Nightmare Complaints in Treatment-Seeking Patients in Clinical Sleep Medicine Settings: Diagnostic and Treatment Implications

Barry Krakow, MD
Sleep & Human Health Institute, Albuquerque, NM; Maimonides Sleep Arts & Sciences, Ltd., Albuquerque, NM; Los Alamos Medical Center, Los Alamos, NM; University of New Mexico School of Medicine Departments of Emergency Medicine and Psychiatry, Albuquerque, NM

Study Objectives: To develop clinical guideposts to identify patients with  salient nightmare conditions.

Design: Prevalence data from a retrospective chart review on a consecutive series of sleep patients to assess how or whether those with (1) rank nightmare complaints compared to other sleep complaints, (2) link to disrupted sleep, (3) report worse sleep symptoms  and health outcomes compared to other sleep patients, and (4) endorse  criteria for a salient nightmare condition on the Disturbing Dream and Nightmare Severity Index.

Setting: Two community sleep facilities: private sleep medical center and a hospital-based sleep lab.

Patients: Seven hundred eighteen patients presenting at intake: sleep center (n = 620); sleep lab (n = 98).

Measurements and Results: Standard sleep parameters and various health outcomes were assessed with self-report measures. Of 718 sleep patients, 186 ranked a nightmare complaint among their sleep problems, of whom 117 linked their bad dreams to disrupted sleep, suggesting a potential salient nightmare condition. Compared to all other sleep patients, these 117 cases demonstrated consistent significant patterns of worse or more prevalent problems with self-reported sleep indexes, insomnia, sleep quality, sleep-fragmentation factors, sleep-related daytime impairment, psychiatric history, medical comorbidity, and parasomnias. The Disturbing Dream and Nightmare Severity Index identified those with salient nightmare complaints and correlated with worse sleep and health


Conclusions: At 2 sleep medical facilities, 16% of patients presented with an apparent salient nightmare condition, and these patients were identified with simple clinical guideposts, which could be incorporated at intake in various sleep medicine settings.

Keywords: Nightmares, insomnia, sleep quality, sleep fragmentation, impairment, imagery rehearsal therapy

Citation: Krakow B. Nightmare complaints in treatment-seeking patients

in clinical sleep medicine settings: diagnostic and treatment implications.

SLEEP 2006;29(10):1313-1319.

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Randy Clare

Randy Clare

Randy Clare brings to The Sleep and Respiratory Scholar more than 25 years of extensive knowledge and experience in the sleep and pulmonary function field. He has held numerous management positions throughout his career and has demonstrated a unique view of the alternate care diagnostic and therapy model. He is considered by many an expert in the use of oral appliances like Silent Nite, EMA and TAP to treat snoring and sleep apnea in the dental office. Mr. Clare's extensive sleep industry experience assists Sleepandrespiratoryscholar in providing current, relevant, data-proven information on sleep diagnostics and sleep therapies that are effective for the treatment of sleep disorders. Mr Clare is director of business development for Glidewell a dental solutions company his focus is on dental treatment for sleep disordered breathing.

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