DOCSLIB.ORG

THINGS THAT GO BUMP in the NIGHT Detection & Management of Potentially Injurious Parasomnias

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
THINGS THAT GO BUMP in the NIGHT Detection & Management of Potentially Injurious Parasomnias 2/13/2015 THINGS THAT GO BUMP IN THE NIGHT Detection & Management of Potentially Injurious Parasomnias Janet E. Tatman, PhD, PA-C Fellow American Academy of Sleep Medicine Certified in Behavioral Sleep Medicine From ghoulies and ghosties And long‐leggedy beasties And things that go bump in the night, Good Lord, deliver us! Traditional Scottish Prayer Patients’ experience fear embarrassment social isolation injury 1 2/13/2015 PARASOMNIA • an undesirable physical event or experience that occurs during entry to sleep, within sleep, or during sleep, i.e., NREM sleep, REM sleep, or transitions to and from sleep • may encompass abnormal, complex movements, behaviors, emotions, perceptions, dreams, and/or abnormal ANS activity—and may affect patient or bedpartner • as sleep-wake cycle oscillates, the normally distinct states of consciousness (NREM, REM, and wake) may devolve into a state that is not fully declared…a temporary unstable state of dissociation, resulting in a “parasomnia”…an admixture of one or more normal states International Classification of Sleep Disorders, 3rd Ed American Academy of Sleep Medicine “Sleep,” from Wikipedia, downloaded 1/5/15 INTERNATIONAL CLASSIFICATION OF SLEEP DISORDERS 3RD ED. • NREM-Related Parasomnias • Other Parasomnias • Disorders of Arousal (from NREM sleep) • Exploding Head Syndrome • Confusional Arousals • Sleep-Related Hallucinations • Sleepwalking • Sleep Enuresis • Sleep Terrors • Parasomnia Due to Medical Disorder • Sleep-Related Eating Disorder • Parasomnia Due to Medication or • REM-Related Parasomnias Substance • REM Sleep Behavior Disorder • Parasomnia, Unspecified • Recurrent Isolated Sleep Paralysis • Normal Variant • Nightmare Disorder • Sleep Talking American Academy of Sleep Medicine 2 2/13/2015 INTERNATIONAL CLASSIFICATION OF SLEEP DISORDERS 3RD ED. • NREM-Related Parasomnias • REM-Related Parasomnias • Disorders of Arousal (from NREM sleep) • REM Sleep Behavior Disorder (RBD) • Confusional Arousals • Recurrent Isolated Sleep Paralysis • Sleepwalking • Nightmare Disorder • Sleep Terrors • Sleep-Related Eating Disorder no discernible neuropathology not 2o psychiatric disease often serious neuropathology (RBD) failed skeletal muscle paralysis → dream some brain areas deactivated, others activated enactment disinhibition of basic drive states American Academy of Sleep Medicine CASE EXAMPLES CASE 1 • 42-year old ♀ goes to sleep at 11:30 PM and wakes around 1:30 AM in the middle of her backyard with nursery plants she had bought 2 days ago scattered around. ─ She is standing next to a 2’ deep hole, has garden soil on her legs and hands, and is naked in temperature of 55o. 3 2/13/2015 CASE 2 • 72-year old British ♂ conveys wife’s reports of him yelling, punching, kicking, and “speechifying” during sleep. Her sleep is disturbed 3-4 nights a week and he is sometimes tired during the day. CASE 3 • 52-year old ♂ vigorously punches or kicks his wife during sleep every 1-2 months. They both are startled awake and frightened. ≈ once a month he leaves the bed, fumbles in the bedroom closet or stumbles along a wall, feeling it with his hands, returning to bed in response to gentle suggestion from his wife. CASE 4 • 37-year old ♂ police officer was surprised to wake in AM on living room sofa. − Wife says that during the night he was “charging around the house” with a loaded service revolver, periodically “hiding” behind furniture, yelling, and seeming to “chase the bad guys.” 4 2/13/2015 STAGES OF SLEEP NREM Sleep REM Sleep – eyes quiet – rapid eye movements – “idling” brain – “alert” brain – relaxed muscle tone – skeletal muscle paralysis – some dreaming – much dreaming – stable physiology – variability