Nightmares: Under-Reported, Undetected, and Therefore Untreated.

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.

Study at a glance

Abstract

Nightmares are a robust and modifiable predictor of increased suicidality and poor psychiatric outcomes, yet nightmare screening and treatment remain rare, even in sleep centers. This paper aims to examine what proportion of nightmare sufferers have discussed nightmares with a healthcare provider, as well as possible explanations for low rates of nightmare complaints. The present study utilized a large United States community sample recruited through mTurk and a student sample recruited from a large public university in the Southeast United States. In Study 1, participants (n = 809) were asked whether they had discussed nightmares with a healthcare provider. In Study 2 participants (n = 747) were asked whether they believed nightmares were treatable in addition to whether or not they had discussed nightmares with a healthcare provider. Of the participants in Study 1 experiencing clinically significant nightmare symptoms only 37.8% of participants reported discussing their nightmares with a healthcare professional. In Study 2 only 11.1% of participants with significant nightmares reporting having told a healthcare provider about their nightmares. Further, of these individuals with clinically significant nightmare symptoms, less than one-third believed that nightmares were treatable. Higher nightmare severity was associated with a greater likelihood of reporting nightmares to a healthcare physician as well as with lower beliefs that nightmares are treatable. Our findings suggest that nightmares are rarely reported to healthcare providers, which may explain the underutilization of nightmare treatments. Given the poor outcomes associated with nightmares, nightmare screening is warranted.