The memory sources of dreams: serial awakenings across sleep stages and time of night.

Memories of waking-life events are incorporated into dreams, but their incorporation is not uniform across a night of sleep. This study aimed to elucidate ways in which such memory sources vary by sleep stage and time of night. Twenty healthy participants (11 F; 24.1 ± 5.7 years) spent a night in the laboratory and were awakened for dream collection approximately 12 times spread across early, middle, and late periods of sleep, while covering all stages of sleep (N1, N2, N3, REM). In the morning, participants identified and dated associated memories of waking-life events for each dream report, when possible. The incorporation of recent memory sources in dreams was more frequent in N1 and REM than in other sleep stages. The incorporation of distant memories from over a week ago, semantic memories not traceable to a single event, and anticipated future events remained stable throughout sleep. In contrast, the relative proportions of recent versus distant memory sources changed across the night, independently of sleep stage, with late-night dreams in all stages having relatively less recent and more remote memory sources than dreams earlier in the night. Qualitatively, dreams tended to repeat similar themes across the night and in different sleep stages. The present findings clarify the temporal course of memory incorporations in dreams, highlighting a specific connection between time of night and the temporal remoteness of memories. We discuss how dream content may, at least in part, reflect the mechanisms of sleep-dependent memory consolidation.

Postural balance in frequent lucid dreamers: a replication attempt.

STUDY OBJECTIVES: Early research suggests that the vestibular system is implicated in lucid dreaming, e.g. frequent lucid dreamers outperform others on static balance tasks. Furthermore, gravity-themed dreams, such as flying dreams, frequently accompany lucid dreaming. Nonetheless, studies are scarce. METHODS: We attempted to: (1) replicate previous findings using more sensitive static balance measures and (2) extend these findings by examining relationships with dreamed gravity imagery more generally. 131 participants (80 F; Mage=24.1 ± 4.1 yrs) estimated lucid dreaming frequency then completed a 5-day home log with ratings for dream lucidity awareness, control, and gravity sensations (flying, falling). They then performed balance tasks on a sensitive force plate, i.e. standing on one or both feet, with eyes open or closed. Center of pressure (CoP) Displacement and CoP Velocity on each trial measured postural stability. RESULTS: Findings partially support the claim of a vestibular contribution to lucid dreaming. Frequent lucid dreamers displayed better balance (lower CoP Velocity) than did other participants on some trials and lucid dreaming frequency was globally correlated with better balance (lower CoP Velocity). Lower CoP Velocity was related to flying sensations in men's dreams and with more dream control in women's dreams. However, body height-possibly due to its relationship to sex-and levels of sleepiness confound some of these effects. CONCLUSION: While findings only provide a partial replication of previous work, they nonetheless support an emerging view that the vestibular system underlies basic attributes of bodily self-consciousness, such as feelings of self-agency and self-location, whether such consciousness occurs during wakefulness or dreaming.

Targeted memory reactivation has a sleep stage-specific delayed effect on dream content.

Although new learning is known to reappear in later dream scenarios, the timing of such reappearances remains unclear. Sometimes, references to new learning occur relatively quickly, 1 day post-learning (day-residue effect); at other times there may be a substantive delay, 5-7 days, before such references appear (dream-lag effect). We studied temporal delays in dream reactivation following the learning of a virtual reality (VR) flying task using 10-day home sleep/dream logs, and how these might be influenced by targeted memory reactivation (TMR). Participants were exposed twice to a VR task in the sleep laboratory; once before and once after a 2-hr opportunity to nap (n = 65) or to read (n = 32). Auditory cues associated with the VR task were replayed in either wake, rapid eye movement (REM) sleep, slow-wave sleep (SWS) or were not replayed. Although we previously showed that TMR cueing did not have an immediate effect on dream content, in the present study we extend these results by showing that TMR in sleep has instead a delayed effect on task-dream reactivations: participants dreamed more about the task 1-2 days later when TMR was applied in REM sleep and 5-6 days later when it was applied in SWS sleep, compared to participants with no cueing. Findings may help explain the temporal relationships between dream and memory reactivations and clarify the occurrence of day-residue and dream-lag phenomena.

