Prevalence Of Nightmares Research Articles

Understanding and Treating Nightmares: A Comprehensive Review of Psychosocial Strategies for Adults and Children.

Nightmares are distressing dreams that evoke strong negative emotions, such as fear or anxiety, often leading to waking from sleep and subsequent sleep disruption. They are prevalent across various age groups, with significant psychological and physiological health implications. This review explores the nature of nightmares, distinguishing them from other sleep disturbances like night terrors and sleep paralysis. It examines the prevalence of nightmares in children and adults, highlighting their impact on mental health and daily functioning. The review also emphasizes the importance of addressing nightmares through effective treatment strategies. While pharmacological options are available, psychosocial interventions offer promising non-pharmacological solutions. Cognitive behavioral therapy (CBT), imagery rehearsal therapy (IRT), and mindfulness-based therapies are discussed as key approaches for managing nightmares. These strategies focus on altering maladaptive thought patterns and emotional responses, reducing nightmares' frequency and intensity, and improving overall sleep quality. Psychosocial interventions provide a comprehensive approach to treating nightmares by addressing the underlying cognitive and emotional factors, benefitting individuals across different age groups. This review aims to highlight the efficacy of these strategies and their role in enhancing the quality of life for those affected by persistent nightmares.

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.

Associations between frequent nightmares, nightmare distress and depressive symptoms in adolescent psychiatric patients

BackgroundNightmares are common in patients with psychiatric disorders. Patients with psychiatric disorders often experience depressive symptoms. Nightmares have been associated with depressive symptoms among adolescents. Previous studies have explored the mediating role of nightmare distress in the relationship between frequent nightmares and depressive symptoms in the general adolescent population. We aimed to explore the associations between frequent nightmares, nightmare distress, and depressive symptoms in Chinese adolescent patients with psychiatric disorders. MethodsA total of 408 adolescents participated in this study. A self-administered questionnaire was used to measure nightmare frequency, nightmare distress, depressive symptoms, and covariates. Linear regressions and mediation analyses were performed to examine the associations between nightmare frequency, nightmare distress, and depressive symptoms. ResultsThe mean age of participants was 15.31 ± 1.88 years, and 152 (37.3%) were boys. The prevalence of frequent nightmares in adolescent patients with psychosis was 49.3%. Girls reported more frequent nightmares and had significantly higher scores of depressive symptoms and nightmare distress. Patients with frequent nightmares had higher scores of nightmare distress and depressive symptoms. Frequent nightmares and nightmare distress were significantly associated with depressive symptoms. Nightmare distress had a full mediating effect on the correlation between frequent nightmares and depressive symptoms. ConclusionsIn Chinese adolescent patients with psychiatric disorders, frequent nightmares and nightmare distress were associated with depressive symptoms, whereas the association between frequent nightmares and depressive symptoms was mediated by nightmare distress. Interventions for nightmare distress may be more useful in reducing depressive symptoms in adolescent patients with psychiatric disorders.

Psychological and sociological characteristics of students suffering from nightmares

Aim. To assess the impact of nightmarish dreams on various aspects of medical students' lives.Materials and methods. A sociological survey was conducted among students of 1–6 courses of five medical universities using an online form which included the following questionnaires: the Pittsburgh Sleep Quality Index, the Hamburg Nightmare Questionnaire, the Insomnia Severity Scale, the Hospital Anxiety and Depression Scale, the Beck Anxiety and Depression Scale. Academic performance was assessed according to the average score of the student's record book according to a 5-point system.Results and conclusions. A high prevalence of both insomnia and nightmares among medical students was found. The high frequency of nightmares was associated with high levels of anxiety and depression. The frequency of nightmares was associated with deterioration of sleep quality, frequency and degree of sleep impairment. Nightmarish dreams had a negative impact on the quality of cognitive activity assessed by academic performance.

