Longitudinal Findings on the Oneiric Activity Changes Across the Pandemic.

Purpose: COVID-19 pandemic waves have strongly influenced individuals' behaviors and mental health. Here, we analyzed longitudinal data collected in the Spring 2020 and 2021 from a large Italian sample with the aim of assessing changes in dream features between the first and third wave. Specifically, we evaluated the modifications of pandemic dream activity as a function of the general distress variations over time. Also, we detected the best explanatory variables of nightmare frequency and distress. Materials and Methods: Participants previously involved in the web survey during the first wave of the pandemic were asked to complete a new online survey on sleep and dream features available in Spring 2021 (N=728). Subjects decreasing their level of psychological general distress in the third (T3) vs the first (T1) pandemic wave were defined as "Improved" (N=330). In contrast, participants with an unchanged or increased level of general distress were defined as "Not Improved" (N=398). Results: Statistical comparisons revealed that dream recall frequency, nightmare frequency, lucid dream frequency, and emotional intensity show a reduction in T3 than T1. Moreover, the Improved group is characterized by lower nightmare rate and nightmare distress than Not Improved people. Our findings confirmed that beyond the trait-like variables (ie, age, sex), specific sleep-related measures are related to nightmare features. In particular, poor sleep hygiene was one of the best determinants of nightmare distress among Not Improved subjects. Conclusion: Our findings revealed that people experienced an adaptation to the pandemic during the third wave. We also strengthen the notion that nightmares and their variations over time are strongly related to human well-being, suggesting that specific trait-like and sleep-related factors could modulate the relationship between mental health and nightmare features.

The long wave of COVID-19: a case report using Imagery Rehearsal Therapy for COVID-19-related nightmares after admission to intensive care unit.

Introduction: The COVID-19 pandemic caused several psychological consequences for the general population. In particular, long-term and persistent psychopathological detriments were observed in those who were infected by acute forms of the virus and need specialistic care in the Intensive Care Unit (ICU). Imagery rehearsal therapy (IRT) has shown promising results in managing nightmares of patients with different traumas, but it has never been used with patients admitted to ICUs for severe COVID-19 despite this experience being considered traumatic in the literature. Methods: The purpose of this case study is to describe the application of a four-session IRT for the treatment of COVID-related nightmares in a female patient after admission to the ICU. A 42-year-old Caucasian woman who recovered from a pulmonary rehabilitation program reported shortness of breath, dyspnea, and everyday life difficulties triggered by the long-COVID syndrome. She showed COVID-related nightmares and signs of post-traumatic symptoms (i.e., hyperarousal, nightmares, and avoidance of triggers associated with the traumatic situation). Psychological changes in the aftermath of a trauma, presence, and intensity of daytime sleepiness, dream activity, sleep disturbances, aspects of sleep and dreams, and symptoms of common mental health status are assessed as outcomes at the baseline (during the admission to pneumology rehabilitation) at 1-month (T1) and 3-month follow-up (T2). Follow-up data were collected through an online survey. Results: By using IRT principles and techniques, the patient reported a decrease in the intensity and frequency of bad nightmares, an increase in the quality of sleep, and post-traumatic growth, developing a positive post-discharge. Conclusion: Imagery rehearsal therapy may be effective for COVID-19-related nightmares and in increasing the quality of sleep among patients admitted to the ICU for the treatment of COVID-19. Furthermore, IRT could be useful for its brevity in hospital settings.

The role of sleep and dreams in long-COVID.

Recent investigations show that many people affected by SARS-CoV2 (COVID-19) report persistent symptoms 2-3 months from the onset of the infection. Here, we report the Italian findings from the second International COVID-19 Sleep Study survey, aiming to investigate sleep and dream alterations in participants with post-acute symptoms, and identify the best determinants of these alterations among patients with long-COVID. Data from 383 participants who have had COVID-19 were collected through a web-survey (May-November 2021). Descriptive analyses were performed to outline the sociodemographic characteristics of long-COVID (N = 270, with at least two long-lasting symptoms) and short-COVID (N = 113, with none or one long-lasting symptom) participants. They were then compared concerning sleep and dream measures. We performed multiple linear regressions considering as dependent variables sleep and dream parameters discriminating the long-COVID group. Age, gender, work status, financial burden, COVID-19 severity and the level of care were significantly different between long-COVID and short-COVID subjects. The long-COVID group showed greater sleep alterations (sleep quality, daytime sleepiness, sleep inertia, naps, insomnia, sleep apnea, nightmares) compared with the short-COVID group. We also found that the number of long-COVID symptoms, psychological factors and age were the best explanatory variables of sleep and oneiric alterations. Our findings highlight that sleep alterations are part of the clinical presentation of the long-COVID syndrome. Moreover, psychological status and the number of post-acute symptoms should be considered as state-like variables modulating the sleep problems in long-COVID individuals. Finally, according to previous investigations, oneiric alterations are confirmed as a reliable mental health index.

