Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
April 1, 2021
Greta Mainieri, Jean-Baptiste Maranci, Pierre Champetier et al.
40 citations
Sleep paralysis and false awakenings are intermediate states between REM sleep and wakefulness. In a sleep-laboratory study of five participants, polysomnography recordings captured five sleep-paralysis episodes and two false awakenings. During sleep paralysis, 70.8% of 3-second mini-epochs showed theta brain waves (compared to 89.7% in normal REM sleep and 21.2% in wakefulness), 93.8% had chin-muscle atonia (vs 89.7% in REM and 33.3% in wakefulness), and 6.9% contained rapid eye movements (vs 11.9% in REM and 8.1% in wakefulness). The electroencephalography spectrum during sleep paralysis was intermediate between wakefulness and REM sleep for alpha, theta, and delta frequencies, while beta frequencies matched normal REM sleep.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
June 15, 2020
Valentina Gnoni, Sean Higgins, Alexander David Nesbitt et al.
12 citations
Three patients with non-REM parasomnias experienced episodes of Cotard delusion—believing they were dead or dying and unable to perceive their bodies as their own. These nihilistic mentations occurred during confusional arousals from sleep and were accompanied by panic. EEG source analysis indicated right-hemispheric hypoactivity during the episodes. The authors argue that aberrant activation of the salience network and default mode network—two major intrinsic networks of wakefulness—underlies these states. Such dreamlike mentations are rarely remembered and likely underreported, but can cause significant distress and worsen clinical outcomes if unaddressed.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
January 22, 2026
Amanda Radtke, Zahari Tchopev, Philip Cushman et al.
Nightmare Disorder is underdiagnosed in active duty U.S. military personnel despite causing significant impairment. At a sleep disorders center, baseline diagnosis rate was 0.60%, yet 59.28% of referred service members reported nightmares and 19.76% screened positive for probable NDO. A quality improvement initiative using three Plan-Do-Study-Act cycles standardized Nightmare Disorder Index documentation on polysomnography reports, provided targeted provider education, and flagged charts of patients screening positive. After seven months, the diagnosis rate increased from 0.60% to 9.12%, and the recognition rate rose from 3.03% to 55.32%, surpassing the goal of 5% without delaying care or increasing staff burden.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
September 1, 2022
Nanke Cui, Marjolein A Van Looij, Kristel M Kasius
A 32-year-old man with mild positional obstructive sleep apnea and sleep paralysis stopped experiencing sleep paralysis episodes after using a Sleep Position Trainer, a device that prevents sleeping on the back. The positional apnea was successfully treated, and the sleep paralysis resolved without additional intervention. This case suggests a possible noninvasive long-term treatment for sleep paralysis.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
August 1, 2022
Helene Vitali, Claudio Campus, Valentina De Giorgis et al.
Dreams originate through multiple brain mechanisms, not a single generator. Frontoparietal regions support dream recall, consistent with the Global Workspace theory of consciousness, but dreams in different sleep stages show distinct features, implying several generators. Blind individuals, including those congenitally blind, can still produce visual dreams, suggesting bottom-up mechanisms linked to innate body schemes or multisensory integration. A new dream-engineering technique may clarify multisensory integration during sleep and offer rehabilitation possibilities for sensory-impaired people. The Theory of Proto-consciousness proposes that waking and dreaming brain states interact for optimal functioning, potentially making dreaming a rehabilitative tool.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
November 15, 2020
Caroline Sierro, Wendy Leslie, Benjamin Putois
A follow-up of a previous trial found that imagery rehearsal therapy (IRT) for chronic nightmares remained effective three to five years after treatment, even during the COVID-19 pandemic. Patients who had received IRT maintained reduced nightmare frequency and distress compared to baseline, suggesting the therapy's benefits are robust over time and through stressful life events.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
June 15, 2018
Timothy I Morgenthaler, Sanford Auerbach, Kenneth R Casey et al.
Nightmare disorder affects about 4% of adults and can occur alone or with PTSD, impairing quality of life. This American Academy of Sleep Medicine position paper, based on a literature review from March 2009 to August 2017 and expert consensus, provides recommendations for treating nightmare disorder in adults. Image rehearsal therapy is recommended for both PTSD-associated nightmares and nightmare disorder. Many other therapies, including cognitive behavioral therapy, prazosin, and several medications, may be used. Clonazepam and venlafaxine are not recommended for nightmare disorder. The positions reflect the strength of evidence and clinical judgment, not clinical preference.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
March 15, 2018
Michael Schredl, Anja S. Göritz
Nightmares involve a wider range of emotions and topics than the standard definitions suggest. Analyzing 1,216 recent nightmares (including childhood nightmares) from a population-based sample, the study found common themes such as being chased, physical aggression, and death or injury of close persons. Less frequent themes, like being the aggressor and suicide, may relate to waking-life psychopathology. The variety of nightmare topics indicates that current diagnostic criteria, which focus mainly on threats to survival or physical integrity, are too narrow. Future research should examine nightmare content specifically in individuals diagnosed with nightmare disorder.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
July 15, 2016
Michael Schredl, Lara Dehmlow, Judith Schmitt
About 20% of 1,125 patients at a sleep center expressed interest in learning more about nightmare causes and treatments, including those who had never sought help before. The findings suggest that nightmares are underdiagnosed and undertreated even in specialized settings, and that health care professionals should routinely ask about nightmares and consider offering internet-based self-help programs as an initial step.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
July 15, 2015
Michael R Nadorff, Danielle K Nadorff, Anne Germain
Nightmares are a strong and changeable predictor of higher suicide risk and poor mental health outcomes, yet they are rarely screened for or treated, even in sleep clinics. In two U.S. surveys, only 37.8% of people with clinically significant nightmares in one sample and 11.1% in another had discussed them with a healthcare provider. Among those with significant nightmares, fewer than one-third believed nightmares were treatable. Greater nightmare severity made people more likely to report them but also less likely to believe they could be treated. The findings indicate that nightmares are seldom reported to healthcare providers, which may explain why effective treatments are underused, and support routine nightmare screening.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
April 15, 2015
Maria-Lucia Muntean, Claudia Trenkwalder, Arthur S Walters et al.
Motor behaviors and vocalizations during REM sleep that do not meet full criteria for REM sleep behavior disorder (RBD) are associated with dream enactment. In a prospective cohort, 13 subjects (10 with Parkinson disease, 3 healthy controls) who had previously shown REM sleep behavioral events (RBEs) were reinvestigated two years later. Nine of the 13 had progressed to RBD based on clinical and electromyographic criteria; all recalled vivid dreams, and seven described dream content. Four subjects had REM sleep without atonia (RWA) below the RBD cutoff; three recalled non-threatening dreams, and two described them in detail. RBEs with low RWA correlate with dreaming and may be a precursor to RBD.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
January 15, 2015
Gilbert Seda, Maria M Sanchez-Ortuno, Carolyn H Welsh et al.
Prazosin and imagery rehearsal therapy (IRT) show comparable short-term effects on nightmares, sleep quality, and posttraumatic stress symptoms, each producing moderate improvements. Combining IRT with cognitive behavior therapy for insomnia yields greater sleep quality gains than prazosin, IRT alone, or IRT plus another psychological intervention. Effect sizes did not differ significantly between pharmacological and psychological treatments for nightmare frequency, sleep quality, or posttraumatic stress symptoms. More randomized trials with long-term follow-up are needed.