Characterization of sleep among deaf individuals

ObjectivesNumerous health disparities are documented in deaf population research, but few empirical sleep assessments exist for this under-served population, despite knowledge that sleep contributes to physical and mental health disparities. We sought to document subjective and objective sleep in deaf adults with cross-sectional and prospective measures. MethodsTwenty deaf participants completed validated sleep and mental health questionnaires, 2-weeks of nightly sleep diaries and continuous wrist-worn actigraphy monitoring, and 1-week of nightly, reduced-montage EEG recordings. ResultsQuestionnaire data suggest high prevalence of insomnia (70%), poor sleep (75%), daytime sleepiness (25%) and nightmares (20%) among participants. Strong correlations were found between depression and sleep quality, fear of sleep, and insomnia severity (p’s < .005). Objective sleep assessments suggest elevated wake after sleep onset and low sleep efficiency and sleep duration. ConclusionsThe prevalence of sleep disturbance recorded from self-report and objective sleep measures provides preliminary evidence of sleep health disparity among deaf adults.

Prevalence of frequent nightmares and their prospective associations with 1-year psychiatric symptoms and disorders and functioning in young adults: a large-scale epidemiological study in Hong Kong.

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. Participants were consecutively recruited from a large-scale epidemiological youth mental health study in Hong Kong (n = 3132). A subset of participants were invited for a follow-up assessment after 1 year (n = 1154 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 generalized anxiety disorder (GAD), both at baseline and follow-up. The long-term functional implications of frequent nightmares were also examined. 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. 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.

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 psychopathological problems in a large sample of Chinese adolescents.

Nightmares are common, especially in pediatric populations and psychiatric patients. Nightmares are associated with daytime distress and negative health outcomes. The data on the prevalence and psychopathological profiles of nightmares in Chinese adolescents are limited. This study examined age and gender differences in nightmare frequency and associated psychopathological problems in a large sample of Chinese adolescents. A total of 11,831 adolescent students (mean age = 14.9, 12-18years) participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort. Participants completed a self-administered questionnaire to report their nightmare frequency, trait anger, hopelessness, and multiple domains of behavioral/emotional problems. Univariate and multivariate analyses were performed to examine psychopathological problems in relation to nightmare frequency. Of the sample, 45.2% reported having nightmares at least once in the past month and 7.9% at least once/week. Girls reported more frequent nightmares than boys. Nightmare frequency significantly declined with age for both boys and girls. Mean scores on trait anger, hopelessness, attention, internalizing problems, and externalizing problems significantly increased with nightmare frequency. Frequent nightmares (at least once/week) were significantly associated with 2-4-fold increased likelihood of behavioral/emotional problems after adjusting for adolescent and family covariates. Nightmares are prevalent in Chinese adolescents. Frequent nightmares are associated with multiple domains of psychopathological problems. Assessment and intervention of frequent nightmares should be incorporated into routine clinical practice and mental health services in adolescents.

A clinical approach to nightmares and bad dreams in cognitive–behavioural therapy

SUMMARYClinicians trained in cognitive–behavioural therapy (CBT) are frequently not trained to work with dreams. Given the high prevalence and impact of nightmares and bad dreams, empowering CBT therapists to effectively work with these sleep phenomena is crucial to improve therapeutic outcomes. This article briefly outlines a cognitive–behavioural model of dreams and reviews some clinical guidelines for directly and indirectly addressing nightmares and bad dreams in CBT practice.

Behavioral problems in the children of women who are victims of intimate partner violence.

The purpose of this study was to investigate the association between the maternal experience of intimate partner violence (IPV) and children's behavioral problems. The secondary data of the National Survey on Women's Health and Life Experience, which included 980 Cambodian children aged 6-12years whose mothers responded to questions, were analyzed. IPV was measured as any experience of physical or sexual violence against a woman by her husband. The children's behavioral problems were indicated by nightmares, bed-wetting, timidity, and aggressive behavior as reported by their mothers. The children of the women who had experienced sexual violence had a higher prevalence of nightmares (adjusted OR (aOR)=2.22, 95% CI: 1.421-3.470), bed-wetting (aOR=2.15, 95% CI: 1.398-3.308), and timidity (aOR=1.80, 95% CI 1.075-3.019) than those without reported IPV. The children of mothers who had experienced physical violence had a higher rate of aggression (OR=2.19, 95% CI: 1.321-3.630). The Cambodian children exposed to IPV against their mothers experienced more behavioral problems. This study presents evidence to support changes in current policy to prevent violence and alleviate behavioral problems.

