Nightmare Severity Research Articles

Treating narcolepsy-related nightmares with cognitive behavioural therapy and targeted lucidity reactivation: A pilot study.

Nightmares are a common symptom in narcolepsy that has not been targeted in prior clinical trials. This study investigated the efficacy of Cognitive Behavioural Therapy for Nightmares (CBT-N), adapted for narcolepsy, in a small group of adults. Given the high prevalence of lucid dreaming in narcolepsy, we added a promising adjuvant component, targeted lucidity reactivation (TLR), a procedure designed to enhance lucid dreaming and dream control. Using a multiple baseline single-case experimental design, adults with narcolepsy and frequent nightmares (≥3/week, N = 6) were randomised to a 2 or 4 week baseline and received seven treatment sessions (CBT-N or CBT-N + TLR). Across the groups, there was a large effect size (between-case standardised mean difference [BC-SMD] = -0.97, 95% CI -1.79 to -0.14, p < 0.05) for reduced nightmare frequency from baseline (M = 8.38/week, SD = 7.08) to posttreatment (M = 2.25/week, SD = 1.78). Nightmare severity improved significantly with large effect sizes on sleep diaries (BC-SMD = -1.14, 95% CI -2.03 to -0.25, p < 0.05) and the Disturbing Dream and Nightmare Severity Index (z = -2.20, p = 0.03, r = -0.64). Treatment was associated with a reduction for some participants in sleep paralysis, sleep-related hallucinations, and dream enactment. NREM parasomnia symptoms (z = -2.20, p = 0.03, r = -0.64) and self-efficacy for managing symptoms (z = -2.02, p = 0.04, r = -0.58) improved significantly with large effect sizes. Participants who underwent TLR (n = 3) all recalled dreams pertaining to their rescripted nightmare. In interviews, participants noted reduced shame and anxiety about sleep/nightmares. This study provides a proof of concept for the application of TLR as a therapeutic strategy with clinical populations, as well as preliminary evidence for the efficacy of CBT-N in treating narcolepsy-related nightmares.

CBT Intervention Post-2023 Southeast Türkiye Quake: A Case Study

This case study investigates the effectiveness of Cognitive Behavioral Therapy (CBT) in treating Post-Traumatic Stress Disorder (PTSD) in an individual survivor of the catastrophic 2023 Southeast Türkiye Earthquake. The study aims to provide detailed insights into the therapeutic process and outcomes of CBT applied in a post-disaster context. A 38-year-old female survivor, pseudonymously named Serpil, participated in an eight-week structured CBT program specifically tailored to address her severe PTSD symptoms following the earthquake. The therapeutic interventions included exposure therapy, cognitive restructuring, and relaxation techniques. Data collection was achieved using quantitative methods such as the Clinician-Administered PTSD Scale (CAPS) and the Beck Depression Inventory (BDI), supplemented by qualitative assessments through detailed therapy session notes and Serpil’s personal reflections. The intervention led to significant improvements in Serpil's PTSD symptoms, particularly a reduction in the frequency and severity of nightmares and flashbacks. Serpil reported enhanced coping mechanisms, which improved her overall psychological resilience and functionality. The data illustrate a notable decrease in PTSD symptomatology, corroborated by scores from CAPS and BDI, indicating an overall improvement in mental health and quality of life. This case study underscores the potential of CBT as a potent intervention for managing PTSD in survivors of natural disasters. It highlights the necessity of integrating specialized psychotherapeutic techniques in disaster response initiatives to address the psychological impacts effectively. The findings advocate for broader implementation and evaluation of similar interventions across diverse post-disaster settings to confirm these results and optimize treatment protocols. Further research with larger sample sizes and longer follow-up periods is recommended to enhance the generalizability and understanding of CBT's long-term effectiveness in disaster-stricken populations.

