![]() One such study was conducted by Vanderheyden and colleagues, and collected electroencephalogram (EEG) data before and after exposing rats to single prolonged stress, and measured freezing behaviors during a fear-learning task to determine PTSD-like symptom severity. Thus, animal models focused on the impact of trauma-like events on sleep and behaviors can provide some novel insights into the potential pathways underlying the pathophysiology of nightmares comorbid with PTSD. Studying nightmares in the sleep laboratory or using sleep neuroimaging methods is highly challenging as these episodes cannot be reliably experimentally induced and rarely occur under laboratory conditions, even in individuals with chronic and frequent nightmares. Thus, targeting the treatment nightmares prior to or early after deployment offers a strategy to enhance resilience and/or mitigate the risk of poor deployment-related psychiatric symptoms and disorders. ![]() Nightmares prior to deployment predicted PTSD at post deployment. , 453 Dutch soldiers were interviewed before and six months after a deployment to Afghanistan. nightmares may also predict higher PTSD severity at a six-month follow-up. Nightmares are not only associated with higher severity of PTSD symptoms at baseline as demonstrated in a study of 80 combat veterans by Pigeon et al. More exploration into cultural differences in nightmare content is warranted because treatment approaches could be modified to meet the needs of patients. The number of dreams in the past month correlated with PTSD symptom severity as measured by the PTSD checklist ( r = −0.53, p < 0.01). Such dreams could also be spiritual attack on the dreamer themselves that are thought to result in severe illness or death. When a deceased loved one appears in dreams, it means he or she is suffering and begging the dreamer for help. In this cultural context, dreams themselves could be traumatic for the dreamer. While investigators did not refer to nightmares specifically, dreams described as “deeply upsetting” by all participants but one of the participants “awoke sobbing” paired with sadness and fear. Hinton and colleagues interviewed Cambodian refugees that survived and lost loved ones in the Pol Pot genocide (1975–1979) about the frequency, content, and meaning of dreams. Traumatic themes may also be subjected to cultural differences. If that is the case, nightmare characteristics such as sensory experiences may inform patient prognosis. Harb and colleagues reasoned that experiencing smells may indicate intensity of a nightmare because of the rudimentary nature of the brain systems responsible for olfactory processing. Reports of olfactory experiences during original nightmares predicted a smaller reduction in sleep disturbances, possibly due to the link between odor perception and emotional memory. Harb and colleagues studied a sample of 48 combat-exposed Vietnam veterans to find a relationship between dream content and treatment outcomes of image rehearsal therapy (IRT), an intervention that promotes mastery over recurrent nightmares by rehearsing modified versions of the disturbing nightmare. Posttraumatic nightmares typically involve themes and sensory input related to a specific traumatic event. ![]() Whether or not the same pattern holds in the civilian population or with nightmares without comorbid PTSD has yet be determined. Males deployed in support of Operation Enduring Freedom (October, 2010) or Operation Iraqi Freedom (March, 2003) are more likely to experience nightmares, numbing, and hyper-vigilance than their female counterparts who experience more concentration problems and distress with reminders. There is early evidence to suggest that men are more likely to experience nightmares as a symptom of PTSD than women. Nightmares are one of the re-experiencing symptoms of PTSD, and affect as many as 50 % of trauma-exposed adults. While nightmares are developmentally common in young children, traumatic events and pharmacological agents are the most commonly identified precipitating factors in adults. Nightmare disorder is characterized by dysphoric dreams that perturb sleep consolidation and daytime functioning. Contrary to several other parasomnias, the sleeper rapidly regains alertness and orientation upon awakening from a nightmare. The third edition of the International classification of sleep disorders (ICSD-3) has recently redefined nightmares as “repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity”. ![]()
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