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An Assessment of Medical Practitioners’ Knowledge of, Experience with, and Treatment Attitudes Towards Sleep Disorders and Nightmares

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Abstract

Sleep disorders are frequently under assessed and not well understood by medical practitioners. This study investigated medical practitioners’ knowledge of, experience with, and treatment considerations for sleep disorders, with a particular emphasis on nightmares. Eighty-eight individuals practicing medicine in the United States completed a survey eliciting information in three domains: (a) professional experience with nightmares, (b) knowledge of nightmares, and (c) attitudes about treatment of sleep disturbances. Seventy percent of participants reported a lack of professional experience with nightmares, 78% endorsed inaccurate definitions of a nightmares, and 82% considered sleep disorders to be a secondary problem, with 75% considering nightmares a secondary problem. Seventy-two percent of participants reported they would be likely to consider psychological treatment for nightmares. Results suggest that medical practitioners may not be receiving updated and/or adequate education about sleep disorders, including nightmares. This lack of information may contribute to sleep disorders being under assessed and untreated.

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References

  • American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.). Darien: American Academy of Sleep Medicine.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Bandla, H., Franco, R. A., Simpson, D., Brennan, K., McKanry, J., & Bragg, D. (2012). Assessing learning outcomes and cost effectiveness of an online sleep curriculum for medical students. Journal of Clinical Sleep Medicine, 8(4), 439–443.

    PubMed  PubMed Central  Google Scholar 

  • Bishop, T. F., Ramsay, P. P., Casalino, L. P., Bao, Y., Pincus, H. A., & Shortell, S. M. (2016). Care management processes used less often for depression than for other chronic conditions in us primary care practices. Health Affairs, 35, 394–400.

    Article  PubMed  Google Scholar 

  • Carney, C. E., Segal, Z. V., Edinger, J. D., & Krystal, A. D. (2007). Comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. Journal of Clinical Psychiatry, 68, 254–260.

    Article  CAS  PubMed  Google Scholar 

  • Cranston, C. C., Miller, K. E., Davis, J. L., & Rhudy, J. L. (2017). Preliminary validation of a brief measure of the frequency and severity of nightmares: The Trauma-Related Nightmare Survey. Journal of Trauma & Dissociation, 18(1), 88–99.

    Article  Google Scholar 

  • Creamer, J. L., Brock, M. S., Matsangas, P., Motamedi, V., & Mysliwiec, V. (2018). Nightmares in United States military personnel with sleep disturbances. Journal of Clinical Sleep Medicine, 14(03), 419–426.

    Article  PubMed  PubMed Central  Google Scholar 

  • Davis, J. L., Rhudy, J. L., Pruiksma, K. E., Byrd, P., Williams, A. E., McCabe, K. M., & Bartley, E. J. (2011). Physiological predictors of response to exposure, relaxation, and rescripting therapy for chronic nightmares in a randomized clinical trial. Journal of Clinical Sleep Medicine, 7, 622–631.

    PubMed  PubMed Central  Google Scholar 

  • Forbes, D., Phelps, A., & Mchugh, T. (2001). Treatment of combat-related nightmares using imagery rehearsal: A pilot study. Journal of Traumatic Stress, 14, 433–442.

    Article  CAS  PubMed  Google Scholar 

  • Galatzer-Levy, I. R., Nickerson, A., Litz, B. T., & Marmar, C. R. (2013). Patterns of lifetime PTSD comorbidity: A latent class analysis. Depression and Anxiety, 30, 489–496.

    Article  PubMed  Google Scholar 

  • Germain, A., & Nielsen, T. (2003). Impact of imagery rehearsal treatment on distressing dreams, psychological distress, and sleep parameters in nightmare patients. Behavioral Sleep Medicine, 1(3), 140–154.

    Article  PubMed  Google Scholar 

  • Hartmann, E. (1996). Who develops PTSD nightmares and who doesn’t. Cambridge: Harvard University Press.

    Google Scholar 

  • Hefez, A., Metz, L., & Lavie, P. (1987). Long-term effects of extreme situational stress on sleep and dreaming. The American Journal of Psychiatry, 144, 344–347.

    Article  CAS  PubMed  Google Scholar 

  • Ho, F. Y. Y., Chan, C. S., & Tang, K. N. S. (2016). Cognitive-behavioral therapy for sleep disturbances in treating posttraumatic stress disorder symptoms: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 43, 90–102.

