Nightmare Disorder Research Articles

Bad dream, nightmares and psychopathology: a systematic review.

Bad dreams and nightmares can have a strong psychological impact. However, although the scientific literature points in the direction of an established association between nightmares and psychopathology, many of the studies investigating these links have been carried out on a general population. This systematic literature review aimed to identify studies that have used a sample from a population with a diagnosis of psychopathological disorders or a diagnosis of nightmare disorder, to highlight the state of knowledge concerning the link between bad dreams, nightmares, and psychopathology. The systematic review included all cross-sectional and longitudinal studies conducted on a psychiatric population in which variables related to bad dreams and/or nightmares were examined and published since 2014. The search was conducted in May 2024 in the PsychINFO and PubMed databases. A total of 34 studies published over the last decade met the inclusion criteria. Psychiatric populations are significantly more affected by nightmares and bad dreams than the general population. Furthermore, the presence of nightmares tends to maximize the clinical symptomatology of patients. However, there are still too few studies available to understand the basis of this relationship.

Nightmare frequency and nightmare distress in psychiatric inpatients.

Previous research indicated that the prevalence of frequent nightmares and/or the presence of a nightmare disorder is quite high in patients with mental disorders. In the present study, 75 randomly selected psychiatric inpatients were interviewed and completed questionnaires regarding nightmares, sleep, and psychopathology. The percentage of patients with nightmares once per week or more often was 61.54% in the group with PTSD diagnosis (N = 13) and 40.32% in the patients without PTSD diagnosis (N = 62). Moreover, depression scores and having PTSD were related to heightened nightmare distress. Based on the high prevalence rates of frequent nightmares, future research should aim at understanding better the interplay between psychopathology and nightmares and test whether nightmare interventions like Imagery Rehearsal Therapy might be beneficial for patients with mental disorders.

Marked Improvement of Nightmare Disorder and Backaches Following Treatment with Amphetamine Salts

Rationale: A relative deficiency of dopamine in various tissues leading to increased tissue permeability allowing infiltration of irritants to cause inflammation with subsequent pain, or disrupt normal function of organs, may be the etiologic factor in a wide variety of medical conditions. Evidence to support this hypothesis has been shown by quick improvement of symptomatology after treatment with dopaminergic drugs especially dextroamphetamine sulfate, but also cabergoline, for both corporeal conditions and psychological ones. Objective: To determine not only if treatment with dextroamphetamine may ameliorate backaches (which has been previously reported) but also improve chronic nightmare syndrome which has never been previously reported. Findings: A total daily dosage of 18.8mg of dextroamphetamine sulfate was not only able to immediately completely relieve the backache, but while taking it he did not have one nightmare during three months of treatment. Previously he never had one week for 30 years without at least 1-3 nightmares. Conclusion: Sometimes one case report provides more valid conclusions of the efficacy of a given drug than a randomized controlled study. The standard medication used for chronic nightmares is prazosin which may not be very effective in ameliorating chronic nightmares. The dramatic complete improvement of chronic nightmare syndrome, though it was only one patient, is sufficient for a treating physician to try dextroamphetamine therapy for prazosin failures or for patients who only had partial relief from prazosin and/or side effects, to try amphetamine therapy. Certainly, it would make sense to try dextroamphetamine for chronic nightmares if the patient also has other manifestations of the increased cellular permeability disorder.

Evaluating the Impacts of Parasomnias on Sleep and Exploring Their Therapeutic Interventions

Sleep disorders are topics of important discussion as they apply to a function crucial for the growth and development of individuals. Sleep plays a pivotal role in one's long-term health but various disorders may limit or prevent high-quality sleep for children and adults. One of these common disorder groups is parasomnias. As there is still much to learn in medicine when it comes to parasomnias and their treatments, it is of utmost importance to understand the processes behind the occurrence of parasomnias and their associated conditions. This review breaks down the most common parasomnias, categorizing them based on the onset of disease during rapid eye movement (REM) or non-rapid eye movement (NREM) sleep stages. This includes somnambulism (sleepwalking), confusional arousals, night terrors, REM behavior disorder (RBD), nightmare disorder, and others. It highlights the characteristics of diagnosis for these individual disorders and attempts to evaluate them through an etiological, epidemiological, and pathophysiological lens. This review also presents the current pharmacological and non-pharmacological interventions for these disorders.