Measuring Stress Experienced by University Students

Background: University students often report feeling intense stress, high anxiety, depressive feelings, low self-esteem, suicidal ideation, and substance abuse. This study presents a new questionnaire measure of student stress consisting of 30 items to investigate the symptoms of stress and potentially protective factors.&#x0D; Method: A total of 100 Canadian university students (mean age 20.2 years, SD=2.5, 33 males, 67 females) participated in an internet survey. They all completed our 30 item questionnaire dealing with the perceived stress of studying and exams, and with symptoms such as nightmares, depression, feelings of “being better off dead,” low self-esteem, and with potentially protective factors such as the extent of positive attitude to professors and pride in or contentment with the social status as a university student.&#x0D; Results: High proportions of students reported feeling, at least at times, better off dead (52%). About a half of them felt that most professors do not seem to like them (56%) and many reported nightmares about exams (53%). Lower perceived levels of student stress were associated with more positive feelings towards the professors (r=-.37) and with more pride in being a university student and the contentment with the related social status (r=-.25). The Cronbach alpha coefficient of internal consistency of our questionnaire was .87, i.e., satisfactory.&#x0D; Discussion: The high prevalence of nightmares about exams, feeling of “being better off dead,” or of not being liked by the professors is worrisome. Positive relations towards the professors or pride in or contentment about being a university student function as statistically significant but only weak and hence insufficient protective factors.&#x0D; Conclusions: More than 50% of students reported nightmares about exams, feeling of “being better off dead,” or of not being liked by the professors. Further research is needed to evaluate correlates of student stress to other protective factors than those explored in the present study.

Prevalence and Characteristics of Posttraumatic Nightmares in War- and Conflict-Affected Students.

IntroductionRecurrent nightmares, frequently associated with traumatic experiences, may impair quality of life and daily functioning. However, there have been few studies of posttraumatic nightmares occurring among children and youth, in particular for trauma-exposed populations in conflict zones.MethodsUsing two quantitative data sets, this study investigates the prevalence and characteristics of recurrent nightmares among conflict-exposed young people in the Gaza Strip (N = 300) and examines the characteristics of posttraumatic nightmares and their association with academic functioning among treatment-seeking students in Gaza (N = 1093).ResultsAmong 300 students (10–12 years old) who lived in the ongoing conflict area in Gaza, nightmares were often mentioned, with 56% reporting recurrent nightmares with an average weekly frequency of 4.20 nights in the past week (SD = 1.94) and a mean duration of 2.48 years (SD = 2.01). Similarly, the large sample of 1093 students (6–17 years of age) who sought help for nightmares and sleep disturbance reported recurrent traumatic nightmares on average 4.57 nights per week, with an average duration of 2.82 years. Their self-reported academic functioning was negatively affected by whether they experienced nightmares but was not associated with nightmare frequency or intensity.DiscussionGiven the high prevalence of nightmares and the relation between nightmares and academic functioning, students in conflict-affected areas appear to be a particularly vulnerable group. This study proposes screening and treating conflict-affected students for recurrent posttraumatic nightmares.

Insomnia in Patients with Borderline Personality Disorder.

ObjectiveBoth sleep disorders and BPD are prevalent in the population, and one is often a comorbidity of the other. This narrative review aims to assess contemporary literature and scientific databases to provide the current state of knowledge about sleep disorders in patients with borderline personality disorder (BPD) and clinical suggestions for managing sleep disorders in BPD patients and future research direction.MethodsArticles were acquired via PubMed and Web of Science, and papers published between January 1980 and October 2020 were extracted. Authors made a series of literature searches using the keywords: Sleep problems, Insomnia, Nightmares, Obstructive sleep apnea, Borderline personality disorder. The inclusion criteria were: published in peer-reviewed journals; studies in humans; or reviews on the related topic; English language. The exclusion criteria were: abstracts from conferences; commentaries; subjects younger than 18 years. After an inspection of the full texts, 42 papers from 101 were selected. Secondary documents from the reference lists of the primary designated papers were searched, assessed for suitability, and included. In total, 71 papers were included in the review process.ResultsSleep disturbance is common among patients with BPD. Nevertheless, the number of investigations is limited, and the prevalence differs between 5–45%. Studies assessing objective changes in sleep architecture in BPD show inconsistent results. Some of them identify REM sleep changes and a decrease in slow-wave sleep, while other studies found no objective sleep architecture changes. There is also a higher prevalence of nightmares in patients with BPD. Untreated insomnia can worsen BPD symptoms via interference with emotional regulation. BPD itself seems to influence the subjective quality of sleep significantly. Proper diagnosis and treatment of sleep disorders in patients with BPD could lead to better results in therapy. Psychotherapeutic approaches can improve both sleep disorders and BPD symptoms.ConclusionRecognising and managing sleep disorders in patients with BPD may help alleviate the disorder’s symptoms. Treatment of people with BPD may be more effective if the treatment plan explicitly addresses sleep problems. Further research is needed to reach reliable conclusions.

