1181 Fear of Sleep Prospectively Predicts Nightmare Severity in Acute Trauma Patients Exposed to Community Violence
Anthony N Reffi, Lily Jankowiak, David Moore, Sattvik Basarkod, Tanja Jovanović, P. Cheng, Hsing-Fang Hsieh, C. Drake
Sleep May 1, 2025 DOI: 10.1093/sleep/zsaf090.1181 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 88 |
| Population | Acute trauma patients hospitalized in the intensive care unit within one week following traumatic injury (mean age 39.53 years, 67.0% male, 67.0% Black, 47.7% with income ≤ $20,000) |
| Duration | Assessments during hospitalization (T1) and approximately two months post-trauma (T2); community violence exposure assessed for the 90 days prior to hospitalization |
| Measures | Fear of Sleep Inventory (FoSI) Short Form, community violence questionnaire, Nightmare Disorder Index (NDI), skin conductance response (SCR) |
| Topics | Dreaming |
| Key findings | Fear of sleep during hospitalization prospectively predicted greater nightmare severity approximately two months after trauma, and exposure to community violence in the 90 days before hospitalization exacerbated this relationship (β = 0.51). In a small subsample, skin conductance response to the Fear of Sleep Inventory was correlated with greater community violence exposure and with staying up late to avoid sleeping, suggesting a possible shared sympathetic activation pathway. |
Abstract
Fear of sleep engenders arousal at bedtime that can promote nightmares. Living in disadvantaged neighborhoods with high rates of community violence may exacerbate fear of sleep and in turn increase nightmare risk. We tested fear of sleep among acute trauma patients as a prospective predictor of nightmares, and whether exposure to community violence moderated this relationship. Patients hospitalized in the intensive care unit within one week following traumatic injury (N = 88; Mage = 39.53 ± SD 14.31, 67.0% male, 67.0% Black, 47.7% income ≤ $20,000). Patients completed the Fear of Sleep Inventory (FoSI) Short Form and a community violence questionnaire during hospitalization (T1; N = 88) and the Nightmare Disorder Index (NDI) approximately two months post-trauma (T2; n = 59). We computed an NDI sum score as our outcome to indicate greater nightmare severity (nightmare frequency and nightmare-related awakenings, distress, and impairment). Skin conductance response (SCR) was collected from a subsample of patients (n = 7) during the FoSI to preliminarily explore the psychophysiological correlates of this scale. Exposure to community violence exacerbated the prospective effect of fear of sleep on future nightmare severity (β = 0.51, p =.039), such that relationship between fear of sleep at T1 and nightmare severity at T2 was strongest for patients reporting exposure to higher levels of community violence in the 90 days prior to hospitalization. SCR to the FoSI was correlated with greater exposure to community violence (r = 0.76, p =.048) and the following fear-of-sleep-related safety behaviors: “I stayed up late to avoid sleeping” (r = 0.87, p =.012) and “I tried to stay as alert as I could while lying in bed,” though this relationship was nonsignificant (r = 0.74, p =.060). Acute trauma patients presenting with a fear of sleep may be at increased risk for posttraumatic nightmares during recovery, especially those living within neighborhoods marked by high levels of community violence. Preliminary results suggest fear of sleep and community violence exposure may share an association with sympathetic activation which, when elevated at bedtime, could increase nightmare production. K23MH134032 (A.N.R.).
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 |