Nightmares, nonrestorative sleep, and headaches co-occur, are common, underdiagnosed, and contribute to substantial disability. Pregabalin modulates excitatory neurotransmission, increases slow-wave sleep, and suppresses REM sleep, suggesting a potential therapeutic role in nightmares and sleep disturbance. Pregabalin's effect on nightmares has not been systematically studied. Although sedation is a common side effect when prescribed 2-3 times daily according to the package insert, the efficacy and tolerability of once-nightly administration remain poorly characterized. Our retrospective case series included 23 outpatients seen in the neurology department of a tertiary care center from November 2022 to August 2025. They were prescribed once-nightly pregabalin for nightmares, nonrestorative sleep, and headaches. Clinical data were extracted from medical records, including nightmare frequency, fraction of 24-hour periods with restorative sleep, headache frequency, severity, and duration, and MIDAS scores. Within-subject pre-post comparisons were performed using paired t-tests or Wilcoxon signed-rank tests. All p-values were Holm-Bonferroni adjusted. Nightmare frequency decreased 81% (17.5 to 3.3/month, padj=0.006). Nightmares decreased numerically more for those who transitioned from gabapentin to pregabalin (91%) than for those not initially taking gabapentin (73%). Restorative sleep frequency increased 127% (1.8 to 4.0/week, padj=0.006). Headache frequency decreased 50% (17.0 to 8.5/month, padj=0.040). Migraine Disability Assessment Questionnaire scores decreased numerically by 34% (38.0 to 24.0) but did not reach statistical significance after correction (padj=0.084). Six patients reported side effects, and 19 continued pregabalin at three months. Once-nightly pregabalin was associated with robust reductions in nightmare frequency, nonrestorative sleep, and headache frequency. The improvement in nightmares validates two prior case reports through systematic cohort evaluation. Nightmares improved even among patients transitioning from gabapentin to pregabalin, suggesting that pregabalin may be superior to gabapentin. No prior studies have addressed these three co-occurring problems simultaneously. Larger controlled studies are needed to test the hypothesis that once-nightly pregabalin may be useful for this patient population. Nightmares are a significant problem for which treatments are limited. Nightmares, poor quality sleep, and headaches often occur together, and can greatly affect daily life, yet this combination of symptoms is frequently overlooked in clinical care. Pregabalin is a medication commonly used for pain, sleep, and some headache disorders, but its effects on nightmares have not been well studied. We reviewed medical records of 23 patients with co-occurring nightmares, poor quality sleep, and headaches, who were prescribed pregabalin once nightly. Analysis of these patient records found significant improvements in nightmare frequency, sleep quality, and headache frequency after taking it for three months. Most patients tolerated the medication well, and the majority chose to continue taking it. This work suggests a potential new treatment approach for nightmares and associated sleep and headache complaints. No prior studies have addressed all three of these problems simultaneously. Because this was a small, uncontrolled study, larger controlled studies are needed to confirm these results.
Suicide is a major public health concern, and identifying early indicators of suicidal crisis remains a key clinical challenge. Nightmares have been suggested as potential early markers of suicide risk. This study aimed to investigate dream alterations preceding a suicidal crisis in patients presenting to a psychiatric emergency department. This prospective study was conducted in a psychiatric emergency center in Paris between March and April 2025.42 patients presenting with severe suicidal ideation or following a suicide attempt completed a self-administered questionnaire assessing dream characteristics, sleep disturbances, anxiety, and depressive symptoms using validated clinical instruments. The timing and evolution of bad dreams, nightmares, and suicidal-themed nightmares preceding the crisis were examined. Overall, 83.0% of patients reported at least one dream alteration. Bad dreams were reported by 61.9% of participants, nightmares by 52.4% and suicidal scenarios occurring within nightmares by 35.7%. Nightmares emerged on average 128 days before the suicidal crisis, whereas suicidal-themed nightmares appeared closer to consultation, approximately 16 days before the emergency visits. More than half of patients (54.8%) experienced an evolutionary pattern in dream content involving at least two successive dream alterations. Nightmare severity was significantly correlated with insomnia severity and anxiety symptoms. Nightmares are highly prevalent among patients presenting psychiatric emergency services during a suicidal crisis and often emerge weeks to months before the acute episode. The temporal proximity of suicidal-themed nightmares to crisis onset and their association with insomnia and anxiety suggest that systematic assessment of nightmares may enhance suicide risk in clinical practice.