Frequent nightmares and its associations with psychological and sleep disturbances in hospitalized patients with cardiovascular diseases.

Frequent nightmares can pose a serious clinical problem, especially in association with sleep and psychological disturbances, in the general population. However, this association has not been investigated in inpatients with cardiovascular (CV) diseases. Furthermore, whether CV medications could induce iatrogenic nightmares remains unknown. In a cross-sectional designed study, we evaluated the prevalence and determinants of frequent nightmares and its association with sleep and psychological disturbances among hospitalized CV patients. A total of 1233 patients (mean age, 64 ± 15 years; 25.1% female) hospitalized for various CV diseases in a single university hospital were enrolled. We assessed nightmares and sleep characteristics using the Pittsburgh Sleep Quality Index (PSQI), sleep-disordered breathing (SDB) using nocturnal pulse oximetry, and psychological disturbances using Hospital Anxiety and Depression Scale (HADS). Overall, 14.8% and 3.6% of the patients had at least one nightmare per month and per week (frequent nightmares), respectively. In this cohort, 45.9% had insomnia (modified PSQI > 5), 28.0% had SDB (3% oxygen desaturation index > 15), 18.5% had depression (HADS-depression ≥ 8), and 16.9% had anxiety (HADS-anxiety ≥ 8). Frequent nightmares were not associated with CV medications and SDB but were associated with depression [odds ratio (OR) = 4.61, 95% confidence interval (CI) = 2.03-10.48], anxiety (OR = 5.32, 95% CI = 2.36-12.01), and insomnia (OR = 7.15, 95% CI = 2.41-21.22). Frequent nightmares were not uncommon in patients hospitalized for CV diseases. Although the cause-effect relationship is unclear, frequent nightmares were associated with psychological disturbances and insomnia, but not iatrogenic factors, among hospitalized CV patients. Cardiologists should be more conscientious to nightmare complaints with respect to screening for psychological disturbances and insomnia.

Prevalence of and factors associated with nightmares in the elderly in a population based cohort study

ObjectivesNightmares are extremely unpleasant and vivid recurring dreams that are accompanied with awakening during sleep. However, earlier studies were mostly conducted with children and adults, with very few studies on nightmares in older adults. This population-based study aims to investigate the prevalence of nightmares and its associated factors nightmares in the elderly. MethodsThis study utilized a subsample from the Korean Genome and Epidemiology Study (KoGES). Participants (n = 2940; mean age 63.71 ± 6.73) completed the questionnaires on nightmares (Disturbing Dream and Nightmare Severity Index; DDNSI), depression, suicidal ideation, sleep quality and stress. ResultsAmong the sample, 2.7% (n = 79) were classified into the nightmare group (NG), which was classified with DDNSI scores. In the age group over 70, prevalence of nightmares was 6.3% (n = 37), which was significantly higher than other age groups. Marital status, employment status and family income were associated with nightmares. Additionally, NG reported significantly more sleep problems, higher suicidal ideation, depression and stress compared to the non-nightmare group (N-NG). Logistic regression analyses results indicated that the NG was 4.35 times at higher risk for depression, and 3.16 higher risks for stress, and 3.45 higher risks for suicidal ideation compared to the N-NG after controlling for covariates. ConclusionsOur results indicate that psychological and demographic factors are associated with nightmares in the elderly. Furthermore, this population-based cohort study showed the prevalence of nightmares increased after age 70, which suggests the need for further studies of nightmares in older populations.

