Portal de Periódicos da CAPES

A Meaningful Step Toward Understanding the Cause and Impact of Nightmares

2019; American Academy of Sleep Medicine; Volume: 15; Issue: 02 Linguagem: Inglês

10.5664/jcsm.7608

1550-9397

Michael R. Nadorff, Caitlin E. Titus, Ashley R. Pate,

Child and Adolescent Psychosocial and Emotional Development

Free AccessStress - Nightmares - Dreams - Eating - Aging - CommentaryA Meaningful Step Toward Understanding the Cause and Impact of Nightmares Michael R. Nadorff, PhD, Caitlin E. Titus, MS, Ashley R. Pate, BS Michael R. Nadorff, PhD Address correspondence to: Michael R. Nadorff, Mississippi State University, PO Box 6161, Mississippi State, MS 39762. Department of Psychology, Mississippi State University, Mississippi State, Mississippi Department of Psychiatry, Baylor College of Medicine, Houston, Texas , Caitlin E. Titus, MS Department of Psychology, Mississippi State University, Mississippi State, Mississippi , Ashley R. Pate, BS Department of Psychology, Mississippi State University, Mississippi State, Mississippi Published Online:February 15, 2019https://doi.org/10.5664/jcsm.7608Cited by:1SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONAlthough it may be thought of as a childhood disorder, with up to 50% of children between ages 3–6 reporting them,1 nightmares commonly persist into adulthood. In fact, 14% of college students2 and 4.3% of older adults report frequent nightmares.3 Nightmares are also very clinically-relevant. For instance, it is known that nightmares are a frequent symptom with posttraumatic stress disorder (PTSD), but some may not realize that the presence of nightmares before a trauma can increase the risk of developing PTSD.4 Nightmares have also been shown to be comorbid with depression,5,6 anxiety,7 schizophrenia,8,9 and suicide.10–12 Even when not leading to psychopathology, nightmares are still associated with substantial daytime distress.13,14 Given its high prevalence and notable comorbidities, there is a great need for theories, and subsequent validation research, to help us understand nightmares, and by proxy to better understand the mechanism by which nightmares contribute to psychopathology and suicide. Levin and Nielsen's Neurocognitive Model15,16 fits the bill, as it is an exceptionally well thought-out and researched model of dysphoric dreams. The model proposes that nightmares may reflect problematic emotion regulation and highlights several brain structures that are likely implicated in nightmares: the amygdala, medial prefrontal cortex, hippocampus, and anterior cingulate cortex. However, one significant limitation of the model is that there is limited validation work that has been published. The theory was based upon a substantial amount of neurological research, but how do these areas actually respond in those who have nightmares?Recently, the anterior cingulate cortex17 and medial prefrontal cortex18 have been shown to be associated with nightmare frequency, but nightmare distress remains unexamined. Although this may sound inconsequential, it is extremely important as nightmare distress is the component that is most closely associated with psychopathology.19 It is very possible that understanding nightmare distress will be key in understanding the association between psychopathology and nightmares, and may lead to new clinical breakthroughs to mitigate their effects.In an innovative new study featured in this issue of the Journal of Clinical Sleep Medicine, Marquis and colleagues20 use SPECT imaging to examine brain activity while looking at neutral and negative pictures among 18 individuals who experience frequent nightmares. The results were consistent with research looking at the neural correlates of nightmare frequency,17,18 and demonstrated potential overlap between the brain areas involved in disturbing dreams and distress during the day. It lays the groundwork for future studies examining the association between nightmares and psychopathology. It also provides further support for the neurocognitive model of nightmares as the medial prefrontal cortex and anterior cingulate cortex were related with disturbing dreams, but not the hippocampus or amygdala, which in and of itself makes it a novel and meaningful addition to the literature.In addition to providing important validation work on a leading theory of nightmares, Marquis and colleagues provide a basis for several important future investigations. First, we agree with Marquis and colleagues that more imaging studies, including studies using other imaging strategies, are warranted. Specifically, more research is needed to better understand the role of the anterior cingulate cortex and the medial prefrontal cortex, especially the latter, in disturbing dreams and related psychopathology. Second, given that emotion regulation is implicated with both the anterior cingulate cortex and medial prefrontal cortex, more research is needed examining the role of emotion regulation in nightmares. Recent research has implicated poor emotion regulation in the association between nightmares and suicidal behavior,21 but the research on emotion regulation explaining the relation between nightmares and psychopathology is still very much in its infancy. Lastly, more nightmare treatment research is needed. In the last year, the research supporting prazosin