Dreams Characteristics and their Relationship with the Psychological Status in Postmenopausal Women

Abstract

Objectives: To analyze dreams characteristics and their relation with the psychological status in postmenopausal women.

Material and Methods: 200 non-hysterectomized women were interviewed: Group I, premenopausal and Group II, postmenopausal. The last three dreams, the prevalence of nightmares and important situations in daily life were documented. The What’s My M3 test was used to evaluate the psychological status. Comparison among the groups was done with Mann Whitney U test and Chi square. Results: After excluding those with hormonal treatment or who didn’t met the inclusion criteria remained in group I, 76 and in group II 95 women. The median of age was 46 (40-50) and 61 (50-84) years for group I and II respectively. There weren’t any differences among the groups in the What’s My M3 score. The frequency of nightmares was greater in group II: group I, 31.8% and group II, 68.2%. In both groups, dreams were related with daily activities and also were a greater percentage of women with nightmares and What’s My M3 score ≥ 33. Actual diseases were related with nightmares (p < 0.023).

Conclusions: Nightmares were more frequent in postmenopausal women and had a relationship with the psychological status in both groups.

KEYWORDS

Premenopausal

Postmenopausal

Psychological status

Nightmares

CITATION

Carranza LS and Toledo RIC. Dreams Characteristics and their Relationship with the Psychological Status in Postmenopausal Women. SM J Sleep Disord. 2016; 2(1): 1003.

INTRODUCTION

Sleeping is a physiologic process whose mechanisms and function aren’t yet very well-known [1-3]. In older adults it has been found that dream latency and night awakenings are increased, which can exacerbate multiple medical conditions in the geriatric population [4-6].

From apsychoanalytic point of view, sigmund Freud distinguished two types of dream’s content, the manifesto and the latent one. The former is just as the person lives it, while the latter is what the dream truly means [7]. The mechanisms of dream elaboration have as purpose to transform the latent’s dream content in an acceptable content for the moral conscience [7].

Beyond the Freudian school, sleeping is necessary for the health as well as for the good development of individual’s activities. It has been observed that sleep dysfunctions and insomni are frequently found in perimenopausal and postmenopausal women and are associated with increased risk for coronary illnesses as well as increased mortality due to cardiac diseases [5]. During the postmenopause, sleep disturbances have different grades of intensity; they can be chronic or transitory and can also include difficulty to sleep during night, restlessness sleep, early wake up, nightmares and decrease of sleeping time [8]. Mood changes are observed at different stages of the woman’s reproductive life and are related to hormonal changes, that’ why during the postmenopause there is a greater predisposition to have depression [9].

The psychological status can be evaluated with the What’s My M3 that is an on-line, selfevaluated test which is directed to any 18 year-old person or older and indicates the relative risk for depression, anxiety disorder, Obsessive Compulsive Disorder (OCD), Bipolar Disorder (BPD) and Post-Traumatic Stress Disorder (PTSD). The individual scores are added and if the total score is ≥ 33 indicates that psychiatric evaluation is needed. This test is useful for diagnosis, to stimulate th treatment attachment and to follow the long term progress [10,11]. It’s known that there is a stron relationship between postmenopausal status and sleep disorders which are related with disturbed psychological status. For that reason, the objective of the present work was to analyze the dreams characteristics and its relationship with the psychological status in postmenopausal women.

MATERIAL AND METHODS

Two-hundred Mexican non-hysterectomized women who attended to the hospital were interviewed from February to June 2016. They were divided in Group I, premenopausal, between 40 and 50 years (n=100) and Group II postmenopausal (more than 12 months since menopause, n=100). In all them age (years), gestation, parturitions, cesarean sections and abortions were investigated. Weights (kg), height (m), waist perimeter (cm), hip perimeter (cm) were measured and the Body Mass Index (BMI, weight/height2) and Waist Hip Ratio (WHR, waist perimeter/hip perimeter) were calculated. The occupation, marital status, number of sexual intercourses per week, and in the case of not having them, the time without them (years), concomitant illnesses, sport practice, smoking habit and alcoholism were documented. In group II, age at menopause (years) and time since menopause (years) were investigated.

The presence of dreams was investigated, and when they were present, the characteristics of the last three were interrogated (such as what they dream about). Also was investigated if they had nightmares in the last month, important daily life situations related with the dreams and how they defined their relationship with its relatives (grand parents, brothers, sisters, sons, daughters, couple) and work partners. All interviews were done by only one person. The psychological status (depression, anxiety, OCD, BPD, PTSD) was investigated with the What’s My M3 test is considering a score ≥ 33 as abnormal [10,11]. For simple size it was considered a 90% confidence level an 80% power, assuming that 20% of those premenopausal had sleep disturbances due to abnormal psychological status and this will occur in 40% of those postmenopausal. So the simple size was 74 patients per group. For the comparison among the groups, Mann Whitney U test and Chi square were used. The project was authorized by the Local Committee of Research and Ethics in Research in Health with the number R-2016-3606-3 and the patients signed the informed
consent form.

