Nightmares Associated with the Onset of Mania: Three Case Reports

One of the most important functions of REM sleep and dreaming is mood-regulation. Clinical observations suggest the putative role of REM sleep in relation to the problem-solving functions of REM sleep (1). REM sleep and dream content are profoundly altered in affective disorders, thus an analysis of the relationship between mood, REM sleep, and dreaming may play a role in our understanding of underlying mechanisms of mood disorders (2-4). Cartwright and Lloyd (5) reported that depressed subjects exhibiting a shorter REM latency following a life stressor have increased accompanying reports early night dream intensity as support hypothesis that reduced REM latency may represent a compensatory mechanism when negative affect exceeds normal limits. On the other hand, prolonged selective REM deprivation by awakenings have been known to be beneficial in the treatment of depression for 20 more years (6). That the majority of antidepressant drugs, across several different categories, exhibit robust suppression of REM sleep appeared to support this finding. However, others, such as bupropion and nefazodone, lack REM suppressant effects (7). Thus, it is still an unresolved issue whether REM sleep abnormalities are depressiogenic or whether early prolonged and more active REM sleep reflects an attempt to compensate for elevated levels of a waking depression. REM sleep abnormalities were welldocumented in depression, whereas REM sleep changes in bipolar disorder are variable; reduced, increased, or unchanged REM sleep may be occurred in manic phase. Shift in mood may be occur during sleep (8). In a recent study, Beauchemin and Hays (8) demonstrated that dream content related to prevailing mood state and certain types of dream preceded upward mood changes in bipolar disorder (manicdepression). To replicate these findings, one year later, they (9) monitored sleep, dream content and mood, in both bipolar and unipolar patients during depressed state. They found that REM latency tends to increase as the mood improves in bipolars but was stable (and even decreases with mood improvements) in unipolar depressives; dream content continued to systematically relate Nightmares Associated with the Onset of Mania: Three Case Reports