of HR, BP, RR, ANS – brain metabolic activity SLEEP MENTATION NREM Sleep REM Sleep – single, basic image – complex stories – more realistic – usually bizarre – difficult to awaken – easily awakened – relative amnesia – good memory – up to 40% of lab awakenings – 85+% of lab awakenings result in result in dream reports dream reports THE DISORDERS 5 2/13/2015 DISORDERS OF AROUSAL Confusional Arousals Sleepwalking Sleep Terrors DISORDERS OF AROUSAL (NREM SLEEP) • Recurrent episodes of incomplete awakening • Inappropriate or absent response to others’ efforts to intervene or redirect • Limited or no cognitive experience or dream imagery • Partial or complete amnesia • Usually occur during first 1/3 of the sleep period • May be confused or disoriented for several minutes upon awakening ICSD from AASM CONFUSIONAL AROUSALS • Meets criteria for Disorder of Arousal • Mental confusion or confused behavior while still in bed • Absence of terror or departure from bed • Usually a lack of autonomic arousal (e.g., mydriasis, tachycardia, tachypnea, diaphoresis) ICSD from AASM 6 2/13/2015 SLEEPWALKING • Meets criteria for Disorder of Arousal • Ambulation and other complex behaviors out of bed ICSD from AASM SLEEP TERRORS • Meets criteria for Disorder of Arousal • Abrupt terror, typically beginning with vocalization, scream, etc. • Intense fear and signs of autonomic arousal ICSD from AASM SLEEP-RELATED EATING DISORDER (SRED) • Recurrent episodes of dysfunctional eating after arousal from major sleep period • Presence of at least one of the following: Eating odd types of combinations of food, inedible or toxic substances Injurious or potentially injurious behavior while seeking or cooking food Adverse health consequences • Partial or complete loss of consciousness w/subsequent impaired recall ICSD from AASM 7 2/13/2015 CLINICAL EVALUATION • Thorough medical/behavioral history • Include bedpartner or family whenever possible • Assess risk • Screen for history suggestive of other sleep disorders • Polysomnography if risk is significant TREATMENT Environmental safety • bedpartner sleeps separately • move mattress & furniture prn Behavioral safety • AVOID sleep deprivation! • reduce stress whenever possible Clonazepam is usually considered first line • start low & go slow • habituation/tolerance typically not seen Other med options → trial and error 8 2/13/2015 REM RELATED PARASOMNIAS REM Sleep Behavior Disorder Recurrent Isolated Sleep Paralysis Nightmare Disorder REM SLEEP BEHAVIOR DISORDER (RBD) • Repeated episodes of vocalization and/or complex motor behaviors • Documented by PSG to occur during REM or are presumed to occur in REM based on clinical hx of dream enactment • PSG demonstrates REM sleep without atonia ICSD from AASM RBD • First described in 19861 • Strongly associated w/ neurodegenerative disorders (PD, DLB, MSA)2 • Severe injuries reported3 1Schenck et al. Sleep, 1986 2ICSD from AASM, 2014 3Schenck & Mahowald, Intensive Care Med, 1991 9 2/13/2015 RBD EVALUATION • Careful history including reports from bedpartner or family (risk, family reports, other sleep disorders) • Polysomnography is necessary ― sustained muscle activity in chin EMG ― excessive transient muscle activity (bursts) in chin or limb EMG QUESTIONNAIRE? • Single question: • “Have you ever been told, or suspected yourself, that you seem to ‘act out your dreams’ while asleep (for example, punching, flailing your arms in the air, making running movements, etc.” Postuma et al. 2012 Mov Disord 27(7), 913-916 • Mayo Sleep Questionnaire (10) questions Boeve et al. 2011 Sleep Med 12(5), 445-453 10 2/13/2015 RBD TREATMENT • Clonazepam effective in 90% of cases1 (caution in dementia, gait disorders, & OSA) • Melatonin considered a good alternative2 • Pressurized bed alarm?3 1Schenck & Mahowald, Cleve Clin J of Med, 1991 2McGrane et al. Sleep Med, 2015 3Howell et al. J Clin Sleep Med, 2011 RECURRENT ISOLATED SLEEP PARALYSIS • Recurrent