Association of nightmares with cardio-cerebrovascular disease, hypertension and hyperlipidemia in older adults: A population-based cross-sectional study

ObjectiveThis cross-sectional study investigated the relationship of nightmares with cardio-cerebrovascular disease (CVD), hypertension and hyperlipidemia which are major preceding diseases of CVD in older adults. MethodsParticipants (n = 2824; mean age 63.6 ± 6.6 years, females 49.3%) completed the Disturbing Dream and Nightmare Severity Index (DDNSI), which was used to divide the sample into either the Nightmare or Non-Nightmare group (cut-off score ≥ 10). Demographic information, history of CVD (cerebrovascular disease, myocardial infarction, congestive heart failure, coronary artery disease, and arrhythmia), hypertension, hyperlipidemia, and self-report questionnaires about stress (Perceived Stress Scale), depression (Beck Depression Inventory), sleep quality (Pittsburgh Sleep Quality Index), and insomnia symptoms were also collected. ResultsAmong the sample, 379 participants (13.4%) reported experiencing nightmares more than once a year, and 73 participants (2.6%) were classified as having nightmare disorder based on DDNSI scores (≥10). 11.3% of participants (n = 319) reported having more than one CVD. Approximately half of the participants reported a history of hypertension (52.1%, n = 1471) and hyperlipidemia (47.7%, n = 1346). Logistic regression analysis indicated the Nightmare group was 2.04 times at higher risk for hyperlipidemia (OR = 2.04, 95% CI 1.22–3.40, p = .006) after controlling for covariates compared to the Non-Nightmare group. Although non-significant, there was a trend toward a higher risk of hypertension in the Nightmare group (OR = 1.67, 95% CI 0.99–2.84, p = .056). ConclusionsResults of this study indicate frequent nightmares in older adults may be associated with hyperlipidemia, which are risk factors for CVD. Further studies are needed to explore nightmares' directionality and health consequences in an aging population.

Features of Nightmare Disorder and Trauma-associated Sleep Disorder Among U.S. Military Personnel (S36.007)

Features of Nightmare Disorder and Trauma-associated Sleep Disorder Among U.S. Military Personnel (S36.007)

Sleeping Problems or Emerging Psychosis? A Review of Emerging Literature

IntroductionSleep disturbance, particularly insomnia, is prevalent across various mental health disorders. While it is a common sign in mood disorders, emerging evidence suggests that insomnia might act as a precursor or an early sign of psychosis. Our case report and literature review emphasize the importance of evaluating sleep disturbances in the diagnosis and management of mental disorders.Objectives-To explore potential neurobiological underpinnings linking sleep disturbances to psychosis onset.-To advocate for the importance of early identification and intervention for sleep disturbances in the broader context of preventing or managing psychotic disorders. Methods We present a case describing a young patient’s first episode of psychosis, which was masked by an initial presentation of insomnia. Additionally, we conducted a review of the relationship between sleep disturbances and psychosis, with a comprehensive literature search from Pubmed, Scopus and psychINFO.Results A 20-year-old African-American male with a history of poor sleep was initially diagnosed with Major Depressive Disorder. He was treated with Bupropion, Quetiapine, and Trazodone. However, he later presented with worsening depression, odd behavior, and signs of disorganization, suggestive of a psychotic episode. After switching his medication to Risperidone 4mg twice daily, the patient’s sleep and other symptoms markedly improved. Through our literature review, we identified that sleep disturbances, especially insomnia, can be a risk factor for developing psychosis. While a cross-sectional study recorded one-fourth of their study population experiencing First Episode Psychosis (FEP) with clinical insomnia, another study reported close to 80% of their study sample with early psychosis suffering from a minimum of one sleep disorder; insomnia and nightmare disorder being the most frequent. A large sample longitudinal analysis lasting one year also observed patients with sleep disorders to be twice at risk of onset and persistence of psychotic episodes. A growing body of evidence also suggests that structural brain abnormalities and neural development alterations in the early stages of psychosis may lead to sleep disturbances and subsequent psychotic symptoms. Findings suggest that thalamic dysfunction may in particular contribute to sleep spindle deficits and altered EEG microstate dynamics. These deficits are unrelated to antipsychotic medication exposure, and are also not observed in patients with other psychiatric illnesses.Conclusions While the correlation between sleep disorders and psychosis has been well-established for decades, very limited literature is available on the role of sleep in FEP. Recognizing and treating sleep disturbances is pivotal in managing psychiatric disorders, including psychosis. Thus, a comprehensive evaluation of sleep issues in patients presenting with psychiatric symptoms is imperative for accurate diagnosis and management.Disclosure of InterestNone Declared