Dreaming of the sleep lab.

The phenomenon of dreaming about the laboratory when participating in a sleep study is common. The content of such dreams draws upon episodic memory fragments of the participant's lab experience, generally, experimenters, electrodes, the lab setting, and experimental tasks. However, as common as such dreams are, they have rarely been given a thorough quantitative or qualitative treatment. Here we assessed 528 dreams (N = 343 participants) collected in a Montreal sleep lab to 1) evaluate state and trait factors related to such dreams, and 2) investigate the phenomenology of lab incorporations using a new scoring system. Lab incorporations occurred in over a third (35.8%) of all dreams and were especially likely to occur in REM sleep (44.2%) or from morning naps (48.4%). They tended to be related to higher depression scores, but not to sex, nightmare-proneness or anxiety. Common themes associated with lab incorporation were: Meta-dreaming, including lucid dreams and false awakenings (40.7%), Sensory incorporations (27%), Wayfinding to, from or within the lab (24.3%), Sleep as performance (19.6%), Friends/Family in the lab (15.9%) and Being an object of observation (12.2%). Finally, 31.7% of the lab incorporation dreams included relative projections into a near future (e.g., the experiment having been completed), but very few projections into the past (2.6%). Results clarify sleep stage and sleep timing factors associated with dreamed lab incorporations. Phenomenological findings further reveal both the typical and unique ways in which lab memory elements are incorporated de novo into dreaming. Identified themes point to frequent social and skillful dream scenarios that entail monitoring of one's current state (in the lab) and projection of the self into dream environments elaborated around local space and time. The findings have implications for understanding fundamental dream formation mechanisms but also for appreciating both the advantages and methodological pitfalls of conducting laboratory-based dream collection.

Whole-body procedural learning benefits from targeted memory reactivation in REM sleep and task-related dreaming.

Sleep facilitates memory consolidation through offline reactivations of memory traces. Dreaming may play a role in memory improvement and may reflect these memory reactivations. To experimentally address this question, we used targeted memory reactivation (TMR), i.e., application, during sleep, of a stimulus that was previously associated with learning, to assess whether it influences task-related dream imagery (or task-dream reactivations). Specifically, we asked if TMR or task-dream reactivations in either slow-wave (SWS) or rapid eye movement (REM) sleep benefit whole-body procedural learning. Healthy participants completed a virtual reality (VR) flying task prior to and following a morning nap or rest period during which task-associated tones were readministered in either SWS, REM sleep, wake or not at all. Findings indicate that learning benefits most from TMR when applied in REM sleep compared to a Control-sleep group. REM dreams that reactivated kinesthetic elements of the VR task (e.g., flying, accelerating) were also associated with higher improvement on the task than were dreams that reactivated visual elements (e.g., landscapes) or that had no reactivations. TMR did not itself influence dream content but its effects on performance were greater when coexisting with task-dream reactivations in REM sleep. Findings may help explain the mechanistic relationships between dream and memory reactivations and may contribute to the development of sleep-based methods to optimize complex skill learning.

Local Neuronal Synchronization in Frequent Nightmare Recallers and Healthy Controls: A Resting-State Functional Magnetic Resonance Imaging Study.