inability to move trunk and all 4 limbs at sleep onset or on waking • Episodes last seconds to minutes • Causes significant distress including bedtime anxiety or fear of sleep ICSD from AASM Reassurance NIGHTMARE DISORDER • Extended, dysphoric dreams that usually involve threats • Rapidly alert and oriented on awakening • Clinically significant distress or impairment in social/occupational/other areas of function evident in at least one of the following Mood Sleep resistance Cognitive impairments Family functioning Behavioral problems Daytime sleepiness Fatigue/low energy Impaired occupational/educational/interpersonal/social function ICSD from AASM Behavioral treatments highly effective (eg, Seda et al. J Clin Sleep Med, 2015) 11 2/13/2015 “The Nightmare” Johann Heinrich Füssli EXPLODING HEAD SYNDROME • Sudden loud noise or sense of explosion in the head at wake-sleep transition or on waking during sleep period • Sensation is followed by abrupt arousal, often with great sense of fright • Not associated with complaints of pain ICSD from AASM SLEEP-RELATED HALLUCINATIONS • Recurrent hallucinations just prior to sleep onset or nocturnal or morning awakenings • Hallucinations are predominantly visual ICSD from AASM 12 2/13/2015 SLEEP ENURESIS • Patient is older than 5 • Recurrent involuntary voiding during sleep at least twice a week • Present for at least 3 months Primary Sleep Enuresis Never consistently dry during sleep Secondary Sleep Enuresis Previously consistently dry for at least 6 months ICSD from AASM HYPNOTIC-INDUCED SLEEPWALKING Businessman Grandma College Student uses zolpidem intermittently zolpidem nightly 1st week of zolpidem House alarm goes off 3 AM for unknown reason Irregular schedule 2o classes & job International business travel (Europe), zolpidem when crossing many time She does not wake, police arrive & zones cannot reach her by phone. They Wakes spontaneously
Load more

Recommended publications
  • Evaluation of Depression and Anxiety, and Their Relationships with Insomnia, Nightmare and Demographic Variables in Medical Students
    Sleep Hypn. 2019 Mar;21(1):9-15 http://dx.doi.org/10.5350/Sleep.Hypn.2019.21.0167 Sleep and Hypnosis A Journal of Clinical Neuroscience and Psychopathology ORIGINAL ARTICLE Evaluation of Depression and Anxiety, and their Relationships with Insomnia, Nightmare and Demographic Variables in Medical Students Alireza Haji Seyed Javadi1*, Ali Akbar Shafikhani2 1MD. of Psychiatry, Associate Professor, Department of Psychiatry, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran 2Department of Occupational Health Engineering, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran ABSTRACT Researchers showed comorbidity of sleep disorders and mental disorders. The current study aimed to evaluate depression and anxiety and their relationship with insomnia, nightmare and demographic variables in the medical students of Qazvin University of Medical Sciences in 2015. The study population included 253 medical students with the age range of 18-35 years. Data were gathered using Beck depression inventory, Cattle anxiety, and insomnia and nightmare questionnaires and were analyzed by proper statistical methods (independent T-test, Chi-square test and Spearman correlation coefficient (P<0.05). Among the participants, 126 (49.6%) subjects had depression and 108 (42.5%) anxiety. The prevalence of depression and anxiety among the subjects with lower family income was significantly higher (X2=6.75, P=.03 for depression and X2=27.99, P<0.05 for anxiety). There was a close relationship between depression with sleep-onset difficulty, difficulty in awakening and daily sleep attacks, and also between anxiety with sleep-onset difficulty and daily tiredness (P <0.05). In addition, there was a close relationship between depression and anxiety with nightmare; 16.2% of the subjects with depression and 26.5% of the ones with anxiety experienced nightmares.