Nightmares and Insomnia in the US National Guard: Mental and Physical Health Correlates.

Nightmares and insomnia are significant concerns that commonly co-occur with each other and with other health disorders. Limited research has examined the unique and shared aspects of insomnia and nightmares, and little is known about sleep in US National Guard personnel. This study sought to determine the prevalence and psychosocial correlates of nightmares with and without insomnia in US National Guard personnel. National Guard personnel (N = 841) completed an online survey and were classified as having nightmares only, insomnia only, both, or neither, using a minimum nightmare frequency of "less than once a week" and an Insomnia Severity Index cutoff of ≥ 15. Analyses examined differences in demographics, physical health, and psychosocial variables and in the prevalence of nightmares and insomnia in personnel with physical and mental health problems. In this sample, 32% reported nightmares only, 4% reported insomnia only, and 12% reported both. Those in the youngest age group (18-21) were more likely to have no nightmares or insomnia. Those with both nightmares and insomnia had more deployments. Nightmares and insomnia were associated with poorer physical and mental health and greater prevalence of comorbid physical and mental health conditions. Personnel with both insomnia and nightmares reported the greatest severity of comorbid conditions. US National Guard personnel with nightmares and/or insomnia reported worse mental and physical health impairment than those without these conditions. Personnel may benefit from screening for nightmares and insomnia and referrals for evidence-based treatment.

1194 An Open-Label Study of Treating Traumatic Nightmares With an Investigational Smartwatch Based System

Abstract Introduction Nightmares are a common problem affecting 2-8% of the general population with the prevalence of comorbid nightmares in those with post-traumatic stress disorder (PTSD) being significantly higher at 72%. The negative sequelae of nightmares are myriad including impaired quality of life, sleep deprivation, insomnia, daytime sleepiness, fatigue, and suicidal ideation. This study investigated a novel approach for the treatment of nightmare disorder in military veterans. Methods All participants in this study were veterans receiving care at the Minneapolis Veterans Affairs Health Care System (VAHCS), diagnosed with PTSD, and had self-reported nightmares. At the baseline assessment, eligible participants were given a digital smartwatch preloaded with an application designed to arouse but not awaken the user out of the nightmare. Paired t-test analysis was used to compare the participants’ baseline and follow-up responses. Results A significant decrease in participant Pittsburgh Sleep Quality Index (PSQI) scores (13.6 to 7.4, p &amp;lt; 0.001), PTSD Checklist for DSM-5 (PCL-5) scores (45.8 to 25.1, p &amp;lt; 0.0025) and Patient Health Questionnaire (PHQ-9) scores (12.2 to 6.1, p &amp;lt; 0.002) was observed over the sixty day trial. All 9 participants experienced a decrease in the Epworth Sleepiness Scale (ESS) upon completion of the trial, with an average decrease of -2.5 ± 1.4. Conclusion These results demonstrate that a novel digital therapeutic smartwatch application is effective in improving sleep quality, reducing the burden associated with PTSD symptoms, and lowering depressive symptoms in those with nightmare disorder within an open label study. These results have initiated further investigation into efficacy of digital therapeutic smartwatch applications in nightmare intervention and improved sleep quality. Support NightWare, Inc.

Traumatic Event Exposure, Posttraumatic Stress Disorder, and Sleep Disturbances in a National Sample of U.S. Adults.

