Dream and nightmare alterations in patients presenting with suicidal crisis: A prospective study in psychiatric emergency department.
Emilie Gagneron, Katayoun Rezaei, Romain Perot, Pierre Alexis Geoffroy, Marine Ambar Akkaoui
Sleep Medicine July 2, 2026 DOI: 10.1016/j.sleep.2026.109110 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective study Peer reviewed |
|---|---|
| Sample size | 42 |
| Population | Patients presenting to a psychiatric emergency department in Paris with severe suicidal ideation or following a suicide attempt |
| Duration | March to April 2025 |
| Topics | Dreaming |
| Keywords | Insomnia Nightmares Psychiatric emergency Sleep disturbances Suicide |
| Key points | Nightmares were highly prevalent among patients during a suicidal crisis, emerging weeks to months before the acute episode, and suicidal-themed nightmares appeared closer to the crisis onset. |
Abstract
Suicide is a major public health concern, and identifying early indicators of suicidal crisis remains a key clinical challenge. Nightmares have been suggested as potential early markers of suicide risk. This study aimed to investigate dream alterations preceding a suicidal crisis in patients presenting to a psychiatric emergency department. This prospective study was conducted in a psychiatric emergency center in Paris between March and April 2025.42 patients presenting with severe suicidal ideation or following a suicide attempt completed a self-administered questionnaire assessing dream characteristics, sleep disturbances, anxiety, and depressive symptoms using validated clinical instruments. The timing and evolution of bad dreams, nightmares, and suicidal-themed nightmares preceding the crisis were examined. Overall, 83.0% of patients reported at least one dream alteration. Bad dreams were reported by 61.9% of participants, nightmares by 52.4% and suicidal scenarios occurring within nightmares by 35.7%. Nightmares emerged on average 128 days before the suicidal crisis, whereas suicidal-themed nightmares appeared closer to consultation, approximately 16 days before the emergency visits. More than half of patients (54.8%) experienced an evolutionary pattern in dream content involving at least two successive dream alterations. Nightmare severity was significantly correlated with insomnia severity and anxiety symptoms. Nightmares are highly prevalent among patients presenting psychiatric emergency services during a suicidal crisis and often emerge weeks to months before the acute episode. The temporal proximity of suicidal-themed nightmares to crisis onset and their association with insomnia and anxiety suggest that systematic assessment of nightmares may enhance suicide risk in clinical practice.
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
Cites 9
- Aetiology and treatment of nightmare disorder: State of the art and future perspectives Journal of Sleep Research January 29, 2019
- Psychosocial treatments for nightmares in adults and children: a systematic review BMC Psychiatry April 21, 2023
- Nightmares Fluctuate Across the Menstrual Cycle and May be More Pronounced in Women With Premenstrual Syndrome Brain and Behavior February 28, 2025
- The nightmare severity index (NSI): A short new multidimensional tool for assessing nightmares. Journal of Sleep Research May 1, 2024
- Bad Dreams and Nightmares Preceding Suicidal Behaviors. The Journal of Clinical Psychiatry November 23, 2022
and 4 more in the library