    [Show full text]
  • Sleeping Disorders and Anxiety in Academicians: a Comparative Analysis
    Original Article / Özgün Makale DO I: 10.4274/jtsm.43153 Journal of Turkish Sleep Medicine 2018;5:86-90 Sleeping Disorders and Anxiety in Academicians: A Comparative Analysis Akademisyenlerde Uyku Bozuklukları ve Kaygı: Karşılaştırmalı Bir Analiz Nimet İlke Akçay, Anthony Awode, Mariyam Sohail, Yeliz Baybar, Kamal Alweithi, Milad Mahmoud Alilou, Mümtaz Güran Eastern Mediterranean University Faculty of Medicine, North Cyprus, Turkey Abstract Öz Objective: This study aims to examine the relationship between anxiety Amaç: Bu çalışma kaygı ve uyku bozuklukları arasındaki ilişkinin and sleep disorders and also to investigate the frequency of sleep irdelenmesini ve kaygı bozukluğu olanlarda uyku bozukluklarının disorders those with anxiety disorders among academicians who is a sıklığının kısıtlı bir çalışma grubu olan akademisyenlerde incelenmesini limited study group. hedeflemektedir. Materials and Methods: Two hundred and fifty academicians from Gereç ve Yöntem: Kampüsümüzdeki farklı fakültelerden 250 different faculties across our campus participated in the study with a akademisyen %47 erkek ve %53 kadın cinsiyet dağılımı ile çalışmaya gender distribution of 47% males and 53% females. The study was dahil edilmiştir. Çalışmada (i) demografik bilgiler, (ii) uyku evreleri ve conducted by a combined questionnaire which has four sections uyku kalitesi taraması, (iii) uyku bozukluklarının ölçeklendirilmesi, ve about (i) demographic information, (ii) sleep stages and sleep quality (iv) kaygı ölçeği olmak üzere 4 bölümden oluşan birleştirilmiş bir anket screening, (iii) scaling of sleep disorders and (iv) scale of anxiety. formu kullanılmıştır. Results: Anxiety in female and male participants was found to be 59% Bulgular: Kadın ve erkek popülasyonda kaygı sırası ile %59 ve %41 and 41% respectively. The total score of anxiety scale was positively olarak belirlenmiştir.
    [Show full text]
  • A Philosophy of the Dreaming Mind
    Dream Pluralism: A Philosophy of the Dreaming Mind By Melanie Rosen A THESIS SUBMITTED TO MACQUARIE UNIVERSITY FOR THE DEGREE OF DOCTOR OF PHILOSOPHY DEPARTMENT OF COGNITIVE SCIENCE, FACULTY OF HUMAN SCIENCE MACQUARIE UNIVERSITY, NSW 2109, AUSTRALIA JULY 2012 Table of Contents Abstract 9 Declaration 11 Acknowledgements 13 Introduction 15 Part 1: Dream Pluralism 25 Chapter 1: The Empirical Study of Dreams: Discoveries and Disputes 27 1.1 Stages of sleep 29 1.1.1 NREM Sleep 30 1.1.2 REM Sleep 32 1.1.3 The Scanning Hypothesis: an attempt to correlate eye movements with dream reports 33 1.2 Dream reports 35 1.2.1 The benefits of lab-based research 36 1.2.2 The benefits of home-based research 38 1.3 Measuring the physiology of the sleeping brain and body 41 1.3.1 Physiological measures: pros and cons 42 1.4 Cognitive and neural features of sleep 48 1.5 Lucid dreamers in the dream lab 55 Conclusion 59 1 Chapter 2: Bizarreness and Metacognition in Dreams: the Pluralist View of Content and Cognition 61 2.1 A pluralistic account of dream content 62 2.1.1 Bizarre and incoherent dreams 63 2.1.2 Dreams are not particularly bizarre 66 2.1.3 Explanations of the conflicting results 69 2.1.4 Dreams vs. fantasy reports 72 2.2 Cognition in dreams: deficient or equivalent? 80 2.2.1 What is metacognition? 80 2.2.2 Metacognition in dreams 83 Conclusion 97 Chapter 3: Rethinking the Received View: Anti-Experience and Narrative Fabrication 99 3.1 Malcolm on dreaming 101 3.1.1 Dreams and verification 102 3.1.2 Evidence against Malcolm 109 3.2 Metaphysical anti-experience theses 115 3.2.1 The cassette view 115 3.2.2 Arguments against the cassette view 118 3.2.3 Consciousness requires recognition or clout 120 3.3 Narrative fabrication in dream reports 122 3.3.1 Rationalisation of strange content 123 3.3.2 Confabulation and memory loss 127 3.3.3 Altered states of consciousness and what it’s like to be a bat.