Construction and Initial Examination of Inter-Rater Reliability of a Structured Clinical Interview for DSM-5-TR Sleep Disorders (SCISD) – Kid

ABSTRACT Study Objectives To construct and evaluate the inter-rater reliability of the Structured Clinical Interview for DSM-5-TR Sleep Disorders – Kid (SCISD-Kid). Method The SCISD-Kid was modeled on the adult SCISD-R and accounted for pediatric developmental and sociocultural factors. Fifty sleep-disturbed children (M age = 11.9, SD = 2.9) and 50 caregivers responded to the final SCISD-Kid. Video recordings were double-scored to evaluate inter-rater reliability. Results The final SCISD-Kid contained approximately 90 questions. Eight of the nine covered disorders had prevalence rates sufficient for analyses for both samples (i.e., k > 2). Inter-rater reliability was examined using Cohen kappa coefficients (κ); reliability estimates ranged from excellent to good. For youth, restless legs syndrome yielded the lowest reliability (.48), while nightmare disorder, narcolepsy, and NREM sleep arousal disorder – sleepwalking type showed the highest reliability (1.00). Across caregivers, NREM sleep arousal disorder – sleep terror type (.49) and hypersomnolence (.54) had the lowest reliability. In contrast, circadian rhythm – delayed sleep phase type, nightmare disorder, and NREM sleep arousal disorder – sleepwalking type showed the highest reliability (1.00). Conclusions The SCISD-Kid is a promising tool for screening sleep disorders. It showed good to excellent reliability across both samples. Next steps for validation will be discussed.

A prospective study of nightmare disorder among Chinese adults in Hong Kong: Persistence and mental health outcomes

ABSTRACT Objectives Previous studies showed that nightmares are prevalent and are associated with negative health outcomes. However, no empirical data is available demonstrating the extent to which nightmare disorder persists over time. Current literature provides a limited understanding of the trajectory and wider mental health outcomes of nightmare disorder. This longitudinal study examined the persistence and mental health outcomes of nightmare disorder. Methods A total of 230 Hong Kong Chinese adults completed standardized assessments twice with an interval of about 6 months. Results Over half (66.7%) of the participants with probable nightmare disorder at baseline remained to meet the DSM-5 criteria for the disorder at follow-up. Participants with probable nightmare disorder at baseline were significantly more likely to screen positive for PTSD (82.1% vs 18.3%) (p < .001) (p < .001), and they reported higher rates of mental health service usage at both timepoints (p = .001 to .003). Baseline nightmare disorder severity was negatively associated with subsequent self-rated mental health (β = -.151, p = .010) and self-esteem (β = -.141, p = .009) and it also predicted subsequent PTSD symptoms (β = .122, p = .012). Conclusions This study provides first empirical data showing that nightmare disorder could be persistent over time. Nightmare disorder symptoms are associated not only with PTSD symptoms but also with a broader range of mental health issues. This study points to the public health importance of identifying and managing nightmare disorder symptoms in the community. Additionally, the presence of nightmare disorder symptoms may be a helpful indicator for identifying post-traumatic stress.

Brief Psychoeducational and Cognitive Therapy for Nightmare Disorder (BPCT-ND)

AbstractIn adults, nightmare disorder is related to sleep deprivation, drug consumption or abuse, or other comorbid sleep disorders such as insomnia or insufficient sleep syndrome. Behavioral treatment has solid scientific evidence in disorders such as insomnia and, more recently, parasomnias. The aim of the present study was to investigate the clinical effectiveness of a Brief Behavioral Telemedicine Therapy in Nightmare Disorder in a 23-year-old female patient. The procedure consisted of the case study, with pre and posttreatment measures as well as follow-up after 1 month; and the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Paris Arousal Disorders Severity Scale, and a sleep diary were applied. In parallel with changes recorded in the sleep diary, a decrease in nightmares, sleepiness, and insomnia symptoms was observed when the intervention was finished. The behavioral intervention was clinically effective; therefore, the present case report provides information on behavioral treatments for nightmare disorder.