for treating nightmares has been substantially weakened by large, strong studies that have failed to show effects22 leaving clinicians with no recommended pharmacological treatments for nightmare disorder. It is possible that treatments that increase activation in the anterior cingulate cortex and medial prefrontal cortex may reduce nightmares, though this is admittedly a very early hypothesis that would require further research. Turning our attention to psychotherapies, research examining the impact of treating emotion regulation on nightmares, as well as the inverse, treating nightmares on emotion regulation, is warranted.In sum, Marquis and colleagues20 have provided us with a valuable study that already enhances the literature in a meaningful way, but that also has tremendous potential for shaping the way we study, view, assess, and treat nightmares in the future.DISCLOSURE STATEMENTThe authors report no conflicts of interest.CITATIONNadorff MR, Titus CE, Pate AR. A meaningful step toward understanding the cause and impact of nightmares. J Clin Sleep Med. 2019;15(2):179–180.REFERENCES1 American Psychiatric AssociationDiagnostic and Statistical Manual of Mental Disorders20135th edWashington, DCAmerican Psychiatric Association Publishing CrossrefGoogle Scholar2 Nadorff MR, Nazem S, Fiske AInsomnia symptoms, nightmares, and suicidal ideation in a college student sampleSleep20113419398 CrossrefGoogle Scholar3 Salvio M-A, Wood JM, Schwartz J, Eichling PSNightmare prevalence in the healthy elderlyPsychol Aging199272324325 CrossrefGoogle Scholar4 Mellman TA, David D, Kulick-Bell R, Hebding JSleep disturbance and its relationship to psychiatric morbidity after Hurricane AndrewAm J Psychiatry19951521116591663 CrossrefGoogle Scholar5 Besiroglu L, Agargun MY, Inci RNightmares and terminal insomnia in depressed patients with and without melancholic featuresPsychiatry Res20051332–3285287 CrossrefGoogle Scholar6 Sandman N, Merikanto I, Määttänen H, et al.Winter is coming: nightmares and sleep problems during seasonal affective disorderJ Sleep Res2016255612619 CrossrefGoogle Scholar7 Nadorff MR, Porter B, Rhoades HM, Kunik ME, Greisinger AJ, Stanley MABad dream frequency in older adults with generalized anxiety disorder: prevalence, correlates, and effect of cognitive behavioral treatment for anxietyBehav Sleep Med20141212840 CrossrefGoogle Scholar8 Hartmann EA preliminary study of the personality of the nightmare sufferer: Relationship to schizophrenia and creativity?Am J Psychiatry19811386794797 CrossrefGoogle Scholar9 Herz MI, Melville CRelapse in schizophreniaAm J Psychiatry19801377801805 CrossrefGoogle Scholar10 Sjöström N, Hetta J, Wærn MPersistent nightmares are associated with repeat suicide attempt: a prospective studyPsychiatry Res20091702–3208211 CrossrefGoogle Scholar11 Tanskanen A, Tuomilehto J, Viinamaki H, Vartiainen E, Lehtonen J, Puska PNightmares as predictors of suicideSleep2001247844847 Google Scholar12 Golding S, Nadorff MR, Winer ES, Ward KCUnpacking sleep and suicide in older adults in a combined online sampleJ Clin Sleep Med2015111213851392 LinkGoogle Scholar13 Köthe M, Pietrowsky RBehavioral effects of nightmares and their correlations to personality patternsDreaming20011114352 CrossrefGoogle Scholar14 Lancee J, Schrijnemaekers NCMLThe association between nightmares and daily distressSleep Biol Rhythms20131111419 CrossrefGoogle Scholar15 Levin R, Nielsen TADisturbed dreaming, posttraumatic stress disorder, and affect distress: a review and neurocognitive modelPsychol Bull20071333482528 CrossrefGoogle Scholar16 Levin R, Nielsen TNightmares, bad dreams, and emotion dysregulation: A review and new neurocognitive model of dreamingCurr Dir Psychol Sci20091828488 CrossrefGoogle Scholar17 Shen C, Wang J, Ma G, et al.Waking-hour cerebral activations in nightmare disorder: A resting-state functional magnetic resonance imaging studyPsychiatry Clin Neurosci20167012573581 CrossrefGoogle Scholar18 Marquis L, Blanchette-Carrière C, Carr M, Julien S, Paquette T, Nielsen TDecreased activity in medial prefrontal cortex and anterior cingulate cortex in idiopathic nightmare sufferers during wakefulnessSleep201639A226(Abstract Suppl) Google Scholar19 Levin R, Fireman GNightmare prevalence, nightmare distress, and self-reported psychological disturbanceSleep2002252205212 Google Scholar20 Marquis LP, Julien SH, Baril AA, et al.Nightmare severity is inversely related to frontal brain activity during waking state picture viewingJ Clin Sleep Med2019152253264 LinkGoogle Scholar21 Ward-Ciesielski EF, Winer ES, Drapeau CW, Nadorff MRExamining components of emotion regulation in relation to sleep problems and suicide riskJ Affect Disord20182414148 CrossrefGoogle Scholar22 Raskind MA, Peskind ER, Chow B, et al.Trial of prazosin for post-traumatic stress disorder in military veteransN Engl J Med20183786507517 CrossrefGoogle Scholar Next article FiguresReferencesRelatedDetailsCited by Nightmare Disorder and Isolated Sleep ParalysisStefani A and Högl B Neurotherapeutics, 10.1007/s13311-020-00966-8 Volume 15 • Issue 02 • February 15, 2019ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationFebruary 7, 2019Submitted in final revised formFebruary 7, 2019Accepted for publicationFebruary 7, 2019Published onlineFebruary 15, 2019 Information© 2019 American Academy of Sleep MedicinePDF download