Idiopathic Nightmares and Dream Disturbances Associated with Sleep–Wake Transitions 1107
Idiopathic Nightmares and Dream Chapter Disturbances Associated with Sleep–Wake Transitions Tore Nielsen and Antonio Zadra 97 Abstract described, with much support for the effectiveness of short- term cognitive and behavior interventions such as systematic Nightmares and other common disturbances of dreaming desensitization and imagery rehearsal. Several related dream involve a perturbation of emotional expression during sleep. disturbances occur at the transitions into or out of sleep and Nightmares, the most prevalent dream disturbance, are now involve dysphoric emotions ranging from malaise to fear to recognized as comprising several dysphoric emotions, includ- frank terror. These disturbances include sleep starts, terrify- ing especially fear, although some argue that existential (or ing hypnagogic hallucinations, sleep paralysis, somniloquy grief) dreams should be considered a separate entity. A with dream content, false awakenings, and disturbed lucid genetic basis for nightmares has been demonstrated and their dreaming. The distinctive nature of these disturbances may pathophysiology involves a surprising underactivation of the be mediated by immediately preceding waking state processes sympathetic nervous system in many instances. Personality (e.g., consciousness, sensory vividness) that intrude upon or factors, such as nightmare chronicity and distress and coping carry over into dreaming. styles are mediating determinants of their clinical severity, as are drug and alcohol use. Many treatments have been Because most common dreaming disturbances (Table pathologic in some sense.15 However, the widespread belief 97-1) involve a perturbation of emotional expression that dreaming can serve an emotionally adaptive function during sleep, their study may help clarify the role of (see Chapter 54) also suggests that some dream distur- emotion in dream formation, dream function, and sleep bances are adaptive reactions to more basic pathophysio- mechanisms more generally.
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