AGE-STRATIFIED INVESTIGATION OF SLEEP DISORDERS AND PTSD PREVALENCE AMONG VIETNAM VETERANS

Abstract Military Veterans often experience a range of sleep disorders that significantly impact their physical and psychological wellbeing. Current study describes prevalence and age differences (≥65 to ≤74yrs; n =193)) vs. (≥75 to ≤ 90yrs; n =157) across insomnia, obstructive sleep apnea (OSA), nightmare disorder (ND), and posttraumatic stress disorder (PTSD). Vietnam Veterans (N = 350; AgeMean= 74.4 [SD= 3.6]) completed a survey (online or paper) of their sleep experiences and PTSD as part of a cross-sectional study. Veterans were mostly White (95%), male (97.7%), from the Army (55%), with some or two-year college (43%), and currently married (76%). Insomnia was screened positive in 27.7% of the Veterans, OSA in 58.6%, ND in 5.7%, and PTSD in 18.6%. There were significant mean differences in insomnia and PTSD across age groups (t(348) = 2.43, p = .016) and (t(348) = 2.06, p =.04), respectively, with younger age group showing higher insomnia, and PTSD. There were no significant mean differences in OSA and ND. Pearson correlation analyses yielded important associations. Insomnia was significantly positively correlated with PTSD (r= .60), OSA (r= .33), and ND (r= .51). PTSD was significantly positively correlated with OSA (r= .30) and ND (r= .67). ND was significantly positively correlated with OSA (r= .22). There were no significant differences in the associations across the two age groups. Recognizing and addressing various sleep disorders and comorbid PTSD are crucial to improving the quality of life of Veterans. Results emphasize need for comprehensive assessment of sleep disorders and PTSD among Veterans.

P015 Dreams, Nightmares and the Relationship with Death Anxiety and Spiritual practices

Abstract Introduction Dreams that evoke intense negative emotions and anxiety, called nightmares, are often linked to mental health conditions like trauma, anxiety disorders, and death anxiety. Historically, people turned to religious and spiritual practices to address anxieties about death, but there has been a decline in such practices in recent years. This study presents preliminary data investigating the relationship between dreams, nightmares, religious/spiritual practice, and death anxiety. Methods Participants &amp;gt;18 years completed a 20-minute survey via REDCap. The survey collected demographic data and validated questionnaires investigating dreams, nightmares, sleep, insomnia symptoms, religious/spiritual practice, mental health, and death anxiety. Results Preliminary data shows that 67% of the sample were married or in a de facto relationship, consisted of primarily female participants (66%), and only 11% had a diagnosed sleep disorder. 56% had a high engagement in the distinct forms of spiritual/religious practice; this was more evident in females (59% vs 48%). The most common dream for males and females was being chased or pursued. 19% of the sample have a potential nightmare disorder, consistent between the sexes. 25% of people have poor sleep quality (PSQI ≥5); this was more prevalent in males (43% vs 22%). 16% of people had clinical insomnia, which was consistent between the sexes. Finally, 16% of people have clinical death anxiety, with a higher prevalence in females (18% vs 10%). Discussion This study's data will help us understand how dreams and spirituality can help alleviate death anxiety, offering new insights for mental health interventions.

The nightmare severity index (NSI): A short new multidimensional tool for assessing nightmares.

This psychometric pilot study aims to evaluate a new multidimensional simple scale, named the nightmare severity index (NSI) - close to the existing insomnia (ISI) and hypersomnia (HSI) severity indexes. The NSI encompasses all main dimensions of nightmare disorder, evaluating four subdimensions: frequency, emotional impact, diurnal impact, and nocturnal impact of nightmares. The NSI was completed by a total of 102 patients. The majority of the population consisted of women (64%) and outpatient individuals (76%) diagnosed with mood disorders such as depression (31%) and bipolar disorder (41%). Comorbidity with post-traumatic stress disorder (PTSD) was prevalent (44%), and psychotropic medications were commonly used (47%). Internal validity analyses indicated that the NSI was well suited for exploratory factor analysis. All items demonstrated satisfactory correlations with the factors, and the questionnaire exhibited good internal consistency (Cronbach's alpha >0.7). Higher NSI scores were observed among individuals experiencing nightmare symptoms considering the DSM-5/ICSD-3 criteria. In summary, the NSI proves to be a promising and valuable tool for clinical practice, demonstrating good acceptability, internal validity, and the ability to assess nightmare severity.

