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Nightmares prevalent, underreported in military personnel

Data published in the Journal of Clinical Sleep Medicine revealed that although nightmare disorder is highly prevalent among military personnel with sleep disturbances, few report them as a reason for evaluation.

“Addressing nightmares as a distinct sleep disorder following a traumatic experience is of clinical importance as patients with disturbed sleep have poor outcomes and sleep-focused therapy can lead to improvement in PTSD, anxiety and depression,” Jennifer Creamer, PhD, Sleep Medicine Center, Martin Army Medical Center, and colleagues wrote. “Research on nightmares in military personnel is limited. Most research evaluating sleep disorders in active duty military personnel has focused on insomnia, obstructive sleep apnea and PTSD.”

To determine the prevalence and associated characteristics of nightmares among U.S. military personnel with sleep disturbances, researchers conducted a retrospective review of 493 active duty military members who underwent sleep medicine evaluation and polysomnography at the Martin Army Community Hospital Sleep Center in Fort Benning, Georgia. Participants were separated into two groups — nightmare disorder and non-nightmare disorder; then researchers compared subjective and objective sleep traits between groups. In secondary analysis, the investigators further assessed participants based on whether their nightmares were related to a traumatic experience or not.

Overall, 68.4% of participants reported excessive daytime sleepiness and 64.1% had insomnia. Although only 3.9% of participants reported nightmares as a reason for undergoing sleep evaluation, 31.2% experienced clinically significant nightmares.

Military personnel with nightmare disorder were more likely to have elevated Insomnia Severity Index scores (P < .001) as well as comorbid depression, anxiety and PTSD (all P < .001) than those without the sleep disorder. Participants with nightmare disorder also had shorter self-reported sleep duration and diminished sleep efficiency (both P < .001). Analysis of polysomnography variables showed that military service members with nightmare disorder experienced longer sleep onset latency and rapid eye movement sleep latency compared with those without nightmares. Participants enlisted in the Army were 1.6 times more likely to have diagnosed nightmare disorder compared with those in the Air Force (95% CI, 1.17-2.08; P = .002).

Trauma-related nightmares occurred in 60% of patients in the nightmare disorder group. Creamer and colleagues found patients with trauma-related nightmares were 1.49 times more likely to have been deployed compared with those with nightmare disorders. These patients also experienced more severe insomnia symptoms and were more likely to be diagnosed with obstructive sleep apnea (RR = 1.25), traumatic brain injury (RR = 5.9), PTSD (RR = 5.44), anxiety (RR = 2.17) and depression (RR = 2.05).

“Military personnel and health care providers require education that nightmares are not normal and there are treatments available,” Creamer said in a press release. “This research provides a basis for furthering the study and knowledge of nightmares in survivors of traumatic experiences. Treatment of nightmares can lead to improvement in sleep, quality of life, and other disorders such as suicidality.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.