Nightmares are highly dysphoric dreams that are well-remembered upon awakening. Frequent nightmares have been associated with psychopathology and emotional dysregulation, yet their neural mechanisms remain largely unknown. Our neurocognitive model posits that nightmares reflect dysfunction in a limbic-prefrontal circuit comprising medial prefrontal and anterior cingulate cortices, hippocampus, and amygdala. However, there is a paucity of studies that used brain imaging to directly test the neural correlates of nightmares. One such study compared the regional homogeneity (ReHo) of resting-state functional magnetic resonance imaging blood-oxygen level-dependent signals between frequent nightmare recallers and controls. The main results were greater regional homogeneity in the left anterior cingulate cortex and right inferior parietal lobule for the nightmare recallers than for the controls. In the present study, we aimed to document the ReHo correlates of frequent nightmares using several nightmare severity measures. We acquired resting-state functional magnetic resonance imaging data from 18 frequent nightmare recallers aged 18-35 (3 males and 15 females) and 18 age- and sex-matched controls, as well as retrospective and prospective disturbed dreaming frequency estimates and scores on the Nightmare Distress Questionnaire. While there were inconsistent results for our different analyses (group comparisons, correlational analyses for frequency estimates/Nightmare Distress scores), our results suggest that nightmares are associated with altered ReHo in frontal (medial prefrontal and inferior frontal), parietal, temporal and occipital regions, as well as some subcortical regions (thalamus). We also found a positive correlation between retrospective disturbed dreaming frequency estimates and ReHo values in the hippocampus. These findings are mostly in line with a recent SPECT study from our laboratory. Our results point to the possibility that a variety of regions, including but not limited to the limbic-prefrontal circuit of our neurocognitive model, contribute to nightmare formation.

Flying dreams stimulated by an immersive virtual reality task.

Despite a high prevalence and broad interest in flying dreams, these exceptional experiences remain infrequent. Our study aimed to (1) induce flying dreams using a custom-built virtual reality (VR) flying task, (2) examine their phenomenological correlates and (3) investigate their relations to participant state and trait factors. 137 participants underwent VR-flying followed by a morning nap. They also completed home dream journals for 5 days before and 10 days after the VR exposure. VR-flying successfully increased the reporting of flying dreams during the laboratory nap and on the following morning compared to both baseline frequencies and a control cohort. Flying dreams were also changed qualitatively, exhibiting higher levels of Lucid-control and emotional intensity, after VR exposure. Factors such as prior dream-flying experiences and level of VR sensory immersion modulated flying dream induction. Findings are consistent with a new vection-based explanation of dream-flying and may facilitate development of dream flight-induction technologies.

Attempted induction of signalled lucid dreaming by transcranial alternating current stimulation.

Neurophysiological correlates of self-awareness during sleep ('lucid dreaming') remain unclear despite their importance for clarifying the neural underpinnings of consciousness. Transcranial direct (tDC) and alternating (tAC) current stimulation during sleep have been shown to increase dream self-awareness, but these studies' methodological weaknesses prompted us to undertake additional study. tAC stimulation was associated with signal-verified and self-rated lucid dreams-but so was the sham procedure. Situational factors may be crucial to inducing self-awareness during sleep.

Early childhood adversity associations with nightmare severity and sleep spindles.

OBJECTIVE: Childhood adversity figures prominently in the clinical histories of children and adolescents suffering from a panoply of physical, mental or sleep disorders, including posttraumatic stress disorder. But the nature and prevalence of early adversity in the case of idiopathic nightmare-prone individuals have received little study. We characterize the types and frequencies of self-reported childhood adversity for nightmare-prone individuals using the developmentally sensitive Traumatic Antecedents Questionnaire (TAQ) and assess relationships between separation adversity and sleep spindles. METHOD: The TAQ was administered to 73 non-treatment-seeking volunteers with frequent idiopathic nightmares and 67 healthy controls. Nightmare severity, anxiety, depression, alexithymia and past and present sleep disorders were also assessed. Sleep was recorded with polysomnography (PSG) for 90 participants and sleep spindles were assessed for 63. RESULTS: Nightmare-prone participants scored higher on most TAQ measures, including adversity at 0-6 years of age. TAQ-derived scales assessing traumatic and nontraumatic forms of adversity were both elevated for nightmare-prone participants; for 0-6 year estimates, nontraumatic adversity was associated with nightmares independent of trauma adversity. Group differences were only partially mediated by current psychopathology symptoms and were largely independent of nightmare frequency but not of nightmare distress. Adversity/nightmare relationships were graded differentially for the two study groups. Separation adversity at 0-6 years of age correlated with current sleep spindle anomalies-in particular, lower slow spindle density-an anomaly known to index both psychopathology and early nightmare-onset. CONCLUSIONS: Self-reported adversity occurring as young as 0-6 years of age is associated with nightmare severity and sleep spindle anomalies. Adversity-linked nightmares may reflect pathophysiological mechanisms common also to the nightmares of pre-clinical and full-blown post-traumatic stress disorder.

