REM dream activity of insomnia sufferers: a systematic comparison with good sleepers.

Patients with primary insomnia have dreams with less positive emotions and more negative content compared to good sleepers, consistent with their waking experiences. In a five-night polysomnography study with 12 patients and 12 controls aged 30–45, dream recall frequency was similar between groups when collected via forced REM-sleep awakenings. Controls' dreams tended to include more positive emotions, while patients' dreams were characterized by more negative elements. Subjectively, controls rated their dreams as more pleasant, joyful, and vivid. Elevated negative dream content was associated with lower sleep efficiency in insomnia. The findings suggest hyperarousal may worsen presleep negative mentation, contributing to poorer sleep quality.

Study at a glance

Abstract

The dream activity of patients with primary insomnia (PI) has rarely been studied, especially using in-laboratory dream collection, although dreams could be linked to their state of hyperarousal and their negative waking experiences. The objective of the study was to compare patients with PI and good sleeper controls (GSCs) in terms of dream recall frequency and dream content. Polysomnography was recorded in 12 patients with PI and 12 GSCs (aged between 30 and 45 years) for five consecutive nights. Rapid eye movement (REM) sleep awakenings were enforced on nights 3 and 5 for dream collections. The REM dream collections revealed that the groups were similar in terms of dream recall frequency (p ≤ 0.7). With respect to dream content variables, the dreams of GSCs tended to comprise more positive emotions (p = 0.06), whereas the dreams of patients with PI were characterized by more negative elements than positive ones (p = 0.001). Subjectively, GSCs characterized their dreams as being more pleasant and containing more joy, happiness, and vividness (p ≤ 0.03) than patients with PI. Finally, elevated negative dream content was associated with lower sleep efficiencies in insomnia (p = 0.004). These results suggest that less positive emotions and greater negative content characterize the dreams of patients with PI, which is in line with their waking experiences. One potential explanation could be hyperarousal exacerbating presleep negative mentation, thus contributing to poorer sleep quality. The lack of difference in dream recall frequency is most likely due to the forced awakening "dream collection" procedure. The study of dream activity seems a promising avenue for understanding the 24-h experience of insomnia better and exploring the potential benefits of dream management techniques.