The mediation effects of nightmares and depression between insomnia and suicidal ideation in young adults

Suicide is prevalent among young adults, and epidemiological studies indicate that insomnia, nightmares, and depression are significantly associated with a high incidence of suicidal ideation (SI). However, the causal relationship between these factors and SI remains unclear. Therefore, the purpose of this study was to examine the association between nightmares and depression and insomnia and SI in young adults, as well as to develop a mediation model to investigate the causal relationship between insomnia, nightmare, depression, and SI. We assessed insomnia, nightmares, depression, and SI in 546 young adults using the Insomnia Severity Scale (ISI), Disturbing Dream and Nightmare Severity Scale (DDNSI), Depression Study Scale (CESD-20), and Columbia-Suicide Severity Rating Scale (C-SSRS). Using the Bootstrap method, the mediation effects of nightmares and depression between insomnia and SI were calculated. The results demonstrated that nightmares and depression fully mediated the relationship between insomnia and SI, including the chain-mediation of insomnia and SI between nightmare and depression with an effect value of 0.02, 95% CI 0.01–0.04, and depression as a mediator between insomnia and SI with an effect value of 0.22, 95% CI 0.15–0.29. This study found that depression and nightmares may be risk and predictive factors between insomnia and SI, which implies that the assessment and treatment of depression and the simple or linked effect of nightmares play crucial roles in preventing SI in young adults.

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.

Factor Analysis and Validation of the Disturbing Dream and Nightmare Severity Index in an Inpatient Sample

ABSTRACT Study Objectives The Disturbing Dream and Nightmare Severity Index (DDNSI) has been used widely in research and clinical practice without psychometric evidence supporting its use in clinical samples. The present study aimed to explore and confirm the factor structure of the DDNSI in an inpatient sample. We also sought to test the measure’s construct validity. Methods Two samples of U.S. inpatients including adult (N = 937) and adolescent (N = 274) participants provided data on nightmares (i.e. DDNSI), sleep quality (i.e. the Pittsburgh Sleep Quality Index) and related psychopathology symptoms (e.g. depression, posttraumatic stress disorder, anxiety). Results Exploratory and confirmatory factor analyses found the six original items of the DDNSI to load onto a single latent factor. Conclusions The DDNSI was found to be a valid measure of nightmare frequency and distress, as it was significantly correlated with the items related to disturbing dreams, and the DDNSI was able to differentiate between nightmares and psychopathology symptoms. Though this research comes nearly two decades after the initial creation and use of the DDNSI, it provides a foundation for the scientific rigor of previous and future studies on nightmares using the DDNSI.

Implications of language use in posttraumatic nightmares on psychological symptoms.

The current study sought to understand how language use in posttrauma nightmare (PTNM) reports may be related to psychological symptoms over the course of treatment. Multiple regression analyses were conducted to examine the relationship between language use in PTNMs and psychological symptoms. Specifically, cognitive processing words (CPW) and emotional tone (ET) measured in PTNMs were analyzed in their relationship to posttraumatic stress disorder (PTSD) and depression symptom severity, as well as nightmare frequency and distress measured at the midtreatment and last treatment sessions. Follow-up hierarchical regressions were used to assess the relationship of language to nightmare severity when controlling for both PTSD and depression severity. The sample consisted of treatment-seeking predominately Caucasian females from the community with a history of criterion A trauma and weekly nightmares. CPW in the nightmare were negatively associated with PTSD and depression symptom severity, as well as nightmare frequency, at the time of the exposure session. Decreased CPW and negative ET within the nightmare remained significantly associated with nightmare frequency at the time of the exposure session, when controlling for PTSD and depression symptom severity. CPW in the rescripted PTNM were negatively associated with PTSD and depression symptom severity at the time of the last treatment session. These results suggest that language use in nightmares may reveal important information about underlying cognitive and emotional processes that may help understand the etiology and maintenance of PTSD symptoms, as well as support PTNMs as co-occurring symptoms requiring targeted treatment, and not merely secondary symptoms of PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Differences in Anxiety, Insomnia, and Trauma Symptoms in Wildfire Survivors from Australia, Canada, and the United States of America.

Many survivors of wildfires report elevated levels of psychological distress following the trauma of wildfires. However, there is only limited research on the effects of wildfires on mental health. This study examined differences in anxiety, depression, insomnia, sleep quality, nightmares, and post-traumatic stress disorder (PTSD) symptoms following wildfires in Australia, Canada, and the United States of America (USA). One hundred and twenty-six participants from Australia, Canada, and the USA completed an online survey. The sample included 102 (81%) women, 23 (18.3%) men, and one non-binary (0.8%) individual. Participants were aged between 20 and 92 years (M age = 52 years, SD = 14.4). They completed a demographic questionnaire, the Disturbing Dream and Nightmare Severity Index (DDNSI), Generalized Anxiety Disorder Questionnaire (GAD-7), the Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), and PTSD Checklist (PCL-5). Results showed that participants from the USA scored significantly higher on the GAD-7 (p = 0.009), ISI (p = 0.003), and PCL-5 (p = 0.021) than participants from Australia and Canada. The current findings suggest a need for more international collaboration to reduce the severity of mental health conditions in Australia, Canada, and the USA.