Rapid eye movements are reduced in blind individuals.

There is ongoing controversy regarding the role of rapid eye movements (EMs) during rapid eye movement (REM) sleep. One prevailing hypothesis is that EMs during REM sleep are indicative of the presence of visual imagery in dreams. We tested the validity of this hypothesis by measuring EMs in blind subjects and correlating these with visual dream content. Eleven blind subjects, of whom five were congenitally blind (CB) and six late blind (LB), and 11 matched sighted control (SC) subjects participated in this study. All participants underwent full-night polysomnography (PSG) recordings that were staged manually following American Academy of Sleep Medicine (AASM) criteria. Nocturnal EMs were detected automatically using a validated EM detector, and EM activity was represented as "EM coverage" computed as percentage of time with EM in each sleep stage. Frequency of sensory dream elements was measured in dream recall questionnaires over a 30-day period. Both blind groups showed less EM coverage during wakefulness, N1, N2 and REM sleep than did controls. CB and LB subjects did not differ in EM activity. Validation of the detector applied to blind subjects revealed an overall accuracy of 95.6 ± 3.6%. Analysis of dream reports revealed that LB subjects reported significantly more visual dream elements than did CB. Although no specific mechanisms can be revealed in the current study, the quasi absence of nocturnal EMs in LB subjects despite preserved visual dream content does not support the visual scanning of dreams hypothesis. Specifically, results suggest a dissociation between EMs and visual dream content in blind individuals.

Nightmare Severity Is Inversely Related to Frontal Brain Activity During Waking State Picture Viewing.

STUDY OBJECTIVES: Growing evidence suggests that nightmares have considerable adverse effects on waking behavior, possibly by increasing post-sleep negative emotions. Dysphoric reactions to nightmares are one component of nightmare severity for which the neural correlates are unknown. Here, we investigate possible neural correlates of nightmare severity in a sample of individuals who frequently recall nightmares. METHODS: Our principal measure of nightmare severity is nightmare distress as indexed by the Nightmare Distress Questionnaire (NDQ), and secondary measures are retrospective and prospective estimates of frequency of recalling dysphoric dreams (DD). We used high-resolution technetium 99m ethyl cysteinate dimer single photon emission computed tomography to assess regional cerebral blood flow (rCBF) while 18 individuals who were frequent nightmare recallers viewed negative and neutral pictures from the International Affective Picture System. We correlated rCBF with NDQ scores and DD recall frequency estimates. RESULTS: Negative correlations were observed between NDQ scores and rCBF during negative picture viewing in bilateral insula and anterior cingulate, right medial frontal gyrus, bilateral superior temporal gyrus, right inferior frontal and precentral gyri, and bilateral putamen. Retrospective DD recall correlated with rCBF activity primarily in regions overlapping those related to NDQ scores. Prospective DD recall was only weakly related to rCBF. Results for the neutral condition overlapped partially with those for the negative condition; in particular, NDQ and retrospective DD recall were related to rCBF in medial prefrontal and anterior cingulate gyri. CONCLUSIONS: Results point to a possible overlap in brain mechanisms involved in nightmare dysphoria (during sleep) and distress (during wakefulness) among individuals who frequently recall nightmares. They provide partial support for a neurocognitive model of nightmares. COMMENTARY: A commentary on this article appears in this issue on page 179.

