Nightmare complaints in treatment-seeking patients in clinical sleep medicine settings: Diagnostic and treatment implications

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 nightmares (1) rank nightmare complaints compared to other sleep complaints, (2) link nightmares 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 outcomes. 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.