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.

Nightmares and Sleep Disturbances in Children with PTSD: A Polysomnographic and Actigraphy Approach Evaluation.

Sleep disturbances (insomnia and nightmare symptoms) are the most sensitive and persistent symptoms of pediatric post-traumatic stress disorder (PTSD). Untreated, these sleep disturbances (SD) associated with PTSD are predictive of PTSD persistence and increased psychiatric complications. The aim of this study was to evaluate sleep and circadian rhythms in children with PTSD under both laboratory and ecological conditions in comparison with a control population and to test for the first time the hypothesis that SD and circadian rhythms are positively correlated with PTSD severity and its comorbidities. This prospective pilot study evaluated PTSD, SD (insomnia, nightmares), and sleep-wake rhythms in 11 children with PTSD (aged 3-18), compared with the age and sex-matched control groups. Assessment of PTSD and subjective and objective measures of sleep and sleep-wake rhythms (questionnaires, 24-h in-laboratory video-polysomnography, 15-day at-home actigraphy recording) were performed between 1 and 6 months after the traumatic event. Children with PTSD had higher sleep fragmentation (increased wake-after-sleep onset, increased number of sleep stage changes) compared to controls, with a change in sleep microarchitecture (micro-arousal index at 14.8 versus 8.2, p = 0.039). Sleep fragmentation parameters correlated with PTSD symptomatology, insomnia, and post-traumatic nightmare severity. The within-group comparison revealed a better sleep architecture in the controlled (sleep laboratory) than in the ecological condition (at home) (total sleep time 586 versus 464 min, p = 0.018). Sleep and rhythm disturbances are strongly associated with PTSD in children. The assessment of SD in children with PTSD should be carried out systematically and preferentially under ecological conditions, and management of SD should integrate the environment (environmental design, psycho-education for the children and their parents) more fully into therapy focused on sleep and trauma.

Nighttime sleep quality & daytime sleepiness across inpatient psychiatric treatment is associated with clinical outcomes

Prior research has demonstrated the strong link between sleep disturbance and mental health outcomes, including the importance of examining nighttime sleep quality and daytime sleepiness as separate constructs in relation to mental health outcomes. As such, the current study examined patients’ self-reported nighttime sleep quality and daytime sleepiness trajectories over the course of inpatient treatment and how these trajectories related to treatment outcomes. Participants were 1,500 adults who voluntarily admitted to an inpatient psychiatric hospital. Mental health outcomes measured were emotion regulation problems, anxiety severity, depression severity, nightmare severity, and suicide risk. Group-based trajectory modeling was used to determine nighttime sleep quality and daytime sleepiness trajectory groups. Multivariate analyses of covariance (MANCOVA) were used to determine between group differences on mental health outcomes. Patients fit into distinct groups based on their trajectories of nighttime sleep quality and daytime sleepiness across inpatient psychiatric treatment: Low, Moderate, and High. Individuals with greater nighttime sleep disturbance and greater daytime sleepiness throughout treatment (High group) demonstrated significantly increased suicide risk, higher nightmare severity, more anxiety, more depression, and more emotion regulation difficulties at discharge. Results suggest an important connection exists between nighttime sleep quality and excessive daytime sleepiness and mental health outcomes for inpatient psychiatry.

The phenomenology of nightmares in post-traumatic stress disorder and complex post-traumatic stress disorder

IntroductionNightmares are a re-experiencing symptom of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). They are intrusive, involuntary and have a significant impact on wellbeing, suggesting they have substantial clinical relevance. However, little is known about the phenomenological features of post-traumatic nightmares and how they are associated with the severity of PTSD and CPTSD symptoms. MethodParticipants (N = 398) who identified that they had experienced a lifetime trauma completed various self-report questionnaires related to PTSD symptoms, CPTSD symptoms and nightmare characteristics. Participants also described their sensory experiences and rated the emotional intensity and vividness of their post-traumatic nightmares. ResultsWe found that elevated scores on various characteristics of nightmares including frequency of awakenings, nightmare severity, impact on wellbeing and the perceived realism of the nightmare were linked to more severe PTSD and CPTSD symptoms. Further, increased frequency, vividness, and emotional intensity of nightmares significantly predicted more severe PTSD symptoms but not CPTSD symptoms. ConclusionsOur study was largely exploratory and was the first to identify that specific nightmare features are related to PTSD and CPTSD symptom severity. However, although nightmare features of frequency, vividness and intensity appear to be related to CPTSD symptom severity, other variables may better predict CPTSD symptoms. Possible explanations for our findings, implications for treatment and directions for future research are discussed.

