Nightmares in United States Military Personnel With Sleep Disturbances

Abstract

Study Objectives: Sleep disturbances are common in United States military personnel. Despite their exposure to combat and trauma, little is known about nightmares in this population. The purpose of this study was to describe the prevalence and associated clinical and polysomnographic characteristics of nightmares in United States military personnel with sleep disturbances. Methods: Retrospective review of 500 active duty United States military personnel who underwent a sleep medicine evaluation and polysomnography at our sleep center. The Pittsburgh Sleep Quality Index and the Pittsburgh Sleep Quality Index-Addendum were used to characterize clinically significant nightmares. Subjective and objective sleep attributes were compared between groups. Results: At least weekly nightmares were present in 31.2%; yet, only 3.9% reported nightmares as a reason for evaluation. Trauma-related nightmares occurred in 60% of those patients with nightmares. Patients with nightmares had increased sleep onset latency (SOL) and rapid eye movement (REM) sleep latency (mean SOL/REM sleep latency 16.6/145 minutes, P = .02 and P = .01 respectively) compared to those without (mean SOL/REM sleep latency 12.5/126 minutes I NTRO DUCTI O NNightmares are defined by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that cause clinically significant distress or impairment in social, occupational, or other areas of functioning. 1 Occasional nightmares are part of a normal adaptive response to life stressors and are not pathologic, with 85% of adults reporting at least one nightmare per year. 2 The prevalence of clinically significant nightmares, which occur at least once per week, is estimated between 0.9% and 6.8%. [3][4][5][6][7][8][9] In the largest study to date (69,813 adults), the prevalence of nightmares was 3.5% in men and 4.8% in women. 10 Participants from the World War II generation had a significantly higher prevalence of 7.2% in men and 7% in women. Nightmares are more common among patients with sleep disturbances, sleep disorders, depression, anxiety, and posttraumatic stress disorder However, most research evaluating sleep disorders in active duty military personnel has focused on insomnia, obstructive sleep apnea (OSA), and PTSD, noting that a recent study focusing on OSA and PTSD did not evaluate nightmares. [18][19][20] Following traumatic experiences, sleep disturbances are frequently reported, including trauma-related nightmares (TRN). 21 The nightmares of trauma survivors tend to be more severe and distressing than idiopathic nightmares. 1,3 Though not exclusive to PTSD, TRN have been referred to as the "hallmark" of this disorder, with rates as high as 90%. 22,23 Addressing nightmares as a distinct sleep disorder following a BRIEF SUMMARY Current Knowledge/Study Rationale: The spectrum of sleep disorders in military personnel is varied and complicated by the presence of comorbidities and psychological disorders. Currently, little is known regarding nightmares, especially trauma-related nig...

Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans

“…More than two thirds of our treatment-seeking sample of CAF members and veterans reported being at least moderately bothered by sleep disturbances; and almost 90% reported being at least moderately bothered by trauma-related nightmares. Congruent with previous research, these findings emphasize that sleep difficulties are a common concern for military personnel and veterans [ 42 , 43 ], and echo the recent findings of Creamer and colleagues [ 44 ], who found that trauma-related nightmares were common amongst a cohort of 500 active duty United States military personnel. Our results also revealed that although sleep disturbances and nightmares were significantly associated with SI on their own, these associations seem to be mediated by depressive symptom severity, which is consistent with previous research supporting an indirect role of sleep disturbance [ 4 , 23 ].…”

Recent Advancements in Treating Sleep Disorders in Co-Occurring PTSD

“…Rates of nightmares seems to depend upon criteria, assessment, and methodology [16]. In a retrospective review of 500 active military personnel, Creamer et al [17•] found 31.2% had nightmares weekly, but only 3.9% reported nightmares as a reason for seeking treatment.…”

Changes in REM Sleep Following Trauma Likely Significant

“…

In his letter to the editor, Gupta alluded that the prolonged rapid eye movement (REM) sleep latency seen in our nightmare disorder (NDO) cohort could be an early marker for underlying psychiatric comorbidities, such as posttraumatic stress disorder (PTSD). 1,2 We concur that REM sleep abnormalities in patients with nightmares and trauma related nightmares are likely significant. REM fragmentation has been described following traumatic events, with increased REM density seen in patients with PTSD.

…”