Cerebral Cortex
February 17, 2011
Philipp G. Sämann, Renate Wehrle, David Hoehn et al.
408 citations
As people fall asleep, the brain's default mode network (DMN) and its anticorrelated network (ACN) break down. In 25 healthy participants, functional connectivity between key brain regions—especially the posterior cingulate cortex, parahippocampal gyrus, and medial prefrontal cortex—decreased with deeper non-REM sleep. The loss of synchronization between the posterior and anterior midline nodes of the DMN, and between the DMN and ACN, suggests that preserved corticocortical connectivity is necessary for maintaining internal and external awareness. The posterior cingulate/retrosplenial cortex appears particularly important for regulating consciousness.
Sleep
June 29, 2012
Martin Dresler, Renate Wehrle, Victor I. Spoormaker et al.
271 citations
Lucid dreaming—being aware that one is dreaming—is associated with reactivation of brain areas that are normally deactivated during REM sleep. In one experienced lucid dreamer who had two episodes of verified lucid REM sleep long enough for fMRI analysis, the bilateral precuneus, cuneus, parietal lobules, and prefrontal and occipito-temporal cortices showed strong activation compared with non-lucid REM sleep. This pattern may explain the return of reflective cognitive abilities that characterize lucid dreaming.
Journal of Sleep Research
January 29, 2019
Annika Gieselmann, Malik Ait Aoudia, Michelle Carr et al.
192 citations
Chronic nightmares arise from an interaction between elevated hyperarousal and impaired fear extinction, facilitated by trait affect distress from traumatic experiences, early childhood adversity, trait susceptibility, elevated thought suppression, and potentially sleep-disordered breathing. Treatment options target nightmare meaning, chronic repetition, or maladaptive beliefs. The paper reviews epidemiological findings, aetiology models for traumatized and non-traumatized individuals, and evidence-based interventions, noting gaps in healthcare provider knowledge and delivery. Future perspectives for nightmare treatment and aetiology research are outlined.
Psychotherapy and Psychosomatics
January 1, 2006
Victor I. Spoormaker, Jan Van den Bout
155 citations
A pilot study tested lucid dreaming treatment (LDT) for chronic nightmares. Twenty-three nightmare sufferers were randomly assigned to an individual LDT session, a group LDT session, or a waiting list. Twelve weeks later, nightmare frequency decreased in both treatment groups. Sleep quality and posttraumatic stress disorder symptom severity showed no significant changes. Becoming lucid during nightmares was not necessary for the reduction in nightmare frequency. The key therapeutic component—exposure, mastery, or lucidity—remains unclear.
Dreaming
September 1, 2003
Victor I. Spoormaker, Jan Van den Bout, Eli J. G. Meijer
54 citations
A series of eight participants received a one-hour lucid dreaming treatment session for nightmares, including exercises and discussion of constructive solutions. Two months later, nightmare frequency decreased and sleep quality slightly improved, but there were no changes in state or trait anxiety. The treatment appears effective for reducing nightmare frequency, though the specific mechanism remains unclear.
Frontiers in Psychology
January 1, 2014
Martin Dresler, Leandra Eibl, Christian Fischer et al.
52 citations
In frequent lucid dreamers, the experience of volition—the sense of control over one's actions—is similar during lucid dreaming and wakefulness, and both are significantly higher than during non-lucid dreaming. However, specific aspects differ: planning ability is strongest while awake, intention enactment is strongest during lucid dreaming, and self-determination is equally strong during wakefulness and lucid dreaming. These findings confirm that different higher-order aspects of consciousness, such as volition, are expressed differently across conscious states.
Journal of Clinical Psychology
January 1, 2017
Annette van Schagen, Jaap Lancee, Marijke Swart et al.
Among 498 patients with diverse moderate-to-severe psychiatric disorders, those who also had nightmare disorder showed higher levels of psychopathology and personality pathology than those without nightmare disorder, with small effect sizes. No significant differences were found in coping strategies between the two groups. The findings suggest that nightmare disorder is linked to greater symptom severity in psychiatric patients.