0681 The Relationship between Safety Behaviors and Insomnia in individuals with Post-Traumatic Stress Disorder

Abstract Introduction Safety behaviors may perpetuate anxiety, maintain an individual’s perception of threats, and may lead to psychosocial impairment. Safety behaviors are commonly seen in those suffering from insomnia and post-traumatic stress disorder (PTSD). Despite their prevalence and associated impairments, there exists no data on the relationship between insomnia and safety behavior in those suffering from PTSD. The aim of this study is to evaluate the relationship between safety behavior and insomnia in those with PTSD. If such a relationship is seen, does the severity of nightmares or overall PTSD mediate this relationship between insomnia and safety behaviors? Methods The study extracted data from baseline assessments of a treatment study conducted at the VA Medical Center at Philadelphia. The subjects were treatment-seeking patients with PTSD (N =43). Safety behavior was evaluated using the 12-item brief Safety Behavior Assessment Form (SBAF), PTSD was evaluated using the PTSD checklist for DSM-5 (PCL-5), and insomnia with Insomnia Severity Index (ISI) scales. Bivariate analyses evaluated the relationship between SBAF total score and age, education, income, PCL-5, and ISI total scores. Nightmare severity was evaluated using item number 2 from the PCL-5 questionnaire. An analysis evaluated the role of the severity of nightmares or PTSD (PCL-5 total score after excluding the sleep and safety items) as independent mediators in the relationship between SBAF and ISI total scores. Results The mean±standard deviation of their age was 56.1±11.6 years and 13.1±2.1 years of education. They were mostly males (86.0%), black (61.9%) and unemployed over the past month (76.8%). The mean total score was 17.1±5.7 on the SBAF, 17.3±7.4 on the ISI, and 52.5±14.5 on the PCL-5. Bivariate analysis demonstrated that SBAF total score was associated with the ISI (β=0.32, p=0.0005 and PCL-5 (β=0.22, p=0.0004) total scores. Mediation analysis demonstrated a significant mediation effect of nightmares (R2=24.6%) and PTSD severity (R2=33.3%) on the association between safety behaviors and insomnia. Conclusion About sixty percent of the variance in safety behaviors was explained by insomnia and its association with PTSD or nightmare severity. Treatment of underlying insomnia, PTSD, or nightmares may improve the safety behaviors associated with PTSD. Support (if any) 1IK2CX000855 (S.C.), and 1 I01 CX001957 (S.C.).

0140 Nightmares are Associated with Increased Suicidality in Young Adulthood: A Population-based Cohort Study

Abstract Introduction Childhood nightmares have a second increase in incidence in young adulthood, which has been attributed to trauma and psychopathology. As suicide rates are high in young adults and have been associated with nightmares, more research is needed regarding this relationship in this age range. This study aimed to examine the association of nightmares, independent of sleep disturbances, insufficient sleep or trauma-history, with suicidality in young adulthood. Methods The Penn State Child Cohort is a random, population-based sample of 700 children (5-12 years at baseline) studied in the sleep laboratory who returned for follow-up visits during adolescence and young adulthood. For the current study, 258 young adults (25.1±2.7 years old, 53.9% female, 24.8% racial/ethnic minority) completed their follow-up visit 15.9±2.0 years later. Nightmares were ascertained by self-report. The presence of suicidality was ascertained from responses on items querying suicidal ideation and/or attempts via clinically-relevant sources (i.e., MINI structured interview, Child Behavior Checklist Adult Self-Report, and Depression Anxiety and Stress Scale). General linear and logistic regression models adjusted for important covariates. Results Subjects reporting nightmares (n=109) had a significantly higher rate of suicidality (29%) than those absent of nightmares (14%; p=0.002), after adjusting for sex, age, sleep disturbances, sleep duration and trauma history. This rate was even higher (46%) in those reporting moderate-to-severe nightmares (n=24; p&amp;lt; 0.01). The odds of suicidality associated with nightmares were 2.3-fold (95%CI=1.1-4.7), after adjusting for sex, age, sleep disturbances, sleep duration and trauma history (p=0.023); a risk that increased to 6.1-fold (95%CI=2.0-18.6) in those reporting moderate-to-severe nightmares (p=0.001). Conclusion These findings further strengthen previous research that has established nightmares’ significant relationship to increased suicidality, even when controlling for other important risk factors such as sleep disturbances and trauma history. Furthermore, as these results come from a random, population-based sample, it also demonstrates the generalizability of the association between nightmares and suicide. As the search for effective prevention strategies for suicide continues, it will be important to assess for the presence and severity of nightmares in those who express suicidal ideation, especially given the treatable nature of nightmares. Support (if any) National Institutes of Health (R01HL136587, R01MH118308, UL1TR000127)