Evidence for an emotional adaptive function of dreams: a cross-cultural study

The function of dreams is a longstanding scientific research question. Simulation theories of dream function, which are based on the premise that dreams represent evolutionary past selective pressures and fitness improvement through modified states of consciousness, have yet to be tested in cross-cultural populations that include small-scale forager societies. Here, we analyze dream content with cross-cultural comparisons between the BaYaka (Rep. of Congo) and Hadza (Tanzania) foraging groups and Global North populations, to test the hypothesis that dreams in forager groups serve a more effective emotion regulation function due to their strong social norms and high interpersonal support. Using a linear mixed effects model we analyzed 896 dreams from 234 individuals across these populations, recorded using dream diaries. Dream texts were processed into four psychosocial constructs using the Linguistic Inquiry and Word Count (LIWC-22) dictionary. The BaYaka displayed greater community-oriented dream content. Both the BaYaka and Hadza exhibited heightened threat dream content, while, at the same time, the Hadza demonstrated low negative emotions in their dreams. The Global North Nightmare Disorder group had increased negative emotion content, and the Canadian student sample during the COVID-19 pandemic displayed the highest anxiety dream content. In conclusion, this study supports the notion that dreams in non-clinical populations can effectively regulate emotions by linking potential threats with non-fearful contexts, reducing anxiety and negative emotions through emotional release or catharsis. Overall, this work contributes to our understanding of the evolutionary significance of this altered state of consciousness.

Sleep disorders and suicide attempts following discharge from residential treatment

IntroductionSuicide is a significant public health concern and its prevention remains a top clinical priority of the Veterans Health Administration. Periods of transition in care (e.g., moving from inpatient to outpatient care) represent a period of increased risk. Sleep disorders are prevalent amongst Veterans and are modifiable risk factor for suicide. The present study examined the relationship of sleep disorders to time to suicide attempt amongst Veterans known to have attempted suicide in the 180 days following discharge from a Mental Health Residential Rehabilitation Treatment Program.MethodThe present sample was comprised of all Veterans enrolled in services with the Veterans Health Administration known to have attempted suicide following discharge from a Mental Health Residential Rehabilitation Treatment Program during Fiscal Years 13 and 14 (N = 1,489). To create this sample, electronic medical record data were extracted from two VHA data sources: the Corporate Data Warehouse and the Suicide Prevention Application Network.ResultsCox regression models revealed that Veterans with a sleep disturbance (N = 1,211) had a shorter time to suicide attempt than those without a sleep disturbance [Hazard Ratio (HR) = 1.16, CI (1.02–1.32)]. A subsequent Cox regression model including age, insomnia, nightmare disorder, and alcohol dependence revealed that sleep-related breathing disorders [HR = 1.19, CI (1.01–1.38)], alcohol dependence [HR = 1.16, CI (1.02–1.33)], and age group were associated with increased risk.ConclusionFindings indicate that sleep disturbance, primarily driven by sleep-related breathing disorders, was associated with time to suicide attempt in this sample of high-risk Veterans known to have attempted suicide in the 180 days following their discharge from a Mental Health Residential Rehabilitation Treatment Program. These findings reveal an opportunity to reduce risk through the screening and treatment of sleep disorders in high-risk populations.

Sex differences in US military personnel with insomnia, obstructive sleep apnea, or comorbid insomnia and obstructive sleep apnea.

The aim of this study was to evaluate sex-related differences in symptoms of sleep disorders, sleep-related impairment, psychiatric symptoms, traumatic brain injury, and polysomnographic variables in treatment-seeking military personnel diagnosed with insomnia, obstructive sleep apnea (OSA), or comorbid insomnia and OSA (COMISA). Participants were 372 military personnel (46.2% women, 53.8% men) with an average age of 37.7 (standard deviation = 7.46) years and median body mass index of 28.4 (5.50) kg/m2. Based on clinical evaluation and video-polysomnography, participants were diagnosed with insomnia (n = 118), OSA (n = 118), or COMISA (n = 136). Insomnia severity, excessive daytime sleepiness, sleep quality, nightmare disorder, sleep impairment, fatigue, posttraumatic stress disorder, anxiety, depression symptoms, and traumatic brain injury were evaluated with validated self-report questionnaires. Descriptive statistics, parametric and nonparametric t-tests, and effect sizes were used to assess sex differences between men and women. There were no significant differences between women and men with insomnia or OSA in sleep-related symptoms, impairment, or polysomnography-based apnea-hypopnea index. Military men with COMISA had a significantly greater apnea-hypopnea index as compared to military women with COMISA, but women had greater symptoms of nightmare disorder, posttraumatic stress disorder, and anxiety. In contrast to civilian studies, minimal differences were observed in self-reported sleep symptoms, impairment, and polysomnography metrics between men and women diagnosed with the most frequent sleep disorders in military personnel (ie, insomnia, OSA, or COMISA) except in those with COMISA. Military service may result in distinct sleep disorder phenotypes that differ negligibly by sex. Mysliwiec V, Pruiksma KE, Matsangas P, etal. Sex differences in US military personnel with insomnia, obstructive sleep apnea, or comorbid insomnia and obstructive sleep apnea. J Clin Sleep Med. 2024;20(1):17-30.

