Nightmares : Assessment, theory, and treatment

Nightmares tend to occur less often in a sleep laboratory. To test this, twelve PTSD-inpatients suffering from posttraumatic nightmares kept a diary and filled out a questionnaire considering their sleep and nightmares. Polysomnographic sleep-data were recorded in the clinic for two consecutive 24-hour periods. Significantly fewer than expected nightmares were recorded with polysomnography. The short duration questionnaire correlated very highly with the diary and seems to be the method of choice for assessing nightmare frequency. Therefore the SLEEP-50 questionnaire, designed to detect sleep disorders as listed in the DSM-IV-TR, was evaluated in a sample of 377 college students, 246 sleep patients, 32 nightmare sufferers, and 44 healthy volunteers. The internal consistency was high; test-retest correlations were good, and the factor-structure closely matched the designed structure. Sensitivity/specificity scores were promising for all sleep disorders; the agreement between all clinical diagnoses and SLEEP-50-classifications was substantial (kappa = .77), indicating the SLEEP-50 can detect a variety of sleep disorders. The SLEEP-50 was then used to investigate the prevalence of sleep disorders and its relations with affective complaints in a non-clinical population. Eight-hundred randomly selected adult persons received the SLEEP-50 and two psychiatric questionnaires. Four-hundred-and-two filled out these questionnaires completely. Forty-one percent reported sleep complaints, 23.5% had a sleep disorder, and 2.7% had two sleep disorders. Prevalences were: insomnia: 8.5%, restless legs: 5.2%, sleep apnea: 4.0%, nightmares: 2.2%, circadian rhythm sleep disorder: 1.7%, hypersomnia: 1.2%, and narcolepsy: 0.7%. Results showed a high interrelatedness between sleep and mental complaints. In addition, the current debate focuses on the DSM-IV-TR definition of nightmares, of which direct awakening from a disturbing dream is a criterion. Forthy-eight nightmare sufferers filled out questionnaires regarding their nightmares, sleep, and mental complaints. Direct awakening was not related to any mental complaint or general psychopathology with the exception of agoraphobia. Only 22.9 percent reported to always wake up from a nightmare. The DSM-IV definition of nightmares needs to be refined. Two pilots were conducted to evaluate the effects of the cognitive-restructuring technique lucid dreaming treatment (LDT) on chronic nightmares. Becoming lucid (realizing that one is dreaming) in a nightmare allows persons to alter the nightmare-storyline in the nightmare itself. LDT consists of exposure, mastery, and lucidity exercises. First, eight participants received a one-hour individual session after filling out the SLEEP-50 and the Spielberger State and Trait Anxiety Inventory. Two months later the nightmare frequency had decreased, while the sleep quality had increased slightly. There were no changes on state and trait anxiety. Second, twenty-three nightmare sufferers were randomized (after having filled out the SLEEP-50 and a PTSD-questionnaire) into; one individual session (8), one group session (8), and a waiting-list (7). The same questionnaires were filled out twelve weeks later; the nightmare frequency of both treatment groups had decreased. Lucidity was not necessary for a reduction in nightmare frequency. Addressing that a change in the nightmare-storyline is possible may be the key-component of this technique; recurrent nightmares seem to be represented in a script. A cognitive model of nightmares is described in this dissertation