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)

0720 Depression and pain are barriers to benzodiazepine and z-drug deprescribing

Abstract Introduction Clinical guidelines recommend avoiding benzodiazepines and z-drugs (BZRAs) in older adults due to an increased risk of adverse outcomes (e.g., falls) in this population. Efforts to reduce BZRA use among older adults are growing, yet long-term BZRA deprescribing among patients with insomnia is challenging. We examined whether clinical conditions commonly comorbid with insomnia (i.e., depression, pain, nightmares, and anxiety) are barriers to BZRA deprescribing. Methods In an ongoing multi-site trial comparing two BZRA deprescribing programs (both include cognitive behavioral treatments for insomnia), participants aged &amp;gt;=55 years with chronic BZRA use for insomnia (N=165, mean age 68.7, sd 7.9) completed baseline Patient Health Questionnaire-9 (PHQ9), Brief Pain Inventory (BPI), Disturbing Dreams and Nightmare Severity Index (DDNSI), and Generalized Anxiety Disorder-7 (GAD-7). Deprescribing outcomes (discontinuation, dose, and frequency of use over 7-days) were assessed 1 week and 6 months after completing the deprescribing program. Using logistic and linear regression models, we assessed whether depression, pain severity, nightmare severity, and anxiety were predictors of BZRA deprescribing outcomes, controlling for site, gender, and age. Results Among participants assessed 1 week (n=133) and 6 months (n=106) after intervention, 77% and 66% discontinued their BZRA use, respectively. Worse PHQ-9 was associated with reduced odds of discontinuation (OR 0.88, 95% CI 0.79-0.99, p=.027) at 6 months, but not frequency of use or dose at follow up. Pain severity predicted more frequent use (b=0.26, p=.02) and higher dose (b=0.94, p=.016) but not discontinuation at 6 months. DDNSI (p values &amp;gt;=.068) and GAD-7 (p values &amp;gt;= 0.15) were not significant predictors of discontinuation, frequency, or dose at follow-up. Conclusion More severe depression at baseline is a predictor of BZRA deprescribing failure long-term. Pain is also a barrier to BZRA reduction efforts. Programs aimed at reducing and discontinuing BZRAs used for insomnia should consider interventions that not only address underlying insomnia, but also depression and pain. Support (if any) NIA R01AG057929; VA IIR 17-234

Prevalence and Predictors of Sleep and Trauma Symptoms in Wildfire Survivors

ObjectiveThis study aimed to establish the prevalence and to identify predictors of insomnia, nightmares and post-traumatic stress disorder (PTSD) in wildfire survivors. MethodA total of 126 (23 males, 102 females, and 1 nonbinary individual, Mage = 52 years, SD = 14.4) wildfire survivors from Australia, Canada and the USA took part in an online survey. Participants completed a demographic questionnaire and self-report measures including: The Insomnia Severity Index (ISI), PTSD Checklist for DSM-5 (PCL-5), and Disturbing Dream and Nightmare Severity Index (DDNSI). ResultsResults showed that 49.2% of the sample reported clinical insomnia on the ISI, 28.7% reported nightmares on the DDNSI, and 77.88% reported PTSD symptoms on the PCL-5. Fear for life of others (Pearson's r = .40, .21, .31), and the impact of smoke (Pearson's r, .47, .25,.41) significantly correlated with insomnia, nightmares and PTSD symptoms, respectively. Hierarchical regression showed that smoke was a significant predictor of insomnia (β = .17, p <.05, 95% CI, 0.15 – 1.49), and insomnia predicted both of PTSD (β = .27, p <.05, 95% CI, 0.26 – 1.05), and nightmares (β = .19, p = .04, 95% CI, 1.01 – 1.45) scores. ConclusionInsomnia, nightmares and PTSD are highly prevalent in wildfire survivors. Smoke, one of the trauma-related factors, was found to be as a significant predictor of insomnia; and insomnia was a significant predictor of both PTSD and nightmares. Future longitudinal studies are needed to establish which disorder emerges first as a result of smoke.