    Article  PubMed  Google Scholar 

  • Klingman, K., Jungquist, C., & Perlis, M. (2017). Introducing the sleep disorders symptom checklist-25: A primary care friendly and comprehensive screener for sleep disorders. Sleep Medicine Research, 8(1), 17–25.

    Article  Google Scholar 

  • Krakow, B., Hollifield, M., & Johnston, L. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association, 286, 537–545.

    Article  CAS  PubMed  Google Scholar 

  • Krystal, A. D. (2006). Sleep and psychiatric disorders: Future directions. Psychiatric Clinics, 29(4), 1115–1130.

    PubMed  Google Scholar 

  • Littlewood, D. L., Gooding, P. A., Panagioti, M., & Kyle, S. D. (2016). Nightmares and suicide in posttraumatic stress disorder: The mediating role of defeat, entrapment, and hopelessness. Journal of Clinical Sleep Medicine, 12(3), 393–399.

    Article  PubMed  PubMed Central  Google Scholar 

  • Matteson-Rusby, S. E., Pigeon, W. R., Gehrman, P., & Perlis, M. L. (2010). Why treat insomnia?. Primary Care Companion to the Journal of Clinical Psychiatry. https://doi.org/10.4088/PCC.08r00743bro

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller, K. E., Brownlow, J. A., Woodward, S., & Gehrman, P. R. (2017). Sleep and dreaming in posttraumatic stress disorder. Current Psychiatry Reports, 19(10), 71–81.

    Article  PubMed  Google Scholar 

  • Mindell, J. A., Bartle, A., Wahab, N. A., Ahn, Y., Ramamurthy, M. B., Huong, H. T. D., … Goh, D. Y. (2011). Sleep education in medical school curriculum: A glimpse across countries. Sleep Medicine, 12(9), 928–931.

    Article  PubMed  Google Scholar 

  • Morin, C. M. (2006). Combined therapeutics for insomnia: Should our first approach be behavioral or pharmacological? Sleep Medicine, 7, 15–19.

    Article  Google Scholar 

  • Nadorff, M. R., Nadorff, D. K., & Germain, A. (2015). Nightmares: Under-reported, undetected, and therefore untreated. Journal of Clinical Sleep Medicine, 11, 747–750.

    PubMed  PubMed Central  Google Scholar 

  • Nadorff, M. R., Nazem, S., & Fiske, A. (2013). Insomnia symptoms, nightmares, and suicide risk: Duration of sleep disturbance matters. Suicide and Life Threatening Behavior, 43, 139–149.

    Article  PubMed  Google Scholar 

  • Ohayon, M. M., & Shapiro, C. M. (2000). Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Comprehensive Psychiatry, 41, 469–478.

    Article  CAS  PubMed  Google Scholar 

  • Olfson, M., Blanco, C., Wang, S., Laje, G., & Correll, C. U. (2014). National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry, 71, 81–90.

    Article  PubMed  Google Scholar 

  • Pacella, M. L., Hruska, B., & Delahanty, D. L. (2013). The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review. Journal of Anxiety Disorders, 27, 33–46.

    Article  PubMed  Google Scholar 

  • Papp, K. K., Penrod, C. E., & Strohl, K. P. (2002). Knowledge and attitudes of primary care physicians toward sleep and sleep disorders. Sleep and Breathing, 6, 103–109.

    Article  PubMed  Google Scholar 

  • Phelps, A. J., Forbes, D., & Creamer, M. (2008). Understanding posttraumatic nightmares: An empirical and conceptual review. Clinical Psychology Review, 28(2), 338–355.

    Article  PubMed  Google Scholar 

  • Pruiksma, K. E., Taylor, D. J., & Wachen, J. S. (2016). Residual sleep disturbances following PTSD treatment in active duty military personnel. Psychological Trauma: Theory, Research, Practice, and Policy, 8, 697–701.

    Article  Google Scholar 

  • Ram, S., Seirawan, H., Kumar, S. K., & Clark, G. T. (2010). Prevalence and impact of sleep disorders and sleep habits in the United States. Sleep and Breathing, 14, 63–70.

    Article  PubMed  Google Scholar 

  • Ritter, P. S., Marx, C., Bauer, M., Leopold, K., & Pfennig, A. (2011). The role of disturbed sleep in the early recognition of bipolar disorder: A systematic review. Bipolar Disorders, 13, 227–237.