Insomnia and obstructive sleep apnea (OSA) are the most prevalent sleep disorders in military personnel. People with both sleep problems (co-morbid insomnia and sleep apnea [COMISA]) experience higher rates of medical and psychiatric comorbidities. Few studies have examined the comorbidity of nightmares among those with insomnia, OSA, or COMISA. This secondary data analysis of data collected in a large sample of military men and women seeking treatment for sleep disturbances aimed to examine the occurrence and impact of nightmares in military personnel with insomnia, OSA, and COMISA. Data collected from a convenience sample of 372 active-duty U.S. military personnel purposefully recruited following a diagnosis based on a clinical evaluation and in-lab video-polysomnography (118 with insomnia, 118 with OSA, 136 with COMISA) were analyzed. The Nightmare Disorder Index (NDI) was used to measure clinically significant nightmares. Self-reported symptoms of insomnia, excessive daytime sleepiness, sleep-related impairment, anxiety, depression, and posttraumatic stress disorder (PTSD) were also analyzed. Chi-squared tests and 2-way analyses of variance were used to address the study aims. This study is a secondary analysis of data collected in the conduct of a prospective observational study originally approved and overseen by the 59th Medical Wing Institutional Review Board, and the U.S. Army Medical Research and Development Command Human Research Protection Office monitored the regulatory approvals. Nightmares were significantly more likely in those with insomnia (35.6%; n = 42/118) or COMISA (38.2%; n = 52/136) than in those with OSA (14.4%; n = 17/118; both Ps < .001). Although there was not a significant interaction between group and nightmares, planned post hoc analyses found nightmares were associated with worse PTSD symptoms in the insomnia group; anxiety, depression, and insomnia symptoms in the OSA group; and insomnia, sleep-related impairment, anxiety, depression, and PTSD symptoms in the COMISA group. Nightmares are associated with increased sleep and mental health symptoms among military personnel with OSA, insomnia, and COMISA. Those with COMISA and nightmares (named COMISA-MARES) exhibited the worst symptoms.
Traumatic nightmares are a core feature in adolescents with complex PTSD (CPTSD) exposed to early and repeated trauma, maintaining hyperactivity and dysregulation. Despite their prevalence and functional impact, targeted treatments for youth remain scarce. Imagery rehearsal therapy (IRT) is a brief cognitive-behavioral intervention effective in adults, but evidence in adolescents with CPTSD is limited. This study assessed the feasibility and preliminary effectiveness of four sessions of IRT adapted for young participants (14-25 years) with CPTSD. Thirty-nine participants presenting ICD-11 criteria for CPTSD were recruited after at least 3 months of psychiatric follow-up. They received IRT and completed pre- and post-intervention self-report measures of nightmare frequency and distress (NDQ-13), sleep quality (PSQI, ISI), PTSD symptoms (CPTS-RI, CPC, PCL-5), anxiety, depression, and quality of life. All participants reported severe traumatic nightmares, mainly linked to repeated sexual (75%) and physical (65%) violence. After four IRT sessions, nightmare frequency per week decreased (5.7 vs. 2.8, p = 0.011) as did the distress rate on the visual analogue scale between 0 and 10 (7.7 vs. 4.4, p = 0.004). Sleep improved (PSQI 9.1 vs. 13.3, p = 0.007; ISI 12.2 vs. 17.9, p = 0.005), and quality of sleep (6.8 vs. 4.4, p = 0.01) and of life increased (6.8 vs. 4.7, p = 0.014), while anxiety and depressive symptomatology remained stable. IRT appears feasible and promising in this population and was associated with reduced nightmare frequency and distress, along with improved sleep and quality of life. These results highlight its potential as a safe and easily disseminable intervention, also suitable for vulnerable or low-resource populations. Traumatic nightmares are highly prevalent and impairing in adolescents with complex PTSD (CPTSD), yet developmentally adapted treatments remain scarce. Imagery Rehearsal Therapy is effective in adults, but evidence in youth exposed to early and repeated trauma is limited. This study suggests that a brief, four-session IRT protocol is feasible and may reduce nightmare frequency and distress in adolescents and young adults with CPTSD. The findings support IRT as a safe and scalable intervention that may help improve sleep and functioning in vulnerable or low-resource populations.