0657 Incidence and Features of Nightmares and Trauma Associated Sleep Disorder in U.S. Military Personnel with Sleep Disturbances

Abstract Introduction The incidence and clinical significance of nightmares is difficult to estimate due to varying criteria across studies. The Nightmare Disorder Index (NDI) is a validated measure to evaluate nightmare disorder. However, there is no measure to differentiate trauma-related nightmares compared to trauma associated sleep disorder (TSD), a unique REM parasomnia. The objectives of this study were to (1) determine the incidence of nightmare disorder and TSD in patients referred for a clinically indicated sleep evaluation, and (2) further characterize TSD. Methods All initial sleep referrals completed intake questionnaires including validated measures such as the NDI, Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI). Patients who endorsed at least weekly nightmares related to trauma, with vocalizations or disruptive nocturnal behaviors, and autonomic surges additionally received a structured clinical interview focusing on thematic content of dreams, dream enactment behavior, self-reported symptoms of autonomic hyperactivity, and, if previously treated, nightmare severity before and after therapy. Results 102 new patients completed the NDI and 56.9% (58) met criteria for probable nightmare disorder (ND). Of the 58 patients with probable ND, 13.8% (8) had symptoms consistent with TSD (7.8% of new referrals). Compared to ND patients, TSD patients were more likely to have higher ISI (24.0 ± 3.0 vs. 18.6 ± 5.6) (p=0.023) and total NDI score (15.8 ± 3.5 vs. 10.0 ± 3.7) (p&amp;lt; 0.001), but not ESS (p=0.158). Structured interview revealed all TSD patients had significant daytime distress or impairment. The nature of trauma was combat for 3 individuals, physical assault for 1, and sexual assault for 4 (one occurring while deployed). All individuals reported tachycardia secondary to nightmares and tachypnea and diaphoresis were each reported in 75% of patients. Regarding dream content, 25% endorsed accurate replay of trauma, 25% related to trauma but non-replay, and 50% mixed. For DNB, 87.5% of patients endorsed vocalization (moaning, screaming, or yelling), 87.5% endorsed movements (tossing, turning, or thrashing), and 37.5% endorsed combative behaviors (striking of bed partner). Conclusion This study reports a surprisingly high incidence of probable ND among all new sleep medicine patients. TSD appears to be a clinically distinct, more severe parasomnia compared to ND. Support (if any)

0667 A digital prescription therapeutic device to treat nightmare disorders: A case series

Abstract Introduction Introduction: Nightmare disorder and post-traumatic stress disorder (PTSD)-associated nightmares can be treatment-resistant in many patients. There are no recommended treatments for these conditions currently. Methods Methods: NightWare is a novel FDA-approved class II medical device which improves sleep in patients with nightmare disorder and PTSD-associated nightmares. It uses data from a smart watch to determine when nightmares are happening using heart rate and movement sensors, and then intervenes to interrupt the nightmare and improve overall sleep quality. We report the 14 consecutive cases of patients using NightWare and the Clinical Global Impression (CGI) of Severity and Change in their sleep and reduction of nightmare burden. Results Results: Of the 14 patients in this series, 10 patients used the device for more than 7 days. 1 discontinued due to perceived lack of efficacy, 2 stopped in part due to a skin rash, and one stopped because he did not want to wear a watch to sleep. At baseline, the 10 patients included in the analysis had a mean CGI Severity score of 4.7 (SD 1.25), which indicates moderate to severe nightmares and daytime dysfunction. Improvement in the CGI Change score with NightWare exceeded that of prazosin for this group of patients. The patients in this series that used the device had a mean score of 2.20 (SD 0.79) on the CGI Change scale, which indicates there was significant improvement from baseline. Six of the 10 patients using NightWare were also taking prazosin prior to starting NightWare. The prazosin dose ranged from 1-8 mg nightly for these patients. These 6 patients had minimal improvement with prazosin alone (CGIC of 3.16 (SD 0.41). Conclusion Conclusion: In this case series, NightWare significantly improved the symptoms of nightmare disorder in 10 of the 14 patients in this series. Patient selection for sympathetic nervous system activation is important to ensure the device’s effectiveness. Support (if any)