    Article  PubMed  Google Scholar 

  • Rosen, R. C., Zozula, R., Jahn, E. G., & Carson, J. L. (2001). Low rates of recognition of sleep disorders in primary care: Comparison of a community-based versus clinical academic setting. Sleep Medicine, 2, 47–55.

    Article  CAS  PubMed  Google Scholar 

  • Ross, R. J., Ball, W. A., Sullivan, K. A., & Caroff, S. N. (1989). Sleep disturbance as the hallmark of posttraumatic stress disorder. The American Journal of Psychiatry, 146(6), 697–707.

    Article  CAS  PubMed  Google Scholar 

  • Sateia, M. J. (2014). International classification of sleep disorders. Chest, 146(5), 1387–1394.

    Article  PubMed  Google Scholar 

  • Schredl, M. (2010). Nightmare frequency and nightmare topics in a representative German sample. European Archieves of Psychiatry and Clinical Neuroscience, 260, 565–570.

    Article  Google Scholar 

  • Seda, G., Sanchez-Ortuno, M. M., Welsh, C. H., Halbower, A. C., & Edinger, J. D. (2015). Comparative meta-analysis of prazosin and imagery rehearsal therapy for nightmare frequency, sleep quality, and posttraumatic stress. Journal of Clinical Sleep Medicine, 11(1), 11–22.

    PubMed  PubMed Central  Google Scholar 

  • Selfridge, J. M., Moyer, K., Capelluto, D. G., & Finkielstein, C. V. (2015). Opening the debate: How to fulfill the need for physicians’ training in circadian-related topics in a full medical school curriculum. Journal of Circadian Rhythms, 13, 1–10.

    Google Scholar 

  • Tanskanen, A., Tuomilehto, J., Viinamäki, H., Vartiainen, E., Lehtonen, J., & Puska, P. (2001). Nightmares as predictors of suicide. Sleep, 24(7), 845–848.

    Google Scholar 

  • Thünker, J., Norpoth, M., Von Aspern, M., Özcan, T., & Pietrowsky, R. (2014). Nightmares: Knowledge and attitudes in health care providers and nightmare sufferers. Journal of Public Health and Epidemiology, 6, 223–228.

    Article  Google Scholar 

  • U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. (2016). Sleep science and sleep disorders. Retrieved from https://www.nhlbi.nih.gov/science/sleep-science-and-sleep-disorders.

  • Woodward, S. H., Arsenault, N. J., Murray, C., & Bliwise, D. L. (2000). Laboratory sleep correlates of nightmare complaint in PTSD inpatients. Biological Psychiatry, 48(11), 1081–1087.

    Article  CAS  PubMed  Google Scholar 

  • World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.

    Google Scholar 

  • Zadra, A., Pilon, M., & Donderi, D. C. (2006). Variety and intensity of emotions in nightmares and bad dreams. The Journal of Nervous and Mental Disease, 194(4), 249–254.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, The University of Kansas, 1915 Tennessee St, Lawrence, KS, 66046, USA

    Westley A. Youngren

  2. Dissemination and Training Division, VA Palo Alto Healthcare System, National Center for PTSD, Palo Alto, CA, USA

    Katherine E. Miller

  3. The University of Tulsa, Tulsa, OK, USA

    Joanne L. Davis

Authors
  1. Westley A. Youngren
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  2. Katherine E. Miller
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  3. Joanne L. Davis
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Correspondence to Westley A. Youngren.

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Conflict of interest

The authors Westley A. Youngren, Katherine E. Miller, and Joanne L. Davis declare that they have no conflict of interest.

Ethical Approval

All protocols were approved by a university institutional review board and were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of Human and Animal Rights

All procedures performed in this study involving human participants were in accordance with the ethical standards of the University and Kansas' IRB committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from every participant in this study.

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Youngren, W.A., Miller, K.E. & Davis, J.L. An Assessment of Medical Practitioners’ Knowledge of, Experience with, and Treatment Attitudes Towards Sleep Disorders and Nightmares. J Clin Psychol Med Settings 26, 166–172 (2019). https://doi.org/10.1007/s10880-018-9574-7

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  • DOI: https://doi.org/10.1007/s10880-018-9574-7

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