Nightmare disorder is historically conceptualised as a rapid eye movement (REM) sleep parasomnia, but evidence also points to altered non-rapid eye movement (NREM) sleep physiology. Here, in a retrospective case-control study, we analysed overnight polysomnography from 26 adults with nightmare disorder and 32 controls using a harmonised event-based EEG pipeline. Nightmare disorder showed reduced frontal slow-oscillation-spindle coupling, whereas delta-spindle coupling was preserved, yielding lower coupling dominance than in controls (0.137 ± 0.083 versus 0.238 ± 0.096; p = 6.8 × 10-5). Stage-adjusted K-complex density across the first 6 h from sleep onset was also lower in nightmare disorder (0.463 ± 0.345 versus 0.723 ± 0.475 events per minute of available N2/N3 sleep; p = 0.019), whereas peak-timing differences were not robust. These findings suggest altered NREM sleep microarchitecture in nightmare disorder rather than a phenotype confined to REM sleep, and warrant prospective confirmation in harmonised, clinically phenotyped cohorts.
Nightmare disorder (NDO) is a clinically under-recognized sleep disorder within the military population. We have previously reported that 31.2% of patients referred to our sleep disorders center incidentally had probable NDO, yet only 3.9% were specifically referred for NDO. Under-recognition and therefore under-treatment of NDO negatively impacts patients' health and military readiness. The initial Plan-Do-Study-Act cycle involved updating the baseline referral rate for NDO at our academic sleep disorders center across a three-month period. Second, leaders from the Internal Medicine Clinic (IMC) were engaged and educated on NDO screening via email. This led to incorporation of the Nightmare Disorder Index (NDI) into routine patient intake within the IMC for a four-week period. Thirdly, leaders from the Family Health Clinic (FHC) were engaged with face-to-face education on NDO and interpretation of the NDI, resulting in incorporation of the NDI into routine patient intake for a four-week period. Finally, leaders and available providers from the Warrior Operational Medicine Clinic (WOMC) were engaged with face-to-face education on NDO, interpretation of the NDI, and nightmares as possible presenting symptoms of other sleep-related disorders. The WOMC incorporated the NDI into routine patient intake for a two-week period. Primary care providers reviewed NDI results and referred patients as appropriate, with subsequent sleep medicine review of NDI results and NDO referral rates for each of the specified time periods. Prior to intervention, zero referrals were received for NDO. Three PCCs agreed to participate for two to four weeks each. The IMC screened 614 patients, with 586 (95.5%) completing the NDI. At FHC, 69 patients were screened with 100% NDI completion. The WOMC screened 29 patients with 100% NDI completion. We subsequently received 74 total referrals from these clinics, with eight (10.8%) specifically for NDO. However, 22 (29.7%) screened patients met criteria for probable NDO. The project successfully integrated the NDI into routine primary care, achieving a high completion rate and increasing NDO referrals from a baseline of zero. A discrepancy between positive screening and referrals persisted. Future steps for further process improvement to address this gap could include provision of more in-depth education on NDO, interpretation of the NDI with added clinical context, and education on the other sleep-related disorders associated with nightmares for primary care providers. The addition of the NDI to primary care sleep disorder screening practices can be generalizable to other institutions and practice settings.
The fear of death (death anxiety) is a risk factor for various mental health conditions. Death anxiety has been theorized to elicit physiological arousal and worry and is empirically associated with attachment insecurity, each of which has been linked to disrupted sleep. However, limited research has explored the relationship between death anxiety, nightmares and insomnia. We examined the relationship between death anxiety and insomnia, as well as attachment style as a potential moderator, and nightmare severity as a possible mediator. Five hundred and fifteen adults completed an online survey; 70% were female, and 89% resided in Australia. Regression analyses revealed that death anxiety was positively related to insomnia, with no significant moderation by attachment style. Analyses using Hayes' PROCESS macro revealed that nightmare severity mediated this relationship. These findings suggest that death anxiety may play a greater role in insomnia than previously considered and may be an important intervention target.
The return to normal life following the COVID-19 pandemic was evaluated in terms of anxiety upon awakening, sleep quality indicators, and dream characteristics. The sample comprised 394 women and 107 men who completed an online self-report questionnaire between August 15, 2022, and December 8, 2022 about their sleep and dream experience from the previous night. Respondents completed the Anxiety upon Awakening Assessment Questionnaire (CEAD, as per the Spanish acronym) and evaluated their experiences of the pandemic. The data were compared to those obtained before the pandemic and those collected during lockdown in a previous study. After the return to normal life, 46.5% of respondents recalled at least one dream scene, and nightmares were recorded in 4.6% of cases. This percentage did not differ significantly from those observed during lockdown or before the pandemic. Compared with the previous periods, participants also reported more dreams with anxious content and greater dream recall. A return to a sleep duration of between 6 and 7 h was observed. However, anxiety upon awakening was higher, suggesting that full normalization had not yet occurred at the time of this study. In this sample, nightmare frequency was less sensitive than anxiety upon awakening to post-pandemic sleep-related emotional activation. The findings may be compatible with emotional-processing accounts of dreaming and with a homeostatic interpretation of sleep in which emotional dream content did not translate into more awakenings.