    [Show full text]
  • Psichologijos Žodynas Dictionary of Psychology
    ANGLŲ–LIETUVIŲ KALBŲ PSICHOLOGIJOS ŽODYNAS ENGLISH–LITHUANIAN DICTIONARY OF PSYCHOLOGY VILNIAUS UNIVERSITETAS Albinas Bagdonas Eglė Rimkutė ANGLŲ–LIETUVIŲ KALBŲ PSICHOLOGIJOS ŽODYNAS Apie 17 000 žodžių ENGLISH–LITHUANIAN DICTIONARY OF PSYCHOLOGY About 17 000 words VILNIAUS UNIVERSITETO LEIDYKLA VILNIUS 2013 UDK 159.9(038) Ba-119 Apsvarstė ir rekomendavo išleisti Vilniaus universiteto Filosofijos fakulteto taryba (2013 m. kovo 6 d.; protokolas Nr. 2) RECENZENTAI: prof. Audronė LINIAUSKAITĖ Klaipėdos universitetas doc. Dalia NASVYTIENĖ Lietuvos edukologijos universitetas TERMINOLOGIJOS KONSULTANTĖ dr. Palmira ZEMLEVIČIŪTĖ REDAKCINĖ KOMISIJA: Albinas BAGDONAS Vida JAKUTIENĖ Birutė POCIŪTĖ Gintautas VALICKAS Žodynas parengtas įgyvendinant Europos socialinio fondo remiamą projektą „Pripažįstamos kvalifikacijos neturinčių psichologų tikslinis perkvalifikavimas pagal Vilniaus universiteto bakalauro ir magistro studijų programas – VUPSIS“ (2011 m. rugsėjo 29 d. sutartis Nr. VP1-2.3.- ŠMM-04-V-02-001/Pars-13700-2068). Pirminis žodyno variantas (1999–2010 m.) rengtas Vilniaus universiteto Specialiosios psichologijos laboratorijos lėšomis. ISBN 978-609-459-226-3 © Albinas Bagdonas, 2013 © Eglė Rimkutė, 2013 © VU Specialiosios psichologijos laboratorija, 2013 © Vilniaus universitetas, 2013 PRATARMĖ Sparčiai plėtojantis globalizacijos proce- atvejus, kai jų vertimas į lietuvių kalbą gali sams, informacinėms technologijoms, ne- kelti sunkumų), tik tam tikroms socialinėms išvengiamai didėja ir anglų kalbos, kaip ir etninėms grupėms būdingų žodžių, slengo,
    [Show full text]
  • Lucid Dreaming and the Feeling of Being Refreshed in the Morning: a Diary Study
    Article Lucid Dreaming and the Feeling of Being Refreshed in the Morning: A Diary Study Michael Schredl 1,* , Sophie Dyck 2 and Anja Kühnel 2 1 Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Zentralinstitut für Seelische Gesundheit, J5, 68159 Mannheim, Germany 2 Department of Psychology, Medical School Berlin, Calandrellistraße 1-9, 12247 Berlin, Germany * Correspondence: [email protected]; Tel.: +49-621-1703-1782 Received: 15 December 2019; Accepted: 10 February 2020; Published: 12 February 2020 Abstract: REM periods with lucid dreaming show increased brain activation, especially in the prefrontal cortex, compared to REM periods without lucid dreaming and, thus, the question of whether lucid dreaming interferes with the recovery function of sleep arises. Cross-sectional studies found a negative relationship between sleep quality and lucid dreaming frequency, but this relationship was explained by nightmare frequency. The present study included 149 participants keeping a dream diary for five weeks though the course of a lucid dream induction study. The results clearly indicate that there is no negative effect of having a lucid dream on the feeling of being refreshed in the morning compared to nights with the recall of a non-lucid dream; on the contrary, the feeling of being refreshed was higher after a night with a lucid dream. Future studies should be carried out to elicit tiredness and sleepiness during the day using objective and subjective measurement methods. Keywords: lucid dreaming; sleep quality; nightmares 1. Introduction Lucid dreams are defined as dreams in which the dreamer is aware that he or she is dreaming [1].
