Nightmare Severity and Sleep Disturbance Among Young Adults Reporting Trauma Exposure in Lahore

Abstract

Nightmare severity and sleep disturbance may co-occur with broader posttraumatic symptoms, but overlapping questionnaire content complicates their interpretation. This study examined concurrent direct and indirect associations among these constructs in 209 young adults aged 18–29 years recruited through educational networks in Lahore, Pakistan. Participants completed the Life Events Checklist for DSM 5, Nightmare Severity Index, PTSD Checklist for DSM 5, and eight item Sleep Condition Indicator. The symptom score used in the primary model excluded the disturbing dreams and sleep difficulty items, and the sleep score was reversed so that higher values indicated greater disturbance. Nightmare severity correlated positively with adjusted posttraumatic symptoms (r = .675) and sleep disturbance (r = .369); adjusted symptoms also correlated with sleep disturbance (r = .377; all p < .001). PROCESS Model 4 with 5,000 bootstrap resamples yielded a positive indirect association, B = 0.196, 95% bootstrap CI [0.042, 0.359], alongside a remaining direct association, B = 0.262, p = .015. The final model explained 16.6% of sleep disturbance variance. These findings support assessing nightmare burden, broader symptoms, and sleep difficulties together, while recognising residual measurement overlap and self-report limitations. Because all variables were measured simultaneously, the results do not establish temporal or causal mediation. Longitudinal replication with verified trauma exposure and complementary sleep measures is warranted.