Fear of Sleep Prospectively Predicts Nightmare Severity in Acute Trauma Patients Exposed to Community Violence

Document Type

Conference Proceeding

Publication Date

5-19-2025

Publication Title

Sleep

Abstract

Introduction: Fear of sleep engenders arousal at bedtime that can promote nightmares. Living in disadvantaged neighbor hoods with high rates of community violence may exacerbate fear of sleep and in turn increase nightmare risk. We tested fear of sleep among acute trauma patients as a prospective predic tor of nightmares, and whether exposure to community violence moderated this relationship. Methods: Patients hospitalized in the intensive care unit within one week following traumatic injury (N = 88; Mage = 39.53 ± SD 14.31, 67.0% male, 67.0% Black, 47.7% income ≤ $20,000). Patients completed the Fear of Sleep Inventory (FoSI) Short Form and a community violence questionnaire during hospital ization (T1; N = 88) and the Nightmare Disorder Index (NDI) approximately two months post-trauma (T2; n = 59). We com puted an NDI sum score as our outcome to indicate greater nightmare severity (nightmare frequency and nightmare-re lated awakenings, distress, and impairment). Skin conductance response (SCR) was collected from a subsample of patients (n = 7) during the FoSI to preliminarily explore the psychophysiolog ical correlates of this scale. Results: Exposure to community violence exacerbated the pro spective effect of fear of sleep on future nightmare severity (β = 0.51, p =.039), such that relationship between fear of sleep at T1 a nd nightmare severity at T2 was strongest for patients reporting exposure to higher levels of community violence in the 90 days prior to hospitalization. SCR to the FoSI was correlated with greater exposure to community violence (r = 0.76, p =.048) and the following fear-of-sleep-related safety behaviors: “I stayed up late to avoid sleeping” (r = 0.87, p =.012) and “I tried to stay as alert as I could while lying in bed,” though this relationship was nonsignificant (r = 0.74, p =.060). Conclusion: Acute trauma patients presenting with a fear of sleep may be at increased risk for posttraumatic nightmares during recovery, especially those living within neighborhoods marked by high levels of community violence. Preliminary results suggest fear of sleep and community violence exposure may share an association with sympathetic activation which, when elevated at bedtime, could increase nightmare production.

Volume

48

First Page

A510

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