    [Show full text]
  • Efficacy and Mechanisms of Imagery Rescripting and Imaginal Exposure for Nightmares: Study Protocol for a Randomized Controlled Trial Anna E
    Kunze et al. Trials (2016) 17:469 DOI 10.1186/s13063-016-1570-3 STUDY PROTOCOL Open Access Efficacy and mechanisms of imagery rescripting and imaginal exposure for nightmares: study protocol for a randomized controlled trial Anna E. Kunze1,2*, Jaap Lancee1, Nexhmedin Morina3, Merel Kindt1,4 and Arnoud Arntz1 Abstract Background: Recurrent nightmares can effectively be treated with cognitive-behavioral techniques such as imagery rehearsal therapy, which involves imagery rescripting (IR) of nightmares, and imaginal exposure (IE) therapy. However, the underlying mechanisms of these treatments remain largely unknown. To investigate this, we identified a number of variables that might mediate the therapeutic effect of rescripting-based and/or exposure-based therapies. Also, to control for the possible confounding influence of (other) treatment components, we designed two stripped-down treatment protocols, which primarily consist of either (1) rescripting of, or (2) exposure to, the nightmare content. In a randomized controlled trial, we aim to investigate the therapeutic efficacy of these stripped-down IR and IE treatments, and explore their working mechanisms. Method: Three weekly sessions of either IR or IE will be compared to a waiting-list control group. Ninety participants suffering from nightmare disorder will be included and randomly allocated to one of the three groups. The primary clinical outcome measures are nightmare frequency and distress caused by nightmares. Secondary clinical outcome measures include sleep complaints, dysfunctional beliefs about nightmares, and posttraumatic stress symptom severity. Outcomes will be assessed weekly from week 1 (pre-assessment) to week 5 (post-assessment). Online follow-up assessments will take place at 3 and 6 months after post-assessment.
    [Show full text]
  • Taking a Bite out of Bruxism by Jordan Moshkovich
    1 Jordan Moshkovich Taking a Bite out of Bruxism In this paper, I will be covering parafunctional habits, bruxism (teeth grinding), and other related dental topics that should not only be of interest to anyone with teeth, but have direct application to overall health. Some of the information in this paper may come as news for some, such as the fact that dentists have begun using botox to help relieve some of the symptoms of bruxism (Nayyar et al). This paper will help educate you about dental health and also might supply important information about dental issues you are already facing. Some of these topics might already be familiar to you, however there should be something new for everyone. An old joke that was once told to me, reminds us, “Be true to your teeth and they won’t be false to you.” Dental health is very important for leading a happy, productive life and even though science continues to make important discoveries every day, the fact is that all humans are diphyodonts, therefore we should treat our teeth well, whether they be deciduous or permanent, because once they are gone, a third dentition will not occur. Diseased teeth can wreak havoc on every aspect of a person’s life and this paper should help you keep yours alive and well for many years to come. Upon reading the opening paragraph, one might well ask, “what are parafunctional th habits?” I know when I first heard those words, I did. According to the 4 ​ edition of Illustrated ​ ​ Dental Embryology, Histology, and Anatomy, parafunctional habits are, "Mandible movements ​ not within normal motions associated with mastication, speech, or respiratory movements" (Fehrenbach).