Aetiology and treatment of nightmare disorder: State of the art and future perspectives.

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non-traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence-based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.

Different Patterns of Sleep-Dependent Procedural Memory Consolidation in Vipassana Meditation Practitioners and Non-meditating Controls.

AIM: Rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep, and sleep spindles are all implicated in the consolidation of procedural memories. Relative contributions of sleep stages and sleep spindles were previously shown to depend on individual differences in task processing. However, no studies to our knowledge have focused on individual differences in experience with Vipassana meditation as related to sleep. Vipassana meditation is a form of mental training that enhances proprioceptive and somatic awareness and alters attentional style. The goal of this study was to examine a potential role for Vipassana meditation experience in sleep-dependent procedural memory consolidation. METHODS: Groups of Vipassana meditation practitioners (N = 22) and matched meditation-naïve controls (N = 20) slept for a daytime nap in the laboratory. Before and after the nap they completed a procedural task on the Wii Fit balance platform. RESULTS: Meditators performed slightly better on the task before the nap, but the two groups improved similarly after sleep. The groups showed different patterns of sleep-dependent procedural memory consolidation: in meditators, task learning was positively correlated with density of slow occipital spindles, while in controls task improvement was positively associated with time in REM sleep. Sleep efficiency and sleep architecture did not differ between groups. Meditation practitioners, however, had a lower density of occipital slow sleep spindles than controls. CONCLUSION: Results suggest that neuroplastic changes associated with meditation practice may alter overall sleep microarchitecture and reorganize sleep-dependent patterns of memory consolidation. The lower density of occipital spindles in meditators may mean that meditation practice compensates for some of the memory functions of sleep.

Sleep spindles are altered in early- but not late-onset nightmare recallers.

Nightmares are a common sleep disorder, defined as highly disturbing mentation which usually awakens the individual from rapid eye movement (REM) sleep. While nightmares are mainly a REM sleep phenomenon, Picard-Deland et al., (2017) recently showed an association between nightmare recall and sleep spindles, which are a non-rapid eye movement (NREM) oscillatory feature. Their results pointed to fewer slow spindles and a higher oscillatory frequency for fast spindles among frequent nightmare recallers compared with controls. To test the suggestion that nightmares stem from changes to emotional neural circuits arising in early childhood (Nielsen, 2017), including early changes in sleep spindles (Scholle et al., 2007), we investigated if the spindle features of early-onset nightmare recallers (ie, recalling nightmares since childhood) (N = 22), differed from those of late-onset nightmare recallers (ie, since adolescence or adulthood) (N = 11), or from those of controls (N = 23). A retrospective analysis of the sleep spindles of 56 participants who had undergone a polysomnographically-recorded morning nap revealed that Early starters uniquely exhibited lower slow spindle densities in five of six derivations (all p < 0.045) and higher fast spindle frequencies in all six derivations (all p < 0.015). These results add precision to previously reported findings for Nightmare recallers: spindle differences are shown to hold only for Early starters. The lifelong occurrence of nightmares may be closely tied to disruptions in the normal development of spindle generation processes occurring early in development.

Sleep spindle and psychopathology characteristics of frequent nightmare recallers.