RESULTS

Two-hundred surveys were carried out in non-hysterectomized women. Group I, premenopausal (n=100) and Group II, postmenopausal (n=100). After excluding those with hormonal treatment or other exclusion criteria, remained 76 in group I and 95 in group II. The median of age in group I was 46 years (40-50) and in group II 61 years (50-84) (p < 0.001). Anthropometric, obstetric and civil status variables are shown in (table I).

Table 1: General data in both groups.

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are median (range).

The number of sexual relationships per week was significantly greater in group I and the time without a sexual relationship was significantly greater in group II. In group II, age at menopause was 49 years (43-53) and time since menopause was 12 years (2-36) (Table I). Women from group I had less concomitant illnesses than those from group II (52.6% vs 77.8%, p < 0.001) (Table II).

Table 2: Civil status, occupation, physical activity.

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are percentage and number of persons.

In group II, the most frequent illnesses were type 2 diabetes mellitus and systemic arterial hypertension, being significantly more frequent than in group I (p < 0.002 and p < 0.007 respectively) (Table III).

Table 3: Concomitant diseases in both groups.

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95) Results are percentage and number of persons.

In group I, concomitant illnesses and ≥ 33 score in the What’s My M3 test was (57.5% n=23, p NS) and in the group II (84.5% n=49, p < 0.047). In both groups the smoking habit and alcoholism were similar (Table IV).

Table 4: Smoking habit, alcoholism, cigarettes and alcohol per week in two groups

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are median (range), percentage and number of persons.

The women’s relationship with their grandparent’s wasn’t possible to establish in both groups because they were deceased and similar happened with parents in group II. In both groups they referred good relationship with brothers and very good with their sons and daughters, good relationship with the couple and work partners,
although in group II many hadn’t any couple and they stayed at home (Table V).

Table 5: Comparison in each group of family and work partners relationship

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are percentage and number of persons.

Nightmares and their monthly number were significantly greater in group II (Table VI).

Table 6: Dreams per month, nightmares and nightmares per month in both groups

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are median (range), percentage and number of persons.

In both groups, women that only referred a dream in the month mostly had dreams related with daily activities, group I, 21.0% (n=16) and group II, 15.8% (n=15), followed in group I by those related with contact with nature or trips 13.1% (n=10) and something related with dead people or cadavers 7.9% (n=6) and in group II with something related with illness or some lesion of a known person or family 13.7% (n=13) and contact with nature 12.6% (n=12) (Table VII).

Table 7: More common dreams in which only had one dream.

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are percentage and number of persons.

In women that had two dreams, in Group I 5.3% (n=4) were related with aggressions of animals toward her, natural disasters, fantasies like flying, to stretch out exaggeratedly and to fall in the vacuity. In group II, the greater percentage were dreams related with dead people or cadavers in 9.5% (n=9), followed by aggression of animals toward her 7.4% (n=7) and dreams related with the death, the devil, evil 6.3% (n=6) (Table VIII).

Table 8: More common dreams in which had two dreams.

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are percentage and number of persons.

In women that had three dreams, in group I, the most frequent were related with aggression or discussion with some person, aggression of animals toward her, natural disasters and relationship with dead people or cadavers, while in group II were the aggression or discussion with some person (Table IX).

Table 9: More common dreams in which had three dreams

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are percentage and number of persons.

Women with irrelevant activities in previous days and without dreams were in Group I 17.1% p < 0.001 and in group II 8.4% p < 0.001 when compared with those with that had other activities and have dreams Group I 60.5% and Group II 69.5%. Previous activities to dreams, were referred as anything out of common in both groups (Group I 42%, n=32 and Group II 44%, n=42) followed in group I by bad relationship or fights with somebody and doing activities like traveling, running, dancing, cooking, singing (10.5%, n=8, for both types) and in group II feeling sick (10.5%, n=10) (Table X).

Table 10: Previous to dream activities in which reported only one activity

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are percentage and number of persons.

In women that referred two activities previous to the dreams, in group I were bad relationship or fights with somebody and fear to something or somebody (1.3%, n=1 for each type) and in group II were stressed in the work or house (8.4%, n=8) (Table XI).

Table 11: Previous to dream activities in which reported two activities.

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are percentage and number of persons

In group I, the association of nightmares with bad family relationship was with the couple (20.6% n=13, p < 0002) and brothers (14.5% n=9, p < 0.039), in group II the results weren’t statistically significant (Table XII) of all women with nightmares,

Table 12: Nightmare association with bad relationships with family and work partners in both groups.

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are percentage and number of persons.

31.8% (n=28) were from group I and 68.2% (n=60) from group II, (p < 0.001). In group I, the presence of nightmares was related with previous activities in 85.7% (n=24, p < 0.001) and in the group II in 85.0% (n=51, p < 0.001). In the whole group, there were 38.5% (n=66) with nightmares and concomitant illnesses (p < 0.023). In group I those who had nightmares and were sick were 23.6% (n=18) and in group II 50.5% (n=48) (p < 0.001 between them). In relation to the psychological status measured with the What’s My M3 test, there was a non-significant difference among the groups in the total score, only the PTSD score was greater in group I, (p < 0.01) (Table XIII).