    [Show full text]
  • Physiological and Psychological Measurement of Sleep Disturbance in Female Trauma Survivors with PTSD and Major Depression
    University of Missouri, St. Louis IRL @ UMSL Dissertations UMSL Graduate Works 7-25-2013 Physiological and Psychological Measurement of Sleep Disturbance in Female Trauma Survivors with PTSD and Major Depression Kimberly Borkowski Werner University of Missouri-St. Louis Follow this and additional works at: https://irl.umsl.edu/dissertation Part of the Psychology Commons Recommended Citation Werner, Kimberly Borkowski, "Physiological and Psychological Measurement of Sleep Disturbance in Female Trauma Survivors with PTSD and Major Depression" (2013). Dissertations. 306. https://irl.umsl.edu/dissertation/306 This Dissertation is brought to you for free and open access by the UMSL Graduate Works at IRL @ UMSL. It has been accepted for inclusion in Dissertations by an authorized administrator of IRL @ UMSL. For more information, please contact [email protected]. SLEEP DISTURBANCE IN FEMALES WITH PTSD AND DEPRESSION 1 Physiological and Psychological Measurement of Sleep Disturbance in Female Trauma Survivors with PTSD and Major Depression Kimberly B. Werner M.A, Psychology – Behavioral Neuroscience, University of Missouri – St. Louis, 2009 B.A., Psychology, Saint Louis University, 2006 A Dissertation Submitted at the University of Missouri – St. Louis in partial fulfillment of the requirements for the degree Doctor of Philosophy in Psychology with an emphasis in Behavioral Neuroscience June 2013 Advisory Committee: Dr. Michael G. Griffin, Ph.D. Chairperson Dr. Tara E. Galovski, Ph.D. Dr. Joseph M. Ojile MD, D.ABSM, FCCP Dr. George Taylor, Ph.D.
    [Show full text]
  • Nightmares and Bad Dreams in Patients with Borderline Personality Disorder: Fantasy As a Coping Skill?
    Eur. J. Psychiat. Vol. 24, N.° 1, (28-37) 2010 Keywords: Borderline Personality Disorder; Night- mares; Affect regulation; Fantasy. Nightmares and bad dreams in patients with borderline personality disorder: Fantasy as a coping skill? Peter Simor*,** Szilvia Csóka*** Róbert Bódizs***,**** * Implicit Laboratory Association, Budapest ** Department of Cognitive Sciences, Budapest University of Technology and Economics, Budapest *** Institute of Behavioural Sciences, Semmelweis University, Budapest **** HAS-BME Cognitive Science Research Group, Hungarian Academy of Sciences, Budapest HUNGARY ABSTRACT – Background and Objectives: Previous studies reported a high prevalence of nightmares and dream anxiety in Borderline Personality Disorder (BPD) and the sever- ity of dream disturbances correlated with daytime symptoms of psychopathology. Howev- er, the majority of these results are based on retrospective questionnaire-based study de- signs, and hence the effect of recall biases (characteristic for BPD), could not be controlled. Therefore our aim was to replicate these findings using dream logs. Moreover, we aimed to examine the level of dream disturbances in connection with measures of emo- tional instability, and to explore the protective factors against dream disturbances. Methods: 23 subjects diagnosed with BPD, and 23 age and gender matched healthy controls were assessed using the Dream Quality Questionnaire, the Van Dream Anxiety Scale, as well as the Neuroticism, Assertiveness and Fantasy scales of the NEO-PI-R ques- tionnaire. Additionally, subjects were asked to collect 5 dreams in the three-week study period and to rate the emotional and phenomenological qualities of the reported dreams using the categories of the Dream Quality Questionnaire. Results: Dream disturbances (nightmares, bad dreams, night terror-like symptoms, and dream anxiety) were more frequent in patients with BPD than in controls.
    [Show full text]
  • Dreams and Nightmares with a Person’S Waking Life
    When nightmares do not disappear spontaneously, psychotherapy may help. Research has demonstrated that simple techniques of dream narration and transformation of the storyline are very useful in eliminating nightmares. Children may be encouraged to share their nightmare experiences with parents and professionals; very young children can benefit from drawing them. It is well documented that traumatic experiences can trigger intensive recurrent nightmares. These NIGHTMARES AND SLEEP nightmares can be associated with post-traumatic TERRORS stress disorder (PTSD), which is often experienced as Dreams and Some dream experiences are particularly distressing a result of war, assault, accidents, and other trauma. and have a negative impact on waking life. Professional help is recommended to alleviate Nightmares are well-elaborated dreams that have recurring nightmares following trauma. Nightmares a frightful, anxious or other dysphoric content that usually wakes up the dreamer. Nightmares tend to WHAT IS DREAMING? occur late in the night and normally during episodes of REM sleep. Sleep terrors, in contrast, are characterized by sudden awakenings from deep (non-REM) sleep near the beginning of the night. Although they too are WHAT ARE THE SOURCES associated with intense and negative mental OF DREAMS? experiences, they are typically very short and not remembered the next morning. The person wakes up from a sleep terror very suddenly with a dramatically increased respiration and heart rate and outward ARE DREAMS USEFUL? expressions of fear or panic. Sleep terrors can cause serious injuries at night and substantial daytime distress. Nightmares increase in prevalence through childhood into adolescence. From 1% to 4% of NIGHTMARES AND parents report their preschoolers have nightmares SLEEP TERRORS “often” or “always”.
