Although Changes in Dreaming during Pregnancy Are Relatively Well Studied,1-4 Those Associated with the Postpartum State

1162 ALTHOUGH CHANGES IN DREAMING DURING PREGNANCY ARE RELATIVELY WELL STUDIED,1-4 THOSE ASSOCIATED WITH THE POSTPARTUM STATE ARE NOT. We have observed informally that many new mothers describe acting out vivid disturbing nightmares about their new infants. A typical episode, which we dubbed the baby-in-bed (BIB) nightmare pattern, involves a dream that the infant has been lost in the mother’s bed and during which the mother searches through the covers, weeps openly, or speaks out loud. At times she may even touch or take hold of her bedpartner while attempting to find the lost infant. When fully awake, she realizes that her infant is not in the bed but she may nevertheless feel compelled to arise and confirm that the infant is indeed sleeping safely. Such behaviors may reflect a mother’s state of maternal vigilance; they may even serve a functional role in her infant caregiving. Or, they may be symptomatic of a disruptive sleep disturbance that interferes with maternal duties. In any case, the prevalence, phenomenologic characteristics, and psychopathologic correlates of these unusual dreams are unknown. There are superficial resemblances between such episodes and other parasomnias with complex behaviors such as rapid eye movement (REM) sleep behavior disorder,5 parasomnia overlap disorder,6 posttraumatic nightmares,7 somnambulism and confusional arousal.7 However, recent evidence8 suggests that most parasomnias—including nightmares—decrease in prevalence immediately after pregnancy. It is therefore possible that postpartum episodes represent an unrecognized parasomnia that arises in specific situations of sleep disruption and/or stress. We used unobtrusive interview methods to evaluate this possibility. We asked women within 12 weeks of giving birth to report dreams and nightmares about their infants and to indicate whether these were accompanied by any of 3 types of dreamassociated behaviors: motor activity, speech, and expressed emotion. We also studied smaller groups of pregnant and nonchild-bearing women using similar questions to determine the specificity of these episodes to the postpartum state. Based on our informal observations, we expected to observe a markedly increased prevalence of both infant dreams and dream-related behaviors selectively among postpartum women.