Idiopathic nightmares are a common disturbance of rapid eye movement sleep (REM) sleep, but studies of comorbid pathologies and sleep architecture suggest that non-REM (NREM) sleep is also affected. Sleep spindles are a NREM sleep characteristic associated with both pathophysiology and sleep-dependent memory consolidation, yet they have not been evaluated in frequent nightmare recallers. The morning naps of 38 participants with frequent idiopathic nightmares (mean age: 23.7 ± 3.78 years) and 25 age- and sex-matched controls (23.9 ± 3.65 years) were recorded and their sleep evaluated. A custom spindle detector assessed NREM sleep stage 2 (N2) sleep spindles on six electroencephalogram (EEG) derivations (F3, F4, C3, C4, O1, and O2) for density (number spindles/N2 time), mean frequency, and amplitude. Total spindles (10-16 Hertz (Hz) range), slow spindles (10-12.79 Hz), and fast spindles (12.8-16 Hz) were all assessed separately. Compared with the Control group, the Nightmare group had longer N2 sleep latency and a marginally greater %N2 sleep. The Nightmare group also had a lower than normal density of slow spindles in most EEG derivations, a higher density of fast spindles in frontal derivations, and an elevated fast spindle oscillatory frequency-"faster fast" spindles-mainly in central derivations. These differences withstood controls for pre-existing group differences in depression. Correlational analyses demonstrated a further pattern of group differences by which higher pathology scores were associated with higher slow spindle densities and slower spindle frequencies for the Nightmare but not the Control group. A similar pattern was observed for some dream content measures, ie, the Nightmare group showed positive correlations of slow spindle density with dreamed fear and word count and negative correlations with dreamed positive emotion. Conversely, the Control group showed opposite trends. Results thus demonstrate abnormalities in the composition of N2 sleep-and especially in N2 spindles-among frequent nightmare recallers and link these abnormalities to both trait (psychopathology) and state (dream content) factors. Spindle findings for psychopathology resemble, but are not identical with, previous findings for patients with major depression, social anxiety, and schizophrenia and are thus consistent with an explanation implicating spindles as trait markers of psychopathology. Correlational analyses go beyond a trait explanation to suggest several possible state-based explanations involving memory consolidation mechanisms, specifically, the possibility that spindles index either emotional or verbal task-based processes.

Preserved sleep microstructure in blind individuals.

The loss of vision, particularly when it occurs early in life, is associated with compensatory cortical plasticity not only in the visual cortical areas, but throughout the entire brain. The absence of visual input to the retina can also induce changes in entrainment of the circadian rhythm, as light is the primary zeitgeber of the master biological clock found in the suprachiasmatic nucleus of the hypothalamus. In addition, a greater number of sleep disturbances is often reported in blind individuals. Here, we examined various electroencephalographic microstructural components of sleep, both during rapid-eye-movement (REM) sleep and non-REM (NREM) sleep, between blind individuals, including both of early and late onset, and normal-sighted controls. During wakefulness, occipital alpha oscillations were lower, or absent in blind individuals. During sleep, differences were observed across electrode derivations between the early and late blind samples, which may reflect altered cortical networking in early blindness. Despite these differences in power spectra density, the electroencephalography microstructure of sleep, including sleep spindles, slow wave activity, and sawtooth waves, remained present in the absence of vision.

Elevated perseveration errors on a verbal fluency task in frequent nightmare recallers: a replication.

A recent study reported that individuals recalling frequent idiopathic nightmares (NM) produced more perseveration errors on a verbal fluency task than did control participants (CTL), while not differing in overall verbal fluency. Elevated scores on perseveration errors, an index of executive dysfunction, suggest a cognitive inhibitory control deficit in NM participants. The present study sought to replicate these results using a French-speaking cohort and French language verbal fluency tasks. A phonetic verbal fluency task using three stimulus letters (P, R, V) and a semantic verbal fluency task using two stimulus categories (female and male French first names) were administered to 23 participants with frequent recall of NM (≥2 NM per week, mean age = 24.4 ± 4.0 years), and to 16 CTL participants with few recalled NM (≤ 1 NM per month, mean age = 24.5 ± 3.8 years). All participants were French-speaking since birth and self-declared to be in good mental and physical health apart from their NM. As expected, groups did not differ in overall verbal fluency, i.e. total number of correct words produced in response to stimulus letters or categories (P = 0.97). Furthermore, groups exhibited a difference in fluency perseveration errors, with the NM group having higher perseveration than the CTL group (P = 0.03, Cohen's d = 0.745). This replication suggests that frequent NM recallers have executive inhibitory dysfunction during a cognitive association task and supports a neurocognitive model which posits fronto-limbic impairment as a neural correlate of disturbed dreaming.

