and improve their sleep. Support (If Any) 1R01AI128359

0052 A mixed-methods examination of perceived challenges during the COVID-19 pandemic: Associations with sleep health and nightmares among healthcare workers

IntroductionThe emergence of CoVID-19 has created an immense burden on healthcare systems across the world, placing healthcare workers (HCWs) under significant, additional stress while they also confront multiple personal, family and sociopolitical challenges during the pandemic. Many studies have reported the negative impact of pandemic-related stress on sleep of HCWs. Our mixed-methods investigation sought to extend existing research by characterizing the themes of HCWs’ primary concerns during the early pandemic and identifying the most salient concerns which might be impacting sleep.MethodsNorth American HCWs (n = 1331) were surveyed during the “second wave” of CoVID-19 case increases (6/9/2020 – 8/17/2020), which included a questionnaire with measures of sleep health (RU-SATED) and nightmare frequency (PSQI). Additionally, each HCW was asked to openly-describe their most salient concern with regard to the pandemic. Each response was categorized by topic. T-tests were conducted to compare frequencies of each response category with sleep health and nightmare frequency.ResultsThe study sample comprised 1331 HCWs (91.7% female; 74.5% non-Hispanic white; 64.31% with exposure to CoVID-19 patients; 85.1% working in-person). Primary concerns were grouped into 8 categories including combinations of personal/familial-level concerns (e.g. concern about CoVID-19 infection/spread), and work-related stressors (e.g. increased workload). Concerns about lack of PPE/equipment was significantly associated with lower scores on RU-SATED (t = -2.69; p = .007) and increased nightmare frequency (t = 2.70; p = .007). Additionally, concerns about increased workload were significantly associated with lower scores on both RU-SATED (t = -2.79; p = .005) and increased nightmare frequency (t = 5.24; p = .000). Individually, primary concerns for CoVID-19 infection/spread was significantly associated with more-frequent nightmares (t = 2.01; p = .045). Neither sleep measure was associated with categories involving societal-level concerns (e.g. sociopolitical concerns) among the sample.ConclusionOur results indicate that the HCWs most concerned about workplace stressors during the pandemic indicated poorer sleep health and more frequent nightmares. Further analyses could help guide proper stratification of therapeutic approaches to improve sleep health and related distress for HCWs.Support (If Any)