Nightmares : Assessment, theory, and treatment

Nightmares tend to occur less often in a sleep laboratory. To test this, twelve PTSD-inpatients suffering from posttraumatic nightmares kept a diary and filled out a questionnaire considering their sleep and nightmares. Polysomnographic sleep-data were recorded in the clinic for two consecutive 24-hour periods. Significantly fewer than expected nightmares were recorded with polysomnography. The short duration questionnaire correlated very highly with the diary and seems to be the method of choice for assessing nightmare frequency. Therefore the SLEEP-50 questionnaire, designed to detect sleep disorders as listed in the DSM-IV-TR, was evaluated in a sample of 377 college students, 246 sleep patients, 32 nightmare sufferers, and 44 healthy volunteers. The internal consistency was high; test-retest correlations were good, and the factor-structure closely matched the designed structure. Sensitivity/specificity scores were promising for all sleep disorders; the agreement between all clinical diagnoses and SLEEP-50-classifications was substantial (kappa = .77), indicating the SLEEP-50 can detect a variety of sleep disorders. The SLEEP-50 was then used to investigate the prevalence of sleep disorders and its relations with affective complaints in a non-clinical population. Eight-hundred randomly selected adult persons received the SLEEP-50 and two psychiatric questionnaires. Four-hundred-and-two filled out these questionnaires completely. Forty-one percent reported sleep complaints, 23.5% had a sleep disorder, and 2.7% had two sleep disorders. Prevalences were: insomnia: 8.5%, restless legs: 5.2%, sleep apnea: 4.0%, nightmares: 2.2%, circadian rhythm sleep disorder: 1.7%, hypersomnia: 1.2%, and narcolepsy: 0.7%. Results showed a high interrelatedness between sleep and mental complaints. In addition, the current debate focuses on the DSM-IV-TR definition of nightmares, of which direct awakening from a disturbing dream is a criterion. Forthy-eight nightmare sufferers filled out questionnaires regarding their nightmares, sleep, and mental complaints. Direct awakening was not related to any mental complaint or general psychopathology with the exception of agoraphobia. Only 22.9 percent reported to always wake up from a nightmare. The DSM-IV definition of nightmares needs to be refined. Two pilots were conducted to evaluate the effects of the cognitive-restructuring technique lucid dreaming treatment (LDT) on chronic nightmares. Becoming lucid (realizing that one is dreaming) in a nightmare allows persons to alter the nightmare-storyline in the nightmare itself. LDT consists of exposure, mastery, and lucidity exercises. First, eight participants received a one-hour individual session after filling out the SLEEP-50 and the Spielberger State and Trait Anxiety Inventory. Two months later the nightmare frequency had decreased, while the sleep quality had increased slightly. There were no changes on state and trait anxiety. Second, twenty-three nightmare sufferers were randomized (after having filled out the SLEEP-50 and a PTSD-questionnaire) into; one individual session (8), one group session (8), and a waiting-list (7). The same questionnaires were filled out twelve weeks later; the nightmare frequency of both treatment groups had decreased. Lucidity was not necessary for a reduction in nightmare frequency. Addressing that a change in the nightmare-storyline is possible may be the key-component of this technique; recurrent nightmares seem to be represented in a script. A cognitive model of nightmares is described in this dissertation

Volitional components of consciousness vary across wakefulness, dreaming and lucid dreaming

Contains fulltext : 136156.pdf (publisher's version ) (Open Access)Consciousness is a multifaceted concept; its different aspects vary across species, vigilance states, or health conditions. While basal aspects of consciousness like perceptions and emotions are present in many states and species, higher-order aspects like reflective or volitional capabilities seem to be most pronounced in awake humans. Here we assess the experience of volition across different states of consciousness: 10 frequent lucid dreamers rated different aspects of volition according to the Volitional Components Questionnaire for phases of normal dreaming, lucid dreaming, and wakefulness. Overall, experienced volition was comparable for lucid dreaming and wakefulness, and rated significantly higher for both states compared to non-lucid dreaming. However, three subscales showed specific differences across states of consciousness: planning ability was most pronounced during wakefulness, intention enactment most pronounced during lucid dreaming, and self-determination most pronounced during both wakefulness and lucid dreaming. Our data confirm the multifaceted nature of consciousness: different higher-order aspects of consciousness are differentially expressed across different conscious states

Dream imaging

Contains fulltext : 237624.pdf (Publisher’s version ) (Open Access

Measuring nightmare frequency: retrospective questionnaires versus prospective logs

Retrospective measurements underestimate nightmare frequency, but little is known about how retrospective duration and attention for nightmares may affect this process. This study evaluates the differences between two retrospective durations, a prospective log, and a retrospective estimate after keeping this log. Forty-nine participants completed the SLEEP-50, kept a nightmare log, and estimated their nightmares after keeping a log. Paired t-tests showed that estimates of nightmare frequencies differed significantly from each other according to measurement type (p < .05). Prospective logs are the most accurate way of estimating nightmare frequency, possibly due to simply forgetting over time. For treatment studies relying solely on retrospective measurements, a short duration is recommended

Internet-delivered or mailed self-help treatment for insomnia?: a randomized waiting-list controlled trial

Cognitive Behavioral Therapy (CBT) is effective in reducing insomnia complaints, but the effects of self-help CBT have been inconsistent. The aim of this study was to determine the effectiveness of self-help for insomnia delivered in either electronic or paper-and-pencil format compared to a waiting-list. Participants kept a diary and filled out questionnaires before they were randomized into electronic (n = 216), paper-and-pencil (n = 205), or waiting-list (n = 202) groups. The intervention consisted of 6 weeks of unsupported self-help CBT, and post-tests were 4, 18, and 48 weeks after intervention. At 4-week follow-up, electronic and paper-and-pencil conditions were superior (p < .01) compared to the waiting-list condition on most daily sleep measures (Δ d = 0.29-0.64), global insomnia symptoms (Δ d = 0.90-1.00), depression (Δ d = 0.36-0.41), and anxiety symptoms (Δ d = 0.33-0.40). The electronic and paper-and-pencil groups demonstrated equal effectiveness 4 weeks after treatment (Δ d = 0.00-0.22; p > .05). Effects were sustained at 48-week follow-up. This large-scale unsupported self-help study shows moderate to large effects on sleep measures that were still present after 48 weeks. Unsupported self-help CBT for insomnia therefore appears to be a promising first option in a stepped care approach. © 2011 Elsevier Ltd