Two years after lockdown: Longitudinal trajectories of sleep disturbances and mental health over the COVID-19 pandemic, and the effects of age, gender and chronotype.

Since the first lockdown of Spring 2020, the COVID-19 contagion waves pervasively disrupted the sleep and mental health of the worldwide population. Notwithstanding the largest vaccination campaign in human history, the pandemic has continued to impact the everyday life of the general population for 2 years now. The present study provides the first evidence of the longitudinal trajectories of sleep disturbances and mental health throughout the pandemic in Italy, also describing the differential time course of age groups, genders and chronotypes. A total of 1062 Italians participated in a three-time-point longitudinal study covering two critical stages of the emergency (the first lockdown in April 2020 and the second partial lockdown in December 2020) and providing a long-term overview 2 years after the pandemic outbreak (April 2022). We administered validated questionnaires to evaluate sleep quality/habits, insomnia, depression, stress and anxiety symptoms. Analyses showed a gradual improvement in sleep disturbances, depression and anxiety. Conversely, sleep duration progressively decreased, particularly in evening-type and younger people. Participants reported substantial earlier bedtime and get-up time. Stress levels increased during December 2020 and then stabilised. This effect was stronger in the population groups apparently more resilient during the first lockdown (older people, men and morning-types). Our results describe a promising scenario 2 years after the pandemic onset. However, the improvements were relatively small, the perceived stress increased, and the re-establishment of pre-existing social/working dynamics led to general sleep curtailment. Further long-term monitoring is required to claim the end of the COVID-19 emergency on Italians' sleep and mental health.

Sleep Deprivation and Insomnia in Adolescence: Implications for Mental Health.

Sleep changes significantly throughout the human lifespan. Physiological modifications in sleep regulation, in common with many mammals (especially in the circadian rhythms), predispose adolescents to sleep loss until early adulthood. Adolescents are one-sixth of all human beings and are at high risk for mental diseases (particularly mood disorders) and self-injury. This has been attributed to the incredible number of changes occurring in a limited time window that encompasses rapid biological and psychosocial modifications, which predispose teens to at-risk behaviors. Adolescents' sleep patterns have been investigated as a biunivocal cause for potential damaging conditions, in which insufficient sleep may be both a cause and a consequence of mental health problems. The recent COVID-19 pandemic in particular has made a detrimental contribution to many adolescents' mental health and sleep quality. In this review, we aim to summarize the knowledge in the field and to explore implications for adolescents' (and future adults') mental and physical health, as well as to outline potential strategies of prevention.

Healthcare Workers after Two Years of COVID-19: The Consequences of the Pandemic on Psychological Health and Sleep among Nurses and Physicians.

COVID-19 has challenged the health workforce worldwide. In this cross-sectional study with a retrospective assessment, we explored the impact of the pandemic on mental health and sleep among a sample of Italian nurses and medical doctors. A total of 287 healthcare workers (212 nurses and 75 physicians) completed a web survey on socio-demographic, psychological, and sleep-related aspects referring to the period before the pandemic and to the present period of February to June 2022. Comparisons between nurses and physicians revealed that the former had greater distress in response to the pandemic. Consistently, the multivariate analysis of covariance showed that even if both groups were negatively impacted by the pandemic, nurses presented a greater worsening over time regarding several psychological and sleep symptoms. Furthermore, we observed that working on the frontline represented an additional risk factor for nurses. In line with previous evidence, we also found that personal experiences with COVID-19 are significant predictors of the current health status. Our results underscore the urgent need for preventive programs among healthcare operators to increase their coping skills and prevent the long-term consequences of chronic stress, especially for high-risk professionals. Specific attention should also be devoted to programs to improve sleep quality and reduce sleep-related traumatic symptoms.

