Whereas approximately 2–8% of the general population suffers from idiopathic nightmares, nightmares are a core feature of PTSD, with up to 80% of individuals with PTSD reporting disturbing and suicidal dreams with some degree of resemblance to the actual traumatic event ( Hasler and Germain, 2009 American Academy of Sleep Medicine, 2014). In contrast, posttraumatic nightmares refer to dreaming disturbances that are part of the stress reaction following exposure to a traumatic event, either during the acute stress response, or over the course of PTSD. However, recent observations point to maladaptive effects of nightmares on sleep and daytime neurobehavioral functions ( Levin and Nielsen, 2007 American Academy of Sleep Medicine, 2014 Scarpelli et al., 2019). According to the “threat simulation theory,” nightmares serve adaptation to stressful events in life ( Revonsuo, 2000). Their content is unspecific and includes interpersonal conflict, failure, helplessness, apprehension, being chased, accident, evil force, disaster, and environmental abnormality ( Mota-Rolim et al., 2013). Idiopathic nightmares are those with unknown etiology and unrelated to other disorders ( American Academy of Sleep Medicine, 2014 Robert and Zadra, 2014). Nightmares may occur occasionally in almost half of adults, but they may become recurrent, that is, repeated, especially in post-traumatic stress disorder (PTSD) ( Hartmann, 1984 Aurora et al., 2010 Morgenthaler et al., 2018), anxiety ( Haynes and Mooney, 1975 Levin, 1998 Nielsen et al., 2000 Zadra and Donderi, 2000 Tanskanen et al., 2001) and depression ( Germain and Nielsen, 2003 Agargun et al., 2007).Īn important etiological distinction made is the difference between idiopathic and posttraumatic nightmares. On awakening from nightmares, subjects rapidly become oriented and alert, but with emotional and physical signs of stress, such as fear, tachycardia, tachypnea, sweating, and daytime impairment in emotion regulation, cognition, and in many social areas of functioning ( Levin and Nielsen, 2007 American Academy of Sleep Medicine, 2014 Scarpelli et al., 2019). Nightmares generally occur during rapid eye movement sleep (REMS) and often result in awakening and worsened sleep quality. We conclude therefore that more research is clearly warranted for a better estimation of the effective conductance and therapeutic outcome of LD treatment in clinical practice.Īccording to the International Classification of Sleep Disorders, 3rd Edition ( American Academy of Sleep Medicine, 2014), nightmare disorder represents repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity. We observed that whereas LD may be a feasible aid in the treatment of patients with nightmares through minimizing their frequency, intensity and psychological distress, the available literature is still scarce and does not provide consistent results.
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We conducted a careful literature search for eligible studies on the use of LD treatment for nightmares. The aim of the present study is to review the existing literature of the use of LD as an auxiliary tool for treatment of nightmares. Thus, lucid dreamers might be able to render nightmares normal dreams, thereby assuring a restoring sleep. These features may open a way to help those who suffer from nightmare disorder through re-significations of the dream scene, i.e., knowing that they are dreaming and having control over their dream content. By contrast, during lucid dreaming (LD), subjects get insight they are dreaming and may even control the content of their dreams. Recurrent nightmares cause significant distress and impairment in occupational and social functioning, as have been commonly observed in post-traumatic stress disorder, depression and anxiety. Nightmares may occur spontaneously (idiopathic) or as recurrent nightmares. Generally, they occur during rapid eye movement sleep (REMS) and lead to awakenings with distress and insufficient overnight sleep. Nightmares are defined as repeated occurrences of extremely dysphoric and well-remembered dreams that usually involve subjective threats to survival, security, or physical integrity.