Dream Recall, Nightmares, and Aggression-Related Dream Content in Patients with REM Sleep Behavior Disorder (RBD)

Ruben Jigalin; Michael Schredl

doi:10.1055/s-0045-1809924

Sleep Science, Table of Contents

CC BY-NC-ND 4.0 · Sleep Sci
DOI: 10.1055/s-0045-1809924

Original Article

Dream Recall, Nightmares, and Aggression-Related Dream Content in Patients with REM Sleep Behavior Disorder (RBD)

Ruben Jigalin

Sleep Laboratory, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany

,

Michael Schredl

Sleep Laboratory, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany

› Author Affiliations

Abstract

Patients with REM sleep behavior disorder (RBD) enact their dreams, leading to enhanced dream recall. They report more negative emotions in their dreams, recall retrospective nightmares more frequently, and often experience more aggressive dreams. This study aims to understand dream characteristics in REM sleep behavior disorder using both retrospective and prospective measures in a controlled sleep laboratory setting to address possible recall biases in retrospective dream recall frequency. The sample comprises 102 iRBD-diagnosed patients (21 women, 81 men; M = 64.08, SD = 11.27) and 208 healthy controls (136 women, 72 men; M = 30.08, SD = 12.03), all undergoing identical procedures of two consecutive nights in the sleep laboratory, enabling a robust comparative examination of dream patterns. Retrospective assessments revealed a higher frequency of dream recall in patients with iRBD, while no significant difference was observed in prospective assessments. Nightmares were also reported more frequently in retrospective assessments in iRBD patients compared to healthy controls. Aggressive dream content was more frequent in patients with iRBD compared to controls, a future prospective diary study might clarify whether this heightened aggression in dreams is related to waking-life traits.

Keywords

dream recall - nightmares - REM sleep behavior disorder - dream content - aggression

