209 Nightmare Content During the COVID-19 Pandemic: Influence of COVID-Related Stress and Sleep Disruption

Introduction: Nightmares are often associated with psychiatric disorders, though acute stress can also induce them. This study explores how the COVID-19 pandemic may have influenced the frequency and content of nightmares. Methods: A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked the degree to which they agree with statements including that due to the COVID-19 pandemic, they have greater general stress, worse overall sleep, and more middle-of-the-night insomnia. They were also asked if they experienced nightmares during the pandemic on a range of topics, including confinement, claustrophobia, suffocation, oppression, drowning, failure, helplessness, natural disasters, anxiety, evil forces, war, domestic abuse, separation from loved ones, totalitarian regimes, being chased, dangerous animals, sickness, death, COVID- 19, and apocalypse. Logistic regression analyses examined each nightmare content as outcome and increased stress, worse sleep, and more middle-of-the-night insomnia as predictors, adjusted for age, sex, and race/ethnicity. Results: Those who reported greater general COVID-related stress were more likely to have nightmares about confinement (OR=1.66,p<0.03), failure (OR=1.64,p<0.005), helplessness (OR=2.89, 0<0.0005), anxiety (OR=2.37,p<0.0005), war (OR=3.42,p<0.0005), separation (OR=2.23,p<0.0005), totalitarianism (OR=3.78,p<0.003), sickness (OR=1.92,p<0.003), death (OR=1.66,p<0.01), COVID (OR=1.96,p<0.01), and apocalypse (OR=2.92,p<0.0005). Those who reported worsened sleep were more likely to have nightmares about confinement (OR=1.80,p<0.003), oppression (OR=2.99,p<0.0005), failure (OR=2.12,p<0.0005), helplessness (OR=1.67, 0<0.0005), disaster (OR=1.86,p<0.005), anxiety (OR=1.97,p<0.0005), evil forces (OR=1.56,p<0.02), war (OR=2.08,p<0.002), domestic abuse (OR=2.22,p<0.009), separation (OR=2.01,p<0.0005), totalitarianism (OR=3.39,p<0.0005), sickness (OR=1.74,p=0.003), death (OR=2.03,p<0.0005), COVID (OR=2.15,p<0.001), and apocalypse (OR=1.86,p<0.006). Those who reported worsened middleof- the-night insomnia were more likely to have nightmares about confinement (OR=1.60,p<0.01), oppression (OR=1.97,p<0.002), failure (OR=2.00,p<0.0005), helplessness (OR=1.60,p<0.001), disaster (OR=1.52,p<0.04), anxiety (OR=2.27,p<0.0005), war (OR=2.10,p<0.001), domestic abuse (OR=1.74,p<0.04), separation (OR=1.86,p<0.0005), totalitarianism (OR=1.87,p<0.03), sickness (OR=1.80,p<0.001), death (OR=2.00,p<0.0005), COVID (OR=1.68,p<0.009), and apocalypse (OR=1.65,p<0.01). Conclusion: The results suggest that increased stress may induce negatively-toned dreams related to that stress. Future studies will have to determine whether (and when) this symptom indicates an emotional regulation mechanism at play or the failure of such a mechanism.