The Effect of COVID-19 on Sleep Quality and Mental Health: Adolescents Are More at Risk Than the Elderly.

After the appearance of a novel coronavirus (2019-nCoV) during 2019, the virus has spread with alarming speed and a pandemic quickly developed [...].

Has the COVID-19 Pandemic Traumatized Us Collectively? The Impact of the COVID-19 Pandemic on Mental Health and Sleep Factors via Traumatization: A Multinational Survey.

Purpose: The COVID-19 pandemic affects mental health and sleep, resulting in frequent nightmares. Therefore, identifying factors associated with nightmare frequency is important, as it can indicate mental health issues. The study aimed to investigate increases in nightmare frequency comparing the pre-pandemic and pandemic period, and identify its risk factors. Further, the mediating role of post-traumatic stress disorder symptoms between the pandemic and nightmares is explored. Patients and Methods: For this cross-sectional survey data were obtained via self-rating online survey (ICOSS: details in Partinen et al, 2021), which was open to anyone older than 18 years. The final volunteer sample consisted of 15,292 participants, divided according to their nightmare frequency (high: ≥1-2 nights/week; low: <1-2 nights/week). A total of 9100 participants were excluded if answers on variables of interest were missing or receiving rewards for participation. Chi-square tests identified changes of nightmare frequency. Predictors of high nightmare frequency were assessed using logistic regression and presented as Odds Ratios. Post-hoc mediation models were used to investigate the role of post-traumatic stress symptoms (PTSS). Results: The mean age was 41.63 (SD=16.55) with 64.05% females. High nightmare frequency increased significantly from 13.24% to 22.35% during the pandemic. Factors associated with it included self-reported PTSS (OR=2.11), other mental disorders and various sleep disorders or problems. Financial burden due to the pandemic, confinement, having had COVID-19, and work situation during the pandemic were associated with nightmare frequency, those relations were partly mediated through PTSS. Conclusion: Our results display the pandemic influence on nightmare frequency, which in turn connects to multiple mental health and sleep factors. These relations were partly mediated through PTSS. The COVID-19 pandemic appears to have caused traumatization of a substantial proportion of society. Health care workers should consider nightmares in their screening routines, as it might indicate PTSS and/or other mental and sleep disorders.

Subjective sleep alterations in healthy subjects worldwide during COVID-19 pandemic: A systematic review, meta-analysis and meta-regression.

OBJECTIVE: We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems. METHODS: Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects models were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses. RESULTS: A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQIgen) was 6.73 (95% CI, 6.61-6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53-9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regressions showed that PSQIgen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality. CONCLUSIONS: We found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orienting further studies on sleep since COVID-19 pandemic.

The fall of vulnerability to sleep disturbances in evening chronotypes when working from home and its implications for depression.

Eveningness is distinctively associated with sleep disturbances and depression symptoms due to the misalignment between biological and social clocks. The widespread imposition of remote working due to the COVID-19 pandemic allowed a more flexible sleep schedule. This scenario could promote sleep and mental health in evening-type subjects. We investigated the effect of working from home on sleep quality/quantity and insomnia symptoms within the morningness-eveningness continuum, and its indirect repercussions on depressive symptomatology. A total of 610 Italian office workers (mean age ± standard deviation, 35.47 ± 10.17 years) and 265 remote workers (40.31 ± 10.69 years) participated in a web-based survey during the second contagion wave of COVID-19 (28 November-11 December 2020). We evaluated chronotype, sleep quality/duration, insomnia, and depression symptoms through validated questionnaires. Three moderated mediation models were performed on cross-sectional data, testing the mediation effect of sleep variables on the association between morningness-eveningness continuum and depression symptoms, with working modality (office vs. remote working) as moderator of the relationship between chronotype and sleep variables. Remote working was associated with delayed bedtime and get-up time. Working modality moderated the chronotype effect on sleep variables, as eveningness was related to worse sleep disturbances and shorter sleep duration among the office workers only. Working modality also moderated the mediation of sleep variables between chronotype and depression. The above mediation vanished among remote workers. The present study suggests that evening-type people did not show their characteristic vulnerability to sleep problems when working from home. This result could imply a reduction of the proposed sleep-driven predisposition to depression of late chronotypes. A working environment complying with individual circadian preferences might ensure an adequate sleep quantity/quality for the evening-type population, promoting their mental health.

