Aggressiveness in the dreams of drug-naïve and clonazepam-treated patients with isolated REM sleep behavior disorder.
Simone Cavallotti, Hans-Christian Stein, Mariantonietta Savarese, Michele Terzaghi, Armando D'Agostino
Sleep Medicine April 1, 2022 DOI: 10.1016/j.sleep.2022.02.022 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective observational study Peer reviewed |
|---|---|
| Sample size | 36 |
| Population | Individuals with isolated REM sleep behavior disorder (drug-naïve and clonazepam-treated) and healthy control subjects |
| Intervention | Clonazepam |
| Duration | 3-week dream diary period |
| Topics | Dreaming |
| Keywords | Aggressiveness Clonazepam |
| Key findings | No significant difference in threatening dream content between drug-naïve RBD patients, clonazepam-treated RBD patients, and healthy controls; aggressiveness was higher only in dreams with dream enactment behaviors. |
Abstract
Although aggressive dream content is considered a distinctive feature of REM Sleep Behavior Disorder (RBD) and patients often report violent dreams during medical interviews, nonviolent behaviors (eating, drinking, urinating) and pleasant actions (e.g laughing, singing, dancing) or simply elemental, jerky limb movements are frequently observed during video-polysomnography. As a first-line pharmacological treatment, clonazepam has been shown to reduce motor symptoms during REM sleep, but its effect on dream content remains unclear. Here, we aimed to prospectively assess the dream content of individuals with drug-naïve isolated RBD (iRBD) and iRBD patients treated with clonazepam. Thirteen (12 Male, 1 Female; age 65.38 ± 10.95) iRBD patients treated with clonazepam (iRBD-T), eleven (9 M, 2 F; age 68.90 ± 6.8) drug-naïve patients (iRBD-NT) and twelve (8 M, 1 F; age 63.33 ± 12.88) healthy control subjects of comparable age kept a dream diary over a 3-week period. Dream content analysis was conducted according to the Hall and Van de Castle method (HVdC). The Threat Simulation Scale (TSS) was employed to assess the frequency of threatening contents. A total of 214 dream reports were collected. No significant differences were found in the frequency of threatening dream contents between the iRBD subsamples and healthy control subjects (p = 0.732). The HVdC analysis detected higher levels of Friendliness in iRBD patients compared to the control group (p = 0.036). Increased levels of Aggressiveness were only observed when differentiating dreams in which dream enactment behaviors (DEB) were present compared to dreams without DEBs, both in the iRBD-T group (p = 0.007) and the iRBD-NT group (p = 0.012). Our study shows no difference in the frequency of violent or threatening dreams in drug-naïve iRBD patients, clonazepam-treated iRBD patients and healthy control individuals. Aggressiveness is more frequent when DEBs are reported, suggesting motor disinhibition could require sufficiently dramatic and emotionally intense dreams, independent of clonazepam treatment.
Comparable studies
Other observational and cohort studies on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Lucid Dreaming: a State of Consciousness with Features of Both Waking and Non-Lucid Dreaming Student volunteers trained to become lucid and signal lucidity with horizontal eye... | 2009 | Observational study | n = 6 |
| Nightmare Prevalence, Nightmare Distress, and Self-Reported Psychological Disturbance Young adults with a mean age of 20 years | 2002 | Prospective observational study | n = 116 |
| Long-term effects of extreme situational stress on sleep and dreaming Survivors of traumatic events who complained of sleep disturbances, compared with... | 1987 | Case-control study | n = 11 |
| The relationship of nightmare frequency and nightmare distress to well‐being Adults who reported dreams | 2004 | Observational cohort | n = 147 |
| Dreaming in NREM Sleep: A High-Density EEG Study of Slow Waves and Spindles Healthy human subjects | 2018 | Observational cohort | n = 14 |
Citations in the library
Cited by 5
- Dreaming Characteristics in Non-Rapid Eye Movement Parasomnia and Idiopathic Rapid Eye Movement Sleep Behaviour Disorder: Similarities and Differences Nature and Science of Sleep March 1, 2024
- The effects of RBD medications on dream content: A critical review of evidence. Sleep Medicine October 21, 2025
- Dream Recall, Nightmares, and Aggression-Related Dream Content in Patients with REM Sleep Behavior Disorder (RBD). Sleep Science August 18, 2025
- A systematic review of dreams and nightmares recall in patients with rapid eye movement sleep behaviour disorder. Journal of Sleep Research June 1, 2023
- Dreaming in Parasomnias: REM Sleep Behavior Disorder as a Model. Journal of Clinical Medicine October 28, 2022
Cites 5
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