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Implantable medical devices (IMDs) increasingly integrate continuous monitoring with autonomous therapeutic functions, transforming clinical practice while raising significant ethical concerns. As these technologies expand - particularly among vulnerable populations such as individuals with substance use disorders - the tension between patient safety and autonomy intensifies. This article examines the ethical and legal implications of IMDs, emphasizing ongoing consent, data governance, and neurorights. We conducted a narrative and normative bioethical analysis grounded in interdisciplinary literature. Empirical and conceptual studies on IMDs, neurotechnologies, and opioid overdose interventions were reviewed alongside regulatory frameworks, including the European General Data Protection Regulation (GDPR), Brazil's General Data Protection Law (LGPD), and the United States Health Insurance Portability and Accountability Act (HIPAA). Highly autonomous IMDs challenge traditional informed consent models, particularly regarding revocation, device deactivation, and continuous data processing. Vulnerable populations may face stigma and expanded secondary uses of sensitive data, while existing regulations leave gaps in neural and biometric data protection. Ethical implementation requires patient-centered frameworks ensuring ongoing consent, secure data governance, and protection of mental privacy.
A frail nonagenarian presented with incessant wide complex tachycardia exhibiting a left bundle branch block (LBBB) morphology. The arrhythmia was transiently responsive to adenosine boluses but proved refractory to direct-current cardioversion, exhibiting a pattern of immediate reinitiation. Upon transient termination, the baseline electrocardiogram demonstrated sinus rhythm with varying degrees of LBBB aberrancy. Intracardiac electrogram analysis was used to narrow the differential diagnosis of the tachycardia mechanism. Crucially, post-termination recordings documented a rare phenomenon of alternating bundle conduction during bradycardia. This was characterized by a severely diseased infra-Hisian conduction system with an H-V interval of 306 ms-representing one of the longest documented intervals in the literature. This case highlights the capacity for extremely slow, albeit tenuous, conduction within a profoundly diseased conduction system.
A 79-year-old woman presents to the hospital with dyspnoea, fever, and hypotension, and is diagnosed with community-acquired pneumonia and septic shock. Resuscitation is initiated with fluids and vasopressors, and a central venous catheter is placed. However, during the procedure, the guide experiences resistance and cannot be removed, becoming trapped. This is confirmed with tomography and reconstruction, demonstrating intravascular position. The patient is then sent to interventional cardiology for extraction, which is successfully performed using the EN Snare (Merit Medical). The significance of this case lies in the complications of not guiding procedures with ultrasound and how to resolve them, such as the guide being trapped in this patient.
Trauma-associated sleep disorder is a proposed sleep disorder characterized by trauma-related nightmares, hyperarousal during sleep, and disruptive nocturnal behaviors following exposure to a traumatic event. Sleep problems are common after trauma, yet little is known about their prevalence among women in the general population. We aimed to estimate the prevalence of trauma-associated sleep disturbances (TASD) and identify associated factors in a large nationally representative cohort. We used data from a population-based cohort of Icelandic women aged 18 to 69 years. Of the 30,403 women who provided informed consent, 27,938 women were included in the analysis. Participants completed assessments of trauma history, TASD, and other mental health outcomes. Past month TASD were identified using established symptom criteria. Prevalence ratios were estimated using modified Poisson regression adjusted for demographic, socioeconomic, behavioral, and trauma-related factors. Here we show that 6.9% of women in the cohort report TASD. Prevalence was highest among young women and those exposed to physical or sexual violence. Experiencing the worst life stressor more than once and close temporal proximity to the worst life stressor was also associated with higher TASD prevalence. TASD are strongly associated with symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and general sleep problems. Results indicate that TASD affect a substantial number of women in the general population and are most prevalent among women exposed to interpersonal violence and among those with repeated or recent traumatic experiences. These findings underscore the importance of early identification of TASD and targeted interventions in healthcare. Some people develop sleep problems after experiencing a difficult life event. These problems can include nightmares, trouble staying asleep, acting out dreams and talking during sleep without fully awakening. We wanted to understand how common these issues are among women and which traumatic experiences are linked to them. Approximately twenty-eight thousand women took part in our study. We found that about 7 out of every 100 women had these symptoms in the past month. They were more common in women who had experienced sexual or physical violence, repeated trauma, or a recent traumatic event. Our results show that sleep can be an important sign of how someone is coping after trauma. Paying attention to sleep problems may help identify women who could benefit from support or treatment.