Dreaming during the COVID-19 pandemic: A narrative review.

According to several influential models, dreams can be affected by state- and trait-like factors, sleep features, and diurnal experiences. The COVID-19 pandemic globally affected daily habits, emotional experiences, and sleep. Previous studies suggested an influence of collective traumatic events on dreaming. Starting from these premises, several studies assessed the effect of the pandemic on dreams. This paper aims to review findings concerning the oneiric activity during the COVID-19 pandemic. We report pandemic-related changes in dreams and nightmares, and we consider the possible factors associated with dreaming. Moreover, we provide results about changes in the oneiric activity in different phases of the pandemic. The reviewed findings suggest a pandemic-related enhancement of dream and nightmare frequency, emotional intensity, and distressing contents, modulated by modifications in restrictive measures and associated with diurnal experiences, emotional status, and sleep pattern. We highlight several methodological issues and a large heterogeneity in the present literature, limiting results' generalizability. However, we provide possible interpretations of the most consistent findings in light of the main theoretical frameworks about dreaming.

The Oneiric Activity during and after the COVID-19 Total Lockdown in Italy: A Longitudinal Study.

A growing body of evidence highlights that the COVID-19 pandemic affected oneiric activity. However, only a few studies have assessed the longitudinal changes in dream phenomenology during different phases of the pandemic, often focused on a limited number of dream variables. The aim of the present study was to provide an exhaustive assessment of dream features during total lockdown (TL) and a post-lockdown (PL) period characterized by eased restrictive measures in Italy. We performed a longitudinal study using a web-based survey to collect demographic, COVID-19 related, clinical, sleep, and dream data at TL and PL. Our final sample included 108 participants. The high frequency of poor sleep quality, anxiety, and depressive symptoms observed during TL remained stable at PL, while sleep latency (t = -4.09; p < 0.001) and PTSD-related disruptive nocturnal behaviors (t = -5.68; p < 0.001) exhibited a reduction at PL. A PL decrease in time spent with digital media was observed (t = -2.77; p = 0.007). We found a strong PL reduction in dream frequency (t = -5.49; p < 0.001), emotional load (t = -2.71; p = 0.008), vividness (t = -4.90; p < 0.001), bizarreness (t = -4.05; p < 0.001), length (t = -4.67; p < 0.001), and lucid dream frequency (t = -2.40; p = 0.018). Fear was the most frequently reported emotion in dreams at TL (26.9%) and PL (22.2%). Only the frequency of specific lockdown-related dream contents exhibited a reduction at PL. These findings highlight that the end of the home confinement had a strong impact on the oneiric activity, in the direction of reduced dream frequency, intensity, and lockdown-related contents. The co-occurrence of such changes with a decline in nocturnal PTSD-related symptoms, sleep latency, and time with digital media suggests an influence of post-traumatic stress levels, lifestyle modifications, and sleep pattern on dream changes during different phases of the pandemic. The stable prevalence of fear in dreams and the large frequency of poor sleep quality, depressive symptoms, and anxiety are probably related to the persistence of many negative consequences of the pandemic. Overall, these results are consistent with the continuity hypothesis of dreams.

The Oneiric Activity during and after the COVID-19 Total Lockdown in Italy: A Longitudinal Study