Table 13: What’s My M3 item and total score by group

Group I: Premenopausal (n=76) Group II: Postmenopausal (n=95). Results are median (range).

In the whole group, those with What’s My M3 ≥ 33, were in group I, 23.4% (n=40) and in group II, 33.9% (n=58) without significant differences among them. In group I, the percentage of those who had nightmares and What’s My M3 test score ≥ 33 was greater than those with score< 33 (82.1%, n=23 and 17.9%, n=5 respectively p < 0.001), and similar happened in group II (68.3%, n=41 and 31.7%, n=19 respectively p < 0.05).

DISCUSSION

In postmenopausal women, several factors increase the possibility to have mood dysfunctions (depression, anxiety, etc.) such as marital relationship, marital status, social isolation or concomitant illnesses [9]. In this study, there weren’t statistically significant results when comparing these items between premenopausal and postmenopausal women.

In this study, premenopausal women had a greater PTSD score, which can be explained by the fact of having a bad couple relationship which agrees with has already been reported [12-14]. In premenopausal women nightmares were associated with bad couple and brothers relationship. All this open the possibility to give family therapy to try to decrease this problem, and probably avoid the presentation of the PTSD. In both groups, the presence of nightmares was related to previous nightmare activities, as has already been described [7]. In those postmenopausal there was a greater frequency of nightmares and an important percentage had a
score ≥ 33 in the What’s My M3 test. In both groups, there were a significant number of women who had nightmares and punctuation ≥ 33 in the What’s My M3 test as has already been described for those postmenopausal [15]. All this can be related to estrogen deficiency, but this study had the limitation of no measuring estrogen levels and correlated with the number and kind of nightmare. Other study need be designed so the effect of estrogen therapy in nightmares can be assessed. The relationship between nightmares and previous activities was significant in both groups, what agrees with that described by Freud [7]. It has been described that postmenopausal women have a greater frequency of chronic degenerative illnesses and greater cardiac morbidity and mortality [16], which was corroborated in this
study, being the most frequent the type 2 diabetes mellitus and the arterial systemic hypertension; also, nightmares were more frequent in sick postmenopausal women.

CONCLUSION

Nightmares are more frequent in postmenopausal women and are related with psychological status in both premenopausal and postmenopausal women.

REFERENCES

1. Aldrich MS. Sleep medicine, Oxford University Press, New York, 1999.
2. Dement WC. History of sleep physiology and medicine, in: M.H. Kryger, T. Roth, W.C. Dement (Eds), Principles and practice of sleep medicine. W.B. Saunders Co., Philadelphia.1994; 3-15.
3. Santamaría J. Mecanismos y funcion del sueňo: su importancia clinica. Med Clin. 2003; 120: 750-755.
4. Buela-Casal G, Sanchez AI. Trastornos del sueňo, Sintesis, Madrid, 2002.
5. Newman AB, Enright PL, Manolio TA, Haponik EF, Wahl PW. Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the Cardiovascular Health Study. J Am Geriatrics Soc. 1997; 45: 1-7.

6. Jones CR, Czajkowsi L. Evaluation and management of insomnia in menopause. Clin Obstet Gynecol. 2000; 43: 171-182.
7. Freud S. Interpretacion de los sueňos. http://www.alejandriadigital. com/2016/01/11/la-interpretacion-de-los-suenos-de-freud-en-pdf-502-paginas-obra-de-dominio-publico-descarga-gratuita/, 2016 (accessed 27.07.16)
8. Tellez A. Trastornos del sueňo. Diagnostico y tratamiento. Mexico: Trillas. 2006.
9. Cole MG, Dendukuri N. Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. Am J Psychiatry. 2003; 160:
1147-1156.
10. What’s My M3. 2006. http://www.whatsmym3.com/aboutassessment.aspx 2006 (accessed 27.07.16).
11. Gaynes BN, DeVeaugh-Geiss J, Weir S, Gu H, MacPherson C, Schulberg HC, et al. Feasibility and diagnostic validity of the M-3 checklist: a brief, self-rated screen for depressive, bipolar, anxiety, and post-traumatic stress disorders in primary care. Ann Fam Med. 2010; 8:160-169.
12. Brokaw J, Fullerton-Gleason L, Olson L, Crandall C, Mc Laughlin S, Sklar D. Health status and intimate partner violence: a cross-sectional study. Ann Emerg Med. 2002; 39: 31-38.
13. Pigeon WR, Cerulli C, Richards H, He H, Perlis M, Caine E. Sleep disturbances and their association with mental health among women exposed to intimate
partner violence. J Womens Health. 2011; 20: 1923-1929.
14. Belleville G, Guay S, Marchand A. Impact of sleep disturbances on PTSD symptoms and perceived health. J Nerv Ment Dis. 2009: 197: 126-132.
15. Asplund R, Aberg HE. Nightmares, cardiac symptoms and the menopause. Climacteric. 2003; 6: 314-320.
16. WHO Technical Report Group Series. 866, Research on the menopause in the 1990s, http://apps.who.int/iris/bitstream/10665/41841/1/WHO_TRS_866.
PDF 1990 (accessed 27.07.16)