    [Show full text]
  • Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies
    Review Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies Alexandre González-Rodríguez 1 , Javier Labad 2 and Mary V. Seeman 3,* 1 Department of Mental Health, Parc Tauli University Hospital, Autonomous University of Barcelona (UAB), I3PT, Sabadell, 08280 Barcelona, Spain; [email protected] 2 Department of Psychiatry, Hospital of Mataró, Consorci Sanitari del Maresme, Institut d’Investigació i Innovació Parc Tauli (I3PT), CIBERSAM, Mataró, 08304 Barcelona, Spain; [email protected] 3 Department of Psychiatry, University of Toronto, #605 260 Heath St. West, Toronto, ON M5T 1R8, Canada * Correspondence: [email protected] Received: 1 September 2020; Accepted: 12 October 2020; Published: 16 October 2020 Abstract: Sleep disturbances accompany almost all mental illnesses, either because sound sleep and mental well-being share similar requisites, or because mental problems lead to sleep problems, or vice versa. The aim of this narrative review was to examine sleep in patients with delusions, particularly in those diagnosed with delusional disorder. We did this in sequence, first for psychiatric illness in general, then for psychotic illnesses where delusions are prevalent symptoms, and then for delusional disorder. The review also looked at the effect on sleep parameters of individual symptoms commonly seen in delusional disorder (paranoia, cognitive distortions, suicidal thoughts) and searched the evidence base for indications of antipsychotic drug effects on sleep. It subsequently evaluated the influence of sleep therapies on psychotic symptoms, particularly delusions. The review’s findings are clinically important. Delusional symptoms and sleep quality influence one another reciprocally. Effective treatment of sleep problems is of potential benefit to patients with persistent delusions, but may be difficult to implement in the absence of an established therapeutic relationship and an appropriate pharmacologic regimen.
    [Show full text]
  • Clinical Management of Chronic Nightmares: Imagery Rehearsal Therapy
    BEHAVIORAL SLEEP MEDICINE, 4(1), 45–70 Copyright © 2006, Lawrence Erlbaum Associates, Inc. Clinical Management of Chronic Nightmares: Imagery Rehearsal Therapy Barry Krakow Maimonides Sleep Arts & Sciences, Ltd. Sleep & Human Health Institute, Albuquerque, NM Antonio Zadra Department of Psychology Université de Montréal, Canada Problems with nightmares are reported by a sizable proportion of individuals with a history of trauma and by approximately 5% to 8% of the general population. Chronic nightmares may represent a primary sleep disorder rather than a symptom of a psy- chiatric disorder, and direct targeting of nightmares is a feasible clinical approach to the problem. Of the treatments proposed, imagery rehearsal therapy (IRT) has re- ceived the most empirical support. An up-to-date account of this cognitive-imagery approach shows how to treat nightmares during 4 roughly 2-hr sessions. The main points covered in each therapy session and their underlying rationale are presented. Dismantling protocols are suggested to discern active ingredients of IRT and to de- velop flexible applications based on patients’ needs. Nightmares occur as an outcome of almost any traumatic experience, and frequent nightmares are also reported by a sizable proportion of individuals without a trauma history. Already in the early 19th century, Waller (1816) had remarked that there were few afflictions more universal among all classes of society than the nightmare. Ernest Jones (1959/1931) began the first chapter of his classic work On the Nightmare by stating, “No malady that causes mortal distress to the sufferer, not even seasickness, is viewed by medical science with such complacent indiffer- ence as the one which is the subject of this book” (p.
    [Show full text]