Sleep structure in blindness is influenced by circadian desynchrony.

We examined the structure, duration and quality of sleep, including non-rapid eye movement sleep and rapid eye movement sleep, in 11 blind individuals without conscious light perception and 11 age- and sex-matched sighted controls. Because blindness is associated with a greater incidence of free-running circadian rhythms, we controlled for circadian phase by a measure of melatonin onset timing. When circadian rhythm was entrained and melatonin onset occurred at normal times, sleep structure did not differ between blind and sighted individuals. On the other hand, an abnormal timing of the circadian phase, including delayed, shifted and unclassifiable melatonin onsets, led to larger rapid eye movement sleep latencies and increased wake times. No differences were observed for stages of non-rapid eye movement sleep, either between congenital and late blind and sighted individuals, or across the different circadian phases. Moreover, abnormal circadian phases were more common in the blind (n = 5) than the sighted (n = 2) sample. Our findings suggest that the sleep structure of blind individuals depends on entrainment of circadian phase, rather than on the absence of vision.

A novel Differential Susceptibility framework for the study of nightmares: Evidence for trait sensory processing sensitivity.

Research on nightmares has largely focused on the nightmare itself and its associated negative consequences, framing nightmare sufferers as victims of a diathesis-stress induced form of psychopathology. However, there is evidence that frequent nightmare recallers are sensitive to a wide range of sensory and emotional experiences, and report vivid, bizarre and even intensely positive dream and daydream experiences. We propose sensory processing sensitivity as a novel trait marker that underlies the unique symptoms and imaginative richness found in nightmare-prone individuals. Sensory processing sensitivity describes an increased emotional reactivity, greater depth of processing, and subtle awareness of environmental stimuli-it is a 'for better and for worse' trait that is associated with positive outcomes in conditions of support, but also confers a tendency to be easily overwhelmed by stressors and adversity. This novel approach places nightmare-prone individuals within the broader framework of Differential Susceptibility and raises the possibility that they may benefit especially from supportive environments-a possibility that is particularly relevant for developing future treatment approaches.

The Stress Acceleration Hypothesis of Nightmares.

Adverse childhood experiences can deleteriously affect future physical and mental health, increasing risk for many illnesses, including psychiatric problems, sleep disorders, and, according to the present hypothesis, idiopathic nightmares. Much like post-traumatic nightmares, which are triggered by trauma and lead to recurrent emotional dreaming about the trauma, idiopathic nightmares are hypothesized to originate in early adverse experiences that lead in later life to the expression of early memories and emotions in dream content. Accordingly, the objectives of this paper are to (1) review existing literature on sleep, dreaming and nightmares in relation to early adverse experiences, drawing upon both empirical studies of dreaming and nightmares and books and chapters by recognized nightmare experts and (2) propose a new approach to explaining nightmares that is based upon the Stress Acceleration Hypothesis of mental illness. The latter stipulates that susceptibility to mental illness is increased by adversity occurring during a developmentally sensitive window for emotional maturation-the infantile amnesia period-that ends around age 3½. Early adversity accelerates the neural and behavioral maturation of emotional systems governing the expression, learning, and extinction of fear memories and may afford short-term adaptive value. But it also engenders long-term dysfunctional consequences including an increased risk for nightmares. Two mechanisms are proposed: (1) disruption of infantile amnesia allows normally forgotten early childhood memories to influence later emotions, cognitions and behavior, including the common expression of threats in nightmares; (2) alterations of normal emotion regulation processes of both waking and sleep lead to increased fear sensitivity and less effective fear extinction. These changes influence an affect network previously hypothesized to regulate fear extinction during REM sleep, disruption of which leads to nightmares. This network consists of a fear circuit that includes amygdala, hippocampus, and medial prefrontal cortex and whose substantial overlap with the stress acceleration findings allows the latter to be incorporated into a wider, more developmentally coherent framework.