A growing body of evidence highlights that the COVID-19 pandemic affected oneiric activity. However, only a few studies have assessed the longitudinal changes in dream phenomenology during different phases of the pandemic, often focused on a limited number of dream variables. The aim of the present study was to provide an exhaustive assessment of dream features during total lockdown (TL) and a post-lockdown (PL) period characterized by eased restrictive measures in Italy. We performed a longitudinal study using a web-based survey to collect demographic, COVID-19 related, clinical, sleep, and dream data at TL and PL. Our final sample included 108 participants. The high frequency of poor sleep quality, anxiety, and depressive symptoms observed during TL remained stable at PL, while sleep latency (t = −4.09;p < 0.001) and PTSD-related disruptive nocturnal behaviors (t = −5.68;p < 0.001) exhibited a reduction at PL. A PL decrease in time spent with digital media was observed (t = −2.77;p = 0.007). We found a strong PL reduction in dream frequency (t = −5.49;p < 0.001), emotional load (t = −2.71;p = 0.008), vividness (t = −4.90;p < 0.001), bizarreness (t = −4.05;p < 0.001), length (t = −4.67;p < 0.001), and lucid dream frequency (t = −2.40;p = 0.018). Fear was the most frequently reported emotion in dreams at TL (26.9%) and PL (22.2%). Only the frequency of specific lockdown-related dream contents exhibited a reduction at PL. These findings highlight that the end of the home confinement had a strong impact on the oneiric activity, in the direction of reduced dream frequency, intensity, and lockdown-related contents. The co-occurrence of such changes with a decline in nocturnal PTSD-related symptoms, sleep latency, and time with digital media suggests an influence of post-traumatic stress levels, lifestyle modifications, and sleep pattern on dream changes during different phases of the pandemic. The stable prevalence of fear in dreams and the large frequency of poor sleep quality, depressive symptoms, and anxiety are probably related to the persistence of many negative consequences of the pandemic. Overall, these results are consistent with the continuity hypothesis of dreams.

Nightmares in People with COVID-19: Did Coronavirus Infect Our Dreams?

INTRODUCTION: A growing number of studies have demonstrated that the coronavirus disease-19 (COVID-19) pandemic has severely affected sleep and dream activity in healthy people. To date, no investigation has examined dream activity specifically in COVID-19 patients. METHODS: As part of the International COVID-19 Sleep Study (ICOSS), we compared 544 COVID-19 participants with 544 matched-controls. A within-subjects comparison between pre-pandemic and pandemic periods computed separately for controls and COVID-19 participants were performed on dream recall and nightmare frequency (DRF; NF). Also, non-parametric comparisons between controls and COVID-19 participants were carried out. Further, we compared psychological measures between the groups collected during pandemic. Ordinal logistic regression to detect the best predictors of NF was performed. RESULTS: We found that people reported greater dream activity during the pandemic. Comparisons between controls and COVID-19 participants revealed a) no difference between groups concerning DRF in the pre-pandemic period and during the pandemic; b) no difference between groups concerning nightmare frequency in the pre-pandemic period; and c) COVID-19 participants reported significantly higher NF than controls during pandemic (p = 0.003). Additionally, we showed that a) anxiety, depression, post-traumatic stress-disorder (PTSD) symptom scores were higher in COVID-19 participants than controls; and b) quality of life and health as well as wellbeing (WHO-5) scores were significantly higher in controls than COVID-19 participants. Finally, ordinal logistic regression indicates that DRF (p < 0.001), PTSD (p < 0.001), anxiety (p = 0.018), insomnia (p = 0.039), COVID-19 severity (p = 0.014), sleep duration (p = 0.003) and age (p = 0.001) predicted NF. DISCUSSION: Our work shows strong associations between increased nightmares in those reporting having had COVID-19. This suggests that the more that people were affected by COVID-19, the greater the impact upon dream activity and quality of life.

Pre-sleep arousal and sleep quality during the COVID-19 lockdown in Italy.

OBJECTIVE: The COVID-19 pandemic has strongly affected daily habits and psychological wellbeing, and many studies point to large modifications in several sleep and sleep-related domains. Nevertheless, pre-sleep arousal during the pandemic has been substantially overlooked. Since hyperarousal represents one of the main factors for the development and the perpetuation of chronic insomnia disorder, the assessment of variables associated with high levels of pre-sleep arousal during the pandemic is clinically relevant. The study aimed to assess the prevalence and predictors of perceived sleep quality and pre-sleep arousal in an Italian sample during the COVID-19 lockdown. METHODS: We used an online survey to collect self-reported sociodemographic, environmental, clinical, sleep, and sleep-related data. Our final sample included 761 participants. RESULTS: Beyond a high frequency of poor sleep quality, depressive and stress symptoms, our results show that almost half of the sample suffered from clinically relevant levels of at least one component (ie, cognitive, somatic) of pre-sleep arousal. Subjects with greater pre-sleep arousal exhibited poorer sleep quality. Also, sleep quality was strongly associated with somatic and cognitive pre-sleep arousal. Regarding the predictors of sleep and sleep-related measures, depressive and event-related stress symptoms were the main factors associated with both poor sleep quality and pre-sleep arousal components. Moreover, specific sociodemographic and environmental variables were uniquely related to sleep quality, cognitive or somatic pre-sleep arousal. CONCLUSIONS: These findings suggest that the assessment of specific sleep-related factors (ie, pre-sleep arousal), together with more global measures of sleep quality, may be crucial to depict the complex impact of the pandemic on sleep, and to help prevent and counteract the spread of insomnia symptoms.

