Nightmares and insomnia within the acute aftermath of trauma prospectively predict suicidal ideation.
Anthony N Reffi, David A Kalmbach, Philip Cheng, David A Moore, Matthew B Jennings, Gregory C Mahr, Grace M Seymour, Lily Jankowiak, Christopher L Drake
Journal of Clinical Sleep Medicine September 1, 2025 DOI: 10.5664/jcsm.11744 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective observational cohort study Peer reviewed |
|---|---|
| Sample size | 88 |
| Population | Patients hospitalized in Detroit, Michigan following traumatic injury (mean age 39.53 years, 67.0% male, 67.0% Black) |
| Duration | Assessments at 1 week, 1 month, and 2 months post-trauma |
| Topics | Dreaming |
| Keywords | Humans Wounds and injuries Risk factors Prospective studies Dreams Adult Middle aged Michigan Female Suicidal ideation Surveys and questionnaires Mental health Longitudinal Posttraumatic stress Sleep disorder Sleep disturbance Trauma-induced insomnia |
| Key findings | Patients with clinically significant nightmares and comorbid insomnia at one month post-trauma reported the highest rate of suicidal ideation at two months (42.9%), versus 8.0% with insomnia alone and 6.7% with neither. Insomnia predicted increased suicidal ideation only among those with comorbid nightmares, an interaction that persisted after accounting for acute stress symptoms. |
Abstract
Study
Objectives: Patients with acute trauma are vulnerable to suicidality following hospitalization. Research suggests nightmares and insomnia may interact to potentiate suicidality, possibly due to nightmares worsening co-occurring insomnia. Nightmares and insomnia are common stress reactions to acute trauma and might compound suicide risk within acutely traumatized patients. We tested the prospective relationship between nightmares and insomnia immediately after trauma on future suicidal ideation (SI).
Methods: Patients hospitalized in Detroit, Michigan following traumatic injury (meanage = 39.53 ± standard deviation 14.31 years, 67.0% male, 67.0% Black) completed surveys at 3 posttrauma timepoints: 1 week (time 1 [T1]; n = 88), 1 month (time 2 [T2]; n = 61), and 2 months (time 3 [T3]; n = 59).
Results: Patients with clinically significant nightmares and comorbid insomnia symptoms at T2 reported the highest rates of SI at T3 (42.9%), whereas patients with insomnia alone (8.0%) or neither sleep disturbance (6.7%) had the lowest SI rates (Ps < .05). We observed an interaction effect wherein insomnia symptoms at T2 predicted increased SI at T3, but only among patients with comorbid nightmares at T2. This interaction remained after accounting for acute stress symptoms at T2. Post hoc analyses showed nighttime awakenings and total wake time at T2 predicted increased SI at T3 with nightmares also moderating this prospective effect.
Conclusions: These novel results suggest clinically significant nightmares strengthen the association between insomnia and suicidality after trauma. As nearly half of acute trauma patients with nightmares and insomnia experience SI 2 months after trauma, early interventions that target both may curb SI rates. Citation: Reffi AN, Kalmbach DA, Cheng P, et al. Nightmares and insomnia within the acute aftermath of trauma prospectively predict suicidal ideation. J Clin Sleep Med. 2025;21(9):1519-1527.
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 4
- Nightmares matter: rethinking suicide risk assessment and intervention in depression Sleep April 8, 2026
- Temporal associations between nightmares and PTSD symptoms in the acute post-sexual assault period: An ecological momentary assessment study Journal of Mood and Anxiety Disorders July 10, 2026
- Voices of Wildfire Survivors: Sleep Disturbance Treatment and Post-Traumatic Growth The Family Journal September 7, 2026
- The Distressing Dream Content Inventory: Development and Initial Validation in Acute Trauma Patients. Journal of Sleep Research March 17, 2026
Cites 7
- Insomnia Symptoms, Nightmares, and Suicidal Ideation in a College Student Sample Sleep 2011
- Understanding nightmares after traumatic events in Detroit (UNiTED): prospective associations with interpersonal violence and posttraumatic stress disorder symptoms European Journal of Psychotraumatology October 8, 2024
- Nightmare frequency is a risk factor for suicidal ideation during the COVID-19 pandemic. Journal of Sleep Research October 1, 2024
- Objective sleep disturbance in nightmares: is prolonged sleep onset latency a proxy for fear-of-sleep-related arousal? Sleep April 1, 2024
- Short-Term Stability and Night-to-Night Variability of Sleep Parameters in Nightmares Comorbid with Chronic Insomnia Disorder Across Multiple Nights of Polysomnography. Sleep February 1, 2024
and 2 more in the library