Fluctuations between sleep and wakefulness: Wake-like features indicated by increased EEG alpha power during different sleep stages in nightmare disorder

Although a growing body of research indicates that frequent nightmares are related to impaired sleep regulation, the pathophysiology of nightmare disorder is far from being fully understood. We examined the relative spectral power values for NREM and REM sleep separately in 19 individuals with nightmare disorder and 21 healthy controls, based on polysomnographic recordings of the second nights' laboratory sleep. Nightmare subjects compared to controls exhibited increased relative high alpha (10-14.5 Hz) and fronto-central increases in high delta (3-4 Hz) power during REM sleep, and a trend of increased fronto-central low alpha (7.75-9 Hz) power in NREM sleep. These differences were independent of the confounding effects of waking emotional distress. High REM alpha and low NREM alpha powers were strongly related in nightmare but not in control subjects. The topographical distribution and spectral components of REM alpha activity suggest that nightmare disordered subjects are characterized by wake-like electroencephalographic features during REM sleep.