A preliminary cross-sectional study found that different sleep complaints had different associations. It did not establish benzodiazepines as a nightmare-prevention treatment.
The analysis included 113 bipolar-disorder outpatients assessed with sleep and clinical questionnaires and plasma markers. Snoring, restless legs, and nightmares, but not insomnia, had reported associations with orexin A.
In the nightmare model, anxiety severity and benzodiazepine exposure were associated with the outcome. The benzodiazepine association was inverse, rather than evidence that all sleep disturbances increased with use.
Prescribing choices, clinical severity, symptom reporting, and other medicines may influence a cross-sectional association. The design cannot establish whether treatment changed nightmares or whether patients with different symptoms received different treatment.
Several symptoms were self-reported without polysomnography, and plasma orexin was not a direct cerebrospinal-fluid measurement. This paper illustrates the need to separate sleep phenotypes and biomarkers. It cannot provide a benzodiazepine response rate, establish an orexin mechanism for its association, or determine whether a particular patient should receive a hypnotic.
Original analysis of the supplied journal article, identified as PMC12538487.