Persistence of the Effects of the COVID-19 Lockdown on Sleep: A Longitudinal Study.

The effects of the COVID-19 pandemic on sleep have been widely documented, but longitudinal evaluations during different phases of the "COVID-19 era" are needed to disentangle the specific consequences of the r145estrictive measures on sleep variables. The aim of this study was to assess the immediate effect of the lockdown's end on sleep and sleep-related dimensions in an Italian sample, also considering the stress and depressive symptoms. We used an online survey to longitudinally collect data on sociodemographic, environmental, clinical, sleep, and sleep-related variables in two time points: during and immediately after the lockdown. The final sample included 102 participants. The large prevalence of poor sleep quality, clinically relevant pre-sleep arousal, and depressive symptoms, as well as poor sleep quality and pre-sleep arousal score observed during the lockdown, remained stable after its end. On the other hand, the prevalence of moderate-to-severe event-related stress and intrusive symptom scores exhibited a drastic reduction after the end of home confinement. Both bedtime and rise time were anticipated after the lockdown, while sleep quality exhibited only a trend of post-lockdown sleep disturbance reduction. Our findings point to a reduced stress level (specific for the intrusive symptomatology) after the end of the lockdown and persistence of sleep problems, suggesting two non-mutually exclusive hypotheses: (a) the strict restrictive measures are not the main cause of sleep problems during the pandemic and (b) home confinement induces long-lasting effects on sleep observable after its end, and a longer period of time might be needed to observe an improvement.

Dreams and Nightmares during the First and Second Wave of the COVID-19 Infection: A Longitudinal Study.

Recent literature shows that the Coronovirus-19 (COVID-19) pandemic has provoked significant changes in dreaming. The current study intends to provide an update about dream variable changes during the second wave of COVID-19. A total of 611 participants completed a web survey from December 2020 to January 2021. Statistical comparisons showed that subjects had lower dream-recall frequency, nightmare frequency, lucid-dream frequency, emotional intensity, and nightmare distress during the second than the first wave of the pandemic. Dreams had a higher negative tone during the second than first wave. We revealed significant differences concerning post-traumatic growth, sleep-related post-traumatic stress disorder (PTSD) symptoms and sleep measures between groups obtained as a function of the changes in the oneiric frequency between the first and second waves. We also found significant correlations between qualitative/emotional dream features and COVID-19-related factors (job change, forced quarantine, having COVID-19 infected relatives/friends, or asking for mental health help). Overall, we found that the second wave affected fewer quantitative features of dream activity and there was less emotional intensity. Moreover, we confirmed the relationship between nightmares and the high risk of PTSD when subjects were grouped as a function of the increasing/decreasing frequency. Finally, our findings are partly coherent with the continuity hypothesis between oneiric and waking experiences.

How our Dreams Changed During the COVID-19 Pandemic: Effects and Correlates of Dream Recall Frequency - a Multinational Study on 19,355 Adults.