The Journal of Clinical Psychiatry
September 1, 2015
Annette van Schagen, Jaap Lancee, Izaäk W De Groot et al.
Imagery rehearsal therapy (IRT) reduces nightmare frequency, nightmare distress, and general psychiatric symptoms in patients with a range of psychiatric disorders. In a trial of 90 patients, those who received six individual IRT sessions added to their usual treatment showed moderate improvements compared with those receiving treatment as usual alone. The benefits were largely sustained three months later. IRT involves patients changing the script of a nightmare into a new dream and practicing it during the day.
Sleep Medicine Reviews
April 1, 2015
Martin Dresler, Renate Wehrle, Victor I. Spoormaker et al.
Lucid dreaming, a rare sleep state where the dreamer becomes aware of dreaming, offers a testable model for psychosis. Recent EEG and fMRI data show that brain areas activated during lucid dreaming overlap strikingly with regions impaired in psychotic patients who lack insight into their condition. This parallel suggests that insight into dreaming and insight into psychosis share similar neural correlates, opening new avenues for therapeutic approaches and testing antipsychotic medication.
Current biology : CB
November 8, 2011
Martin Dresler, Stefan P. Koch, Renate Wehrle et al.
During lucid REM sleep, performing a dreamed hand movement activates the sensorimotor cortex in the same way as an actual movement. By combining fMRI and NIRS with polysomnography, the study used eye signals as temporal markers to link neural activity to specific dream content. This provides first evidence that the contents of REM-associated dreams can be visualized by neuroimaging, overcoming the previous impossibility of experimentally controlling spontaneous dream activity.
Journal of Sleep Research
September 1, 2011
Jaap Lancee, Victor I. Spoormaker, Jan Van den Bout
Two cognitive-behavioural self-help interventions for nightmares, imagery rehearsal and exposure, produced effects that were almost completely sustained 42 weeks after treatment ended. The initial improvements in nightmare measures persisted with effect sizes between 0.50 and 0.70. No differences in effectiveness were found between the two interventions. These long-term results suggest that nightmares can be effectively treated with targeted self-help approaches, and an internet-delivered intervention may serve as a good first step in a stepped-care model.
Psychotherapy and Psychosomatics
January 1, 2010
Jaap Lancee, Victor I. Spoormaker, Jan Van den Bout
Imagery rehearsal therapy (IRT) and exposure to nightmare imagery, delivered as self-help treatments over six weeks, both reduce nightmare frequency and distress, improve subjective sleep quality, and lessen anxiety (after IRT) and depression (after exposure) compared to a waiting list. Keeping a nightmare diary (recording) also helps, though less so. IRT reduces nightmare frequency more than recording alone, while exposure reduces distress more. IRT produces faster reductions in diary-reported nightmares. The findings suggest that exposure to nightmare imagery may be the key therapeutic ingredient, with cognitive restructuring adding immediate benefits.
Sleep Medicine Reviews
February 1, 2006
Victor I. Spoormaker, Michael Schredl, Jan Van den Bout
The DSM-IV-TR definition of nightmares is too narrow, as nightmares can involve emotions other than fear, such as anger or grief, and waking directly from a bad dream does not necessarily increase distress. Measuring nightmare frequency is problematic: polysomnography reduces nightmare frequency, retrospective reports underestimate it, and frequent nightmare sufferers may avoid daily logs. Idiopathic and posttraumatic nightmares differ, with posttraumatic ones linked to more and longer awakenings and both associated with periodic limb movements. Nightmares correlate with neuroticism and general psychopathology, and nightmare distress mediates daily impact. Imagery rehearsal therapy is the preferred cognitive-behavioral treatment, though no randomized controlled trial with an attention control group has been conducted. Nightmares should be treated as a separate, prevalent sleep disorder.