Full Text

References

References
1 American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed, text revision. Darien, IL: American Academy of Sleep Medicine; 2023
2 Arnulf I. Dreaming in REM sleep behavior disorder. In: Pagel JF. ed. Parasomnia dreaming: Exploring other forms of sleep consciousness. New York: Nova Science; 2020: 175-209
3 Leclair-Visonneau L, Oudiette D, Gaymard B, Leu-Semenescu S, Arnulf I. Do the eyes scan dream images during rapid eye movement sleep? Evidence from the rapid eye movement sleep behaviour disorder model. Brain 2010; 133 (Pt 6): 1737-1746
4 Muntean M-L, Trenkwalder C, Walters AS, Mollenhauer B, Sixel-Döring F. REM Sleep Behavioral Events and Dreaming. J Clin Sleep Med 2015; 11 (05) 537-541
5 Valli K, Frauscher B, Gschliesser V. et al. Can observers link dream content to behaviours in rapid eye movement sleep behaviour disorder? A cross-sectional experimental pilot study. J Sleep Res 2012; 21 (01) 21-29
6 Valli K, Frauscher B, Peltomaa T, Gschliesser V, Revonsuo A, Högl B. Dreaming furiously? A sleep laboratory study on the dream content of people with Parkinson's disease and with or without rapid eye movement sleep behavior disorder. Sleep Med 2015; 16 (03) 419-427
7 Ehrminger M, Latimier A, Pyatigorskaya N. et al. The coeruleus/subcoeruleus complex in idiopathic rapid eye movement sleep behaviour disorder. Brain 2016; 139 (Pt 4) 1180-1188
8 Luppi P-H, Clément O, Sapin E. et al. The neuronal network responsible for paradoxical sleep and its dysfunctions causing narcolepsy and rapid eye movement (REM) behavior disorder. Sleep Med Rev 2011; 15 (03) 153-163
9 Boeve BF, Silber MH, Saper CB. et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain 2007; 130 (Pt 11): 2770-2788
10 Postuma RB, Iranzo A, Hu M. et al. Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study. Brain 2019; 142 (03) 744-759
11 Silber MH, StLouis EK, Boeve BF. Rapid Eye Movement sleep parasomnias. In: Kryger M, Roth T, Dement WC. eds. Principles and practice of sleep medicine. 6th edi. Elsevier; 2022: 1093-1101
12 Fantini ML, Corona A, Clerici S, Ferini-Strambi L. Aggressive dream content without daytime aggressiveness in REM sleep behavior disorder. Neurology 2005; 65 (07) 1010-1015
13 Godin I, Montplaisir J, Nielsen T. Dreaming and Nightmares in REM Sleep Behavior Disorder. Dreaming 2015; 25 (04) 257-273
14 Herlin B, Leu-Semenescu S, Chaumereuil C, Arnulf I. Evidence that non-dreamers do dream: a REM sleep behaviour disorder model. J Sleep Res 2015; 24 (06) 602-609
15 Lee HG, Choi JW, Lee YJ, Jeong D-U. Depressed REM Sleep Behavior Disorder Patients Are Less Likely to Recall Enacted Dreams than Non-Depressed Ones. Psychiatry Investig 2016; 13 (02) 227-231
16 McCarter SJ, St Louis EK, Boswell CL. et al. Factors associated with injury in REM sleep behavior disorder. Sleep Med 2014; 15 (11) 1332-1338
17 Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 2000; 123 (Pt 2): 331-339
18 Zhou J, Zhang J, Du L. et al. Characteristics of early- and late-onset rapid eye movement sleep behavior disorder in China: a case-control study. Sleep Med 2014; 15 (06) 654-660
19 Mariotti P, Quaranta D, Di Giacopo R. et al. Rapid eye movement sleep behavior disorder: a window on the emotional world of Parkinson disease. Sleep 2015; 38 (02) 287-294
20 Oudiette D, Constantinescu I, Leclair-Visonneau L, Vidailhet M, Schwartz S, Arnulf I. Evidence for the re-enactment of a recently learned behavior during sleepwalking. PLoS One 2011; 6 (03) e18056
21 Uguccioni G, Golmard J-L, de Fontréaux AN, Leu-Semenescu S, Brion A, Arnulf I. Fight or flight? Dream content during sleepwalking/sleep terrors vs. rapid eye movement sleep behavior disorder. Sleep Med 2013; 14 (05) 391-398
22 Martin JM, Andriano DW, Mota NB. et al. Structural differences between REM and non-REM dream reports assessed by graph analysis. PLoS One 2020; 15 (07) e0228903
23 Nemeth G. The route to recall a dream: theoretical considerations and methodological implications. Psychol Res 2023; 87 (04) 964-987