Suicidal behaviors-including suicidal ideation, suicide attempts, and suicide deaths-represent a major global health concern. Identifying proximal, modifiable risk factors is crucial to improve early detection and prevention. Sleep disturbances have emerged as proximal and modifiable risk factor for suicide, yet their role is often underestimated in clinical practice. This chapter synthesizes evidence from epidemiological, clinical, and neurobiological studies examining the associations between sleep disturbances and suicidal behaviors. Both subjective (insomnia, nightmares, sleep duration, daytime sleepiness) and objective markers (polysomnography, actigraphy, circadian misalignment) are discussed, alongside potential underlying mechanisms and therapeutic perspectives. Insomnia, nightmares, abnormal sleep duration, and circadian rhythm disruptions are consistently associated with suicidal ideation, suicide attempts, and suicide deaths, independently of psychiatric disorders. Objective sleep measures, such as nocturnal wakefulness and REM sleep alterations, further support the association with suicidal risk. Potential mechanisms involve inflammation, neurotransmitter dysregulation, impaired prefrontal-limbic connectivity, and psychosocial factors such as hopelessness and nocturnal isolation. Suicide risk assessment may be strengthened by incorporating sleep-related interview questions, validated questionnaires, and objective sleep measures such as actigraphy. Interventions targeting sleep-including CBT-I, sleep medications, and Imagery Rehearsal Therapy-show promise in reducing suicidal ideation. Systematic assessment and treatment of sleep disturbances may significantly improve suicide risk detection and prevention strategies.
To describe a potential emerging neuropsychiatric adverse effect, abnormal dreams or night terrors, associated with atogepant (a calcitonin gene-related peptide receptor antagonist) observed in 4 patients treated at a tertiary headache clinic, and to place these observations in the context of existing postmarketing pharmacovigilance signals. Four patients with migraine developed vivid abnormal dreams, nightmares, or night terrors after starting atogepant for migraine prevention. Symptoms were bothersome, often led to atogepant discontinuation, and generally resolved after stopping use of the drug; one patient improved despite continuing therapy. Although confounders existed, timing and causality assessment supported a possible association, consistent with US Food and Drug Administration Adverse Event Reporting System pharmacovigilance signals. Abnormal dreams and night terrors may represent an underrecognized adverse effect of atogepant. Based on this case series, the effect appears potentially reversible with discontinuation and may diminish over time in some patients who continue therapy. For patients who are taking atogepant and report sleep disturbances and dream-related symptoms, a possible correlation with atogepant should be considered. During follow-up, proactively asking about sleep disturbances and dream-related symptoms should be considered.
Mechanical ventilation (MV) is a frequently used lifesaving treatment in intensive care units (ICUs); yet, earlier research suggests that it may expose patients to unpleasant physiological and psychological stressors. While international literature characterises MV as distressing, limited research has explored these experiences within the specific sociocultural context of Maltese and Mediterranean ICUs. To explore the lived experience of adults who received MV during an ICU stay and how they made sense of this unique experience. A qualitative approach was adopted utilising Interpretative Phenomenological Analysis (IPA). Purposive, homogeneous sampling was used to recruit adults (n = 7) who were invasively ventilated for at least 4 days in a general ICU at a public hospital in Malta. Data collection took place in 2023 through semi-structured interviews and continued until sufficient idiographic depth was achieved. Data analysis was guided by the stages of IPA to identify shared patterns across participants while adhering to idiographic principles. Four Group Experiential Themes emerged: (1) delivered into the hands of others, representing the transition to a state of profound vulnerability, voicelessness and dependence; (2) living in a disconnected world, involving a psychological detachment from reality characterised by vivid hallucinations and terrifying nightmares; (3) an agonising experience, encompassing both physical pain and a long-term emotional burden after discharge; and (4) Supportive encounters, highlighting the role of healthcare worker dedication, family networks and spirituality as vital mediators of suffering. Patients may perceive MV as a disorienting journey defined by a loss of autonomy and identity. The psychological impact of delusions often lingers long after discharge, which underscores the necessity of humanising critical care and providing compassionate interventions. The findings highlight the need for tailored communication strategies and the integration of spiritual care as a core component of the care for mechanically ventilated patients. Environmental adjustments, ICU diaries, flexible visiting hours and non-pharmacological interventions like music therapy should be prioritised to facilitate holistic recovery and reduce the risk of post-intensive care syndrome.