0672 Nightmare Disorder &amp; Insomnia Severity in Complex Posttraumatic Stress Disorder

Abstract Introduction Most adults experience a traumatic event at some point in their lifetime, and some also go on to develop posttraumatic stress disorder (PTSD). Sleep disorders such as insomnia and nightmares are common in PTSD, which may be due to hyperarousal and distressing memories that disrupt the sleep-wake cycle. Complex PTSD (C-PTSD) is a new distinct diagnosis of PTSD that includes three new symptom domains: emotional dysregulation, negative self-cognitions, and interpersonal hardships. Despite evidence linking PTSD and sleep disturbances, this work has yet to be extended to C-PTSD. To address this gap, the current study examined the association between nightmares, insomnia, and C-PTSD symptoms, as well as explored gender and the time elapsed since the traumatic event as moderating variables. Methods Data were obtained from a sample of 243 trauma-exposed participants recruited online. Most participants identified as White (n = 207; 85%), non-Hispanic (n = 219; 90%), and female (n = 135; 56%), with an average age of 37.26 years (SD = 11.39). The Complex Trauma Inventory (CTI) and International Trauma Questionnaire (ITQ) were utilized to measure C-PTSD symptoms. Results Greater C-PTSD symptoms measured via the CTI were associated with greater insomnia symptoms (b = 3.22, 95% CI [2.46, 3.97]) and nightmare disorder symptoms (b = 2.14, 95% CI [1.57, 2.72]). Similarly, greater C-PTSD symptoms measured via the ITQ were also associated with greater insomnia symptoms (b = 0.28, 95% CI [0.22, 0.34]) and nightmare disorder symptoms (b = 0.18, 95% CI [0.13, 0.23]). No moderating effects of gender or time elapsed since trauma were found. Conclusion Results underscore that C-PTSD symptoms are strongly linked to nightmares and problems falling asleep, staying asleep, and waking up too early—regardless of a person’s gender identity or how long ago they experienced a traumatic event. Findings may inform more targeted, sleep-focused cognitive-behavioral treatments for C-PTSD. Support (if any)

0659 Nightmares in the acute aftermath of trauma predict later suicidal ideation in trauma survivors

Abstract Introduction Nightmares are a common occurrence after experiencing a traumatic event and are a symptom of post-traumatic stress disorder (PTSD). Additionally, nightmares are associated with higher levels of suicidal ideation, attempt, and death from suicide. Nightmares may be an early sign of suicide risk in populations that have experienced trauma, however, there are no studies that have investigated this potential link. This study aims to determine whether more severe nightmares in the aftermath of trauma will prospectively predict later suicidal ideation, independent of comorbid insomnia. Methods We recruited adults that were admitted to the intensive care unit at Henry Ford Hospital in Detroit after experiencing a DSM-5 Criterion A traumatic event (N = 76, Mage = 38.39, 65.8% male). Participants completed study surveys at three time points: T1 (an average of 6 days after trauma), T2 (two weeks after T1), and T3 (1 month after T1). Nightmare and insomnia severity were measured at T2 with the Nightmare Disorder Index (NDI) and Insomnia Severity Index (ISI), respectively. Suicidal ideation was measured at T3 using item nine on the Patient Health Questionnaire (PHQ-9). Results More severe nightmares in the acute aftermath of trauma (T2) predicted more severe SI two weeks later at T3 (β = 0.49, SE = .17, p = .004, R2 = .22). This association remained even after adjusting for T1 SI, T2 ISI, age, and sex (β = 0.36, SE = .18, p = .044, R2 = .31). Conclusion More severe nightmares in the acute aftermath of trauma predicted more severe SI one month after trauma, independent of comorbid insomnia symptoms and baseline suicidal ideation. These findings suggest that the onset of nightmares immediately after trauma may confer a unique risk for SI. In clinical practice, it may be useful to detect nightmares in the aftermath of trauma using brief measures such as the NDI. Trauma survivors that develop frequent and severe nightmares within the acute recovery phase could then be given targeted nightmare treatment to reduce the risk of later SI. Support (if any)