OBJECTIVE: Many have reported odd dreams during the pandemic. Given that dreams are associated with mental health, understanding these changes could provide crucial information about wellbeing during the pandemic. This study explored associations between COVID-19 and dream recall frequency (DRF), and related social, health, and mental health factors. METHODS: We conducted a cross-sectional web survey of 19,355 individuals in 14 countries from May to July 2020. We collected data on COVID-19, mental health, sleep and DRF during the pandemic. We performed McNemar Tests to compare low (<3 nights per week) and high DRF (≥3 nights per week) before and during COVID-19 and to evaluate changes in sleep variables segmented by DRF. Chi-square tests were conducted to compare characteristics between low and high DRF. Logistic regression analyses were conducted to examine associations between various independent variables and DRF. RESULTS: Reports of high DRF during the pandemic were higher than before the pandemic (P<0.001). Female gender (aOR=1.25, 95% CI 1.10-1.41), nightmares (aOR=4.22, 95% CI 3.45-5.17), sleep talking (aOR= 2.36, 1.73-3.23), sleep maintenance problems (aOR=1.34, 95% CI 1.15-1.56), symptoms of REM sleep behavior disorder (RBD; aOR=1.24, 95% CI 1.09-1.41) and repeated disturbing thoughts (posttraumatic stress disorder (PTSD) symptoms) were associated with high DRF. Age group 55-64 years (aOR=0.69, 95% CI 0.58-0.83) reported less high DRF than younger participants. Unadjusted OR showed associations between depression, anxiety, and DRF; however, in adjusted regression depression (aOR= 0.71, 0.59-0.86) and anxiety (aOR=0.79, 95% CI 0.66-0.94) were negatively associated with high DRF. CONCLUSION AND RELEVANCE: DRF was higher than pre-pandemic levels across four continents. DRF was associated with gender and parasomnias like nightmares and RBD symptoms, sleep maintenance problems, PTSD symptoms and negatively associated with depression and anxiety. The results implicate that COVID-19 is reflected in our dreams as an expression of the emotional intensity of the pandemic.

Changes in sleep pattern and dream activity across and after the COVID-19 lockdown in Italy: A longitudinal observational study.

A large body of evidence has documented the impact of the global COVID-19 outbreak - and especially the lockdown period - on sleep quality and quantity. Here, we present the first Italian longitudinal study on sleep and COVID-19 considering four different time points collected during lockdown (from 29 March 2020 to 3 May 2020) and a subsequent follow-up period (October 2020). We used an online survey to collect socio-demographic and COVID-19 related information. Subjects were also asked to complete a sleep diary at each time point of the study. Our longitudinal sample included 147 participants. Statistical comparison across time intervals showed remarkable changes in sleep patterns during and after the lockdown. In particular, during lockdown we observed longer sleep latency, less ease of falling asleep, a higher total bedtime, and a lower dream frequency. The week-by-week evaluation described relatively stable patterns in the observed measures during the lockdown period, except for dream frequency, affected by a rapid increase in the early phase of lockdown. Our findings are in line with the current literature. Furthermore, the prospective longitudinal investigation comprising several time points offered the possibility of (a) observing the temporal dynamics and the different entities of such changes over time, and (b) reducing the typical memory bias for these studies.

The impact of the end of COVID confinement on pandemic dreams, as assessed by a weekly sleep diary: a longitudinal investigation in Italy.

The Coronavirus 2019 pandemic strongly affected our sleep and dream activity. Many cross-sectional studies highlighted increased dream recall frequency, and revealed a great presence of pandemic-related oneiric contents. Here, we present the first prospective study carried out on an Italian sample. One-hundred subjects were requested to fill out a web-survey including socio-demographic information, and questionnaires collecting sleep and clinical measures during lockdown. A final sample of 90 subjects participated in the longitudinal protocol lasting 2 weeks: (a) the first week (April 28-May 4) of full lockdown; and (b) the second week (May 5-May 11) of easing of restrictions. Subjects were asked to record at home their dream experiences, and complete a sleep-dream diary each morning. Statistical comparisons showed that participants had higher numbers of awakenings, lower ease of falling asleep, higher dream recall and lucid dream frequency during lockdown than post-lockdown. Further, subjects reported more dreams, including "being in crowded places" during post-lockdown than lockdown. The poorer sleep quality during lockdown is quite consistent with previous findings. The relationship between traumatic events and dream recall frequency confirmed the idea of pandemic as "collective trauma". Also, we hypothesized that the greater presence of lucid dreams during confinement could reflect the attempt to cope with the waking pandemic-experiences. Finally, the presence of crowded places into dream scenarios during the second week of our protocol appears consistent with the continuity-hypothesis, as the possibility to access places frequented by other people could represent a relevant experience after a long period of confinement.