24 Lam S-P, Li SX, Chan JWY. et al. Does rapid eye movement sleep behavior disorder exist in psychiatric populations? A clinical and polysomnographic case-control study. Sleep Med 2013; 14 (08) 788-794
25 Zhou J, Zhang J, Li Y. et al. Gender differences in REM sleep behavior disorder: a clinical and polysomnographic study in China. Sleep Med 2015; 16 (03) 414-418
26 Jun J-S, Kim R, Jung H-M. et al. Emotion dysregulation in idiopathic rapid eye movement sleep behavior disorder. Sleep 2020; 43 (02) 1-7
27 Li SX, Wing YK, Lam SP. et al. Validation of a new REM sleep behavior disorder questionnaire (RBDQ-HK). Sleep Med 2010; 11 (01) 43-48
28 Sunwoo J-S, Cha KS, Byun J-I. et al. Abnormal activation of motor cortical network during phasic REM sleep in idiopathic REM sleep behavior disorder. Sleep 2019; 42 (02) 1-10
29 You S, Moon H-J, Do SY. et al. The REM Sleep Behavior Disorder Screening Questionnaire: Validation Study of the Korean Version (RBDQ-KR). J Clin Sleep Med 2017; 13 (12) 1429-1433
30 Fernández-Arcos A, Iranzo A, Serradell M, Gaig C, Santamaria J. The clinical phenotype of idiopathic rapid eye movement sleep behavior disorder at presentation: A study in 203 consecutive patients. Sleep 2016; 39 (01) 121-132
31 Godin I, Montplaisir J, Gagnon J-F, Nielsen T. Alexithymia associated with nightmare distress in idiopathic REM sleep behavior disorder. Sleep 2013; 36 (12) 1957-1962
32 Lloyd R, Tippmann-Peikert M, Slocumb N, Kotagal S. Characteristics of REM sleep behavior disorder in childhood. J Clin Sleep Med 2012; 8 (02) 127-131
33 D'Agostino A, Manni R, Limosani I, Terzaghi M, Cavallotti S, Scarone S. Challenging the myth of REM sleep behavior disorder: no evidence of heightened aggressiveness in dreams. Sleep Med 2012; 13 (06) 714-719
34 Cavallotti S, Stein H-C, Savarese M, Terzaghi M, D'Agostino A. Aggressiveness in the dreams of drug-naïve and clonazepam-treated patients with isolated REM sleep behavior disorder. Sleep Med 2022; 92: 19-23
35 Schredl M, Göritz AS. Umgang mit Alpträumen in der Allgemeinbevölkerung: Eine Online-Studie. Psychother Psychosom Med Psychol 2014; 64 (05) 192-196
36 Schredl M. Reliability and stability of a dream recall frequency scale. Percept Mot Skills 2004; 98 (3 Pt 2) 1422-1426
37 Stumbrys T, Erlacher D, Schredl M. Reliability and stability of lucid dream and nightmare frequency scales. Vorab-Onlinepublikation 2013;
38 Schredl M. Stability and variability of dream content. Percept Mot Skills 1998; 86 (02) 733-734
39 Schredl M, Kraft-Schneider B, Kröger H, Heuser I. Dream content of patients with sleep apnea. Somnologie (Berl) 1999; a 3: 319-323
40 Görtelmeyer R. SF-A und SF-B. Schlaffragebogen A und B. (3. Aufl.). Internationale Skalen für Psychiatrie; 1986
41 Schredl M, Burchert N, Gabatin Y. The effect of training on interrater reliability in dream content analysis. Sleep Hypn 2004; 6: 139-144
42 Kallus KW. Erholungs-Belastungs-Fragebogen: EBF. ; Handanweisung: Swets Test Services; 1995
43 Fasiello E, Scarpelli S, Gorgoni M, Alfonsi V, Galbiati A, De Gennaro L. A systematic review of dreams and nightmares recall in patients with rapid eye movement sleep behaviour disorder. J Sleep Res 2023; 32 (03) e13768
44 Schredl M. The problem of dream length in analysis of content. Percept Mot Skills 1999; b 88 (02) 434-436
45 Zunker M, Althoff HK, Apel J, Lässig HS, Schültke L, Schredl M. Comparing questionnaire and diary measures for eliciting nightmare frequency. Int J Dream Res 2015; 8 (02) 129-134
46 Nielsen TA. A review of mentation in REM and NREM sleep: “covert” REM sleep as a possible reconciliation of two opposing models. Behav Brain Sci 2000; 23 (06) 851-866 , discussion 904–1121
47 Krakow B, Zadra A. Clinical management of chronic nightmares: imagery rehearsal therapy. Behav Sleep Med 2006; 4 (01) 45-70
48 Ouchene R, El Habchi N, Demina A, Petit B, Trojak B. The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review. Encephale 2023; 49 (05) 525-531
49 Bugalho P, Magriço M, Ferreira VM. REM sleep behavior disorder: Relation between aggressiveness and emotions expressed in dream enactment and cognitive and anxiety/depression status. Sleep Med 2024; 124: 669-673 ; Advance online publication