This paper examines how camp, an aesthetic grounded in exaggeration, humor, and theatricality, functions as a legitimate nursing practice that challenges the cisheteronormative seriousness embedded in professional nursing culture. I begin by tracing how seriousness became a dominant aesthetic standard in nursing, shaping expectations for comportment, emotional restraint, and professionalism in ways that marginalize queer and trans nurses. Drawing from Sontag's Notes on Camp, I argue that seriousness is not an objective requirement of safe or ethical care but a culturally specific performance that restricts who and what count as 'professional'. I then introduce camp as a counter-aesthetic that exposes the performative nature of these norms. Through playfulness and intentional artifice, camp destabilizes the boundaries of professional conduct and opens space for alternative, culturally grounded expressions of care. To illustrate this, I examine the work of Bobbi Campbell, known as Sister Florence Nightmare RN, as a historical exemplar of a drag nurse who promoted health education, reduced stigma, and community resilience during the early HIV/AIDS epidemic. I then pull on Nurse Anne Thracks and Mandy Mango as contemporary examples of drag-as-nursing. These examples demonstrate how queer nurses use drag and camp to strategically engage communities, communicate health information, and model radically inclusive care. I extend this analysis to contemporary nursing contexts, arguing that integrating camp is a form of ethical authenticity aligned with the profession's commitments to dignity, self-regard, and social justice. I show how campy and drag nurses actively subvert restrictive norms by transforming the figure of the nurse-through language, attire, and performance-while still providing effective, culturally relevant care. Ultimately, I propose camp as a generative framework for reimagining nursing aesthetics and practice. Embracing camp expands the boundaries of what is considered professional, ethical, and therapeutic, offering a model of nursing that honors joy, relationality, sociopolitical wellness.
Reports remain limited on individual eye movement desensitization and reprocessing (EMDR) for prolonged trauma-related symptoms linked to occupational memories after COVID-19 administrative redeployment among public health nurses. A woman in her 30s working as a public health nurse developed prolonged depressive symptoms, intrusive recollections, nightmares, and hyperarousal after reassignment to unfamiliar COVID-19 administrative duties. During inpatient treatment in 2021, EMDR was applied to early family-related memories in routine care, whereas occupational memories were deferred and later remained symptomatically active. Symptoms persisted despite pharmacotherapy and two courses of repetitive transcranial magnetic stimulation. Between June and October 2025, she received six outpatient EMDR sessions targeting occupational memories related to citizen complaints, procedural ambiguity, and workplace conflict. Scores on the Posttraumatic Diagnostic Scale for DSM-5, PTSD Checklist for DSM-5, and Impact of Event Scale-Revised decreased from 31, 32, and 25 in June 2025 to 12, 11, and 7 in December 2025, respectively. Available session-level records suggested reduced distress in documented target assessments, although ratings were not recorded uniformly across sessions. This case illustrates the clinical relevance of assessing occupational memories as possible contributors to persistent trauma-related symptoms after administrative redeployment.
Refugees and asylum seekers face significant mental health challenges, yet sleep disturbances remain underrecognized despite their critical impact on well-being. This systematic review and meta-analysis assessed sleep quality and insomnia severity across 66 studies (n = 42,956). Pooled analyses of the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) based on studies identified in Cochrane, Embase, and PubMed from database inception to December 2024 revealed clinically significant sleep disturbances. The pooled mean ISI score (13.76, 95% CI 10.39-17.13) falls within the upper end of the subthreshold range, bordering on moderate clinical insomnia, while PSQI scores (8.59, 95% CI 2.11-15.07) exceeded clinical thresholds for poor sleep. The pooled prevalence of sleep adversities was 43.2% in adults and 36.4% in children. Secondary findings highlighted prolonged sleep latency and frequent nightmares. Although subgroup analyses suggested trends across populations and assessment methods, statistical significance was limited by sample heterogeneity. Standardized sleep assessments must be integrated into refugee health protocols, with targeted interventions addressing insomnia risk factors.