Treatment with morning blue light increases left amygdala volume and sleep duration among individuals with posttraumatic stress disorder.

BackgroundPosttraumatic stress disorder (PTSD) is associated with numerous cognitive, affective, and psychophysiological outcomes, including problems with sleep and circadian rhythms. We tested the effectiveness of a daily morning blue-light exposure treatment (BLT) versus a matched amber light treatment (ALT) to regulate sleep in individuals diagnosed with PTSD. Moreover, PTSD is also associated with reliable findings on structural neuroimaging scans, including reduced amygdala volumes and other differences in cortical gray matter volume (GMV) that may be indicative of underlying neurobehavioral dysfunctions. We examined the effect of BLT versus ALT on GMV and its association with sleep outcomes.MethodsSeventy-six individuals (25 male; 51 female) meeting DSM-V criteria for PTSD (Age = 31.45 years, SD = 8.83) completed sleep assessments and structural neuroimaging scans, followed by random assignment one of two light groups, including BLT (469 nm; n = 39) or placebo ALT (578 nm; n = 37) light therapy daily for 30-min over 6-weeks. Participants wore a wrist actigraph for the duration of the study. After treatment, participants returned to complete sleep assessments and a structural neuroimaging scan. Neuroimaging data were analyzed using the Computational Anatomy Toolbox (CAT12) and Voxel-Based Morphometry (VBM) modules within the Statistical Parametric Mapping (SPM12) software.ResultsThe BLT condition produced significant increases in total time in bed and total sleep time from actigraphy compared to the ALT condition, while ALT improved wake after sleep onset and sleep efficiency compared to BLT. Additionally, BLT led to an increase in left amygdala volume compared to ALT but did not affect hypothesized medial prefrontal regions. Finally, within group correlations showed that improvements in sleep quality and nightmare severity were correlated with increases in left amygdala volume over the course of treatment for the BLT group but not the ALT group.ConclusionIn individuals with PTSD, daily exposure to morning blue light treatment was associated with improvements in objective sleep duration and increased volume of the left amygdala compared to amber placebo light treatment, and changes in amygdala volume correlated with subjective improvement in sleep. These findings suggest that daily morning BLT may provide an important non-pharmacologic adjunctive approach for facilitating sleep and neurobehavioral recovery from PTSD.

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

Characterizing Patterns of Nurses' Daily Sleep Health: a Latent Profile Analysis.

Nursing is a demanding occupation characterized by dramatic sleep disruptions. Yet most studies on nurses' sleep treat sleep disturbances as a homogenous construct and do not use daily measures to address recall biases. Using person-centered analyses, we examined heterogeneity in nurses'daily sleep patterns in relation to psychological and physical health. Nurses (N = 392; 92% female, mean age = 39.54years) completed 14 daily sleep diaries to assess sleep duration, efficiency, quality, and nightmare severity, as well as measures of psychological functioning and a blood draw to assess inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP). Using recommended fit indices and a 3-step approach, latent profile analysis was used to identify the best-fitting class solution. The best-fitting solution suggested three classes: (1) "Poor Overall Sleep" (11.2%), (2) "Nightmares Only" (8.4%), (3) "Good Overall Sleep" (80.4%). Compared to nurses in the Good Overall Sleep class, nurses in the Poor Overall Sleep or Nightmares Only classes were more likely to be shift workers and had greater stress, PTSD symptoms, depression, anxiety, and insomnia severity. In multivariate models, every one-unit increase in insomnia severity and IL-6 was associated with a 33% and a 21% increase in the odds of being in the Poor Overall Sleep compared to the Good Overall Sleep class, respectively. Nurses with more severe and diverse sleep disturbances experience worse health and may be in greatest need of sleep-related and other clinical interventions.

Factor analysis and validation of the Disturbing Dreams and Nightmare Severity Index.

Factor analysis and validation of the Disturbing Dreams and Nightmare Severity Index.