Posttraumatic stress disorder (PTSD) is a highly prevalent, debilitating disorder found to develop after exposure to a potentially traumatic event (PTE). Individuals with PTSD often report sleep disturbances, specifically nightmares and insomnia, which are listed within the criteria for PTSD. This research examined prevalence of insomnia and nightmares within a national sample of 2,647 adults (data weighted by age and sex to correct for differences in sample distribution) who had been exposed to one or more PTEs. Prevalence of self-reported sleep disturbance, sleep disturbances by PTE type, and gender differences were examined. All participants completed a self-administered, structured online interview that assessed exposure to stressful events and PTSD symptoms. Among individuals who met DSM-5 criteria for PTSD, a large majority (more than 92%) reported at least one sleep disturbance. Insomnia was relatively more prevalent than PTE-related nightmares among individuals with PTSD and among all PTE-exposed individuals. A higher number of PTEs experienced significantly increased the likelihood of both trauma-related nightmares and insomnia, McFadden's pseudo R2 = .07, p < .001. Women exposed to PTEs were more likely to endorse experience of insomnia, χ2 (1, N = 2,647) = 99.13, p < .001, φ = .194, and nightmares compared to men, χ2 (1, N = 2,648) = 82.98, p < .001, φ = .177, but this gender difference was not significant among individuals with PTSD, ps = .130 and .050, respectively. Differences in sleep disturbance prevalence by PTE type were also examined. Implications for treatment and intervention and future directions are discussed.

Prevalence of Parasomnias in Patients With Obstructive Sleep Apnea. A Registry-Based Cross-Sectional Study.

Objective: To assess the prevalence of parasomnias in relation to presence and severity of obstructive sleep apnea (OSA). We hypothesized higher parasomnia prevalence with higher OSA severity.Methods: The sample comprised 4,372 patients referred to a Norwegian university hospital with suspicion of OSA (mean age 49.1 years, 69.8% males). OSA was diagnosed and categorized by standard respiratory polygraphy (type 3 portable monitor). The patients completed a comprehensive questionnaire prior to the sleep study, including questions about different parasomnias during the last 3 months. Pearson chi-square tests explored differences according to the presence and severity of OSA. Furthermore, logistic regression analyses with the parasomnias as dependent variables and OSA severity as predictor were conducted (adjusted for sex, age, marital status, smoking, and alcohol consumption).Results: In all, 34.7% had apnea-hypopnea index (AHI) <5 (no OSA), 32.5% had AHI 5-14.9 (mild OSA), 17.4% had AHI 15-29.9 (moderate OSA), and 15.3% had AHI ≥30 (severe OSA). The overall prevalence of parasomnias was 3.3% (sleepwalking), 2.5% (sleep-related violence), 3.1% (sexual acts during sleep), 1.7% (sleep-related eating), and 43.8% (nightmares). The overall parasomnia prevalence was highest in the no OSA group. In the chi-square analyses, including all OSA groups, the prevalence of sleep-related violence and nightmares were inversely associated with OSA severity, whereas none of the other parasomnias were significantly associated with OSA severity. In adjusted logistic regression analyses the odds of sleepwalking was significantly higher in severe compared to mild OSA (OR = 2.0, 95% CI = 1.12–3.55). The other parasomnias, including sleep-related violence and nightmares, were not associated with OSA presence or severity when adjusting for sex and age.Conclusions: We found no increase in parasomnias in patients with OSA compared to those not having OSA. With the exception of sleepwalking, the parasomnias were not associated with OSA severity.

Nightmares and sleep paralysis among the general Japanese population: a nationwide representative survey

The objective of this study was to determine the prevalence of nightmares and sleep paralysis and their associated factors in the general population in Japan. This study was designed as a cross-sectional sampling survey conducted in November 2007. Subjects were selected randomly from among 300 districts throughout Japan. Data from 8099 people (3748 men and 4351 women) were used. Participants completed a self-reported questionnaire on the frequency of nightmares and sleep paralysis in the previous month. In the total sample, the prevalence (95% confidence interval) of nightmares and sleep paralysis was 3.0% (2.6–3.4%) and 2.4% (2.1–2.8%). As for nightmares, multiple logistic analyses revealed that long sleep duration, use of hypnotic medication, difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, excessive daytime sleepiness, and distress had higher odds ratios. As for sleep paralysis, younger age, smoking, difficulty maintaining sleep, and distress had higher odds ratios. This study revealed the prevalence of nightmares and sleep paralysis among the general Japanese population. The results indicate that nightmares and sleep paralysis are induced by high levels of stress and insomnia symptoms in Japanese adults. Therefore, adequate stress-coping skills, sleep education to raise awareness of the importance of maintaining an appropriate circadian rhythm, and effective treatments for insomnia are required.