SAN DIEGO — Frequent distressing dreams are linked to faster biologic aging and an increased risk for premature death, independent of traditional risk factors, new research suggested.
Distressing dreams include bad dreams without awakening and/or nightmares with awakening.
An analysis of data from more than four large studies in the United States and the United Kingdom found that experiencing distressing dreams at least once a week was significantly associated with aging at both the cellular level and throughout the body, as well as a threefold increased risk for death before age 70.
“It’s difficult to prove causation in observational studies, though you can definitely make an association,” lead investigator Abidemi Otaiku, MD, clinical research fellow at Imperial College London, London, England, told Medscape Medical News.
He added that if the relationship turns out to be causal, one possible mechanism is that nightmares act as a stressor, negatively affecting the body. Over time, the cumulative effect of frequent bad dreams could lead to the release of cortisol, a stress hormone that may accelerate aging at the cellular level. In addition, disrupted sleep itself is linked to a range of negative outcomes, including a detrimental effect on mental health.
“The takeaway message is that people who have more nightmares are aging faster and dying sooner. Nightmares are more important than people realize, and clinicians should ask about them,” said Otaiku, who is also affiliated with the UK Dementia Research Institute.
The findings were presented on April 6 at the American Academy of Neurology (AAN) 2025 Annual Meeting.
Link to Psychiatric, Neurologic Disorders
Otaiku noted that 4%-10% of individuals experience distressing dreams weekly, and 20%-30% experience them every month, and 85% experience them at least once a year.
A 2010 study showed that about 45% of the variation in frequency can be explained by genetic factors. These types of dreams have been linked to a variety of mental health concerns, including increased suicide risk.
In addition, Otaiku has published recent research that showed a link between distressing dreams and increased risk for Parkinson’s disease (PD) and between these dreams and cognitive decline and risk for dementia.
A year later, he reported a significant link between distressing dreams in childhood and an increased risk for cognitive impairment or PD in adulthood.
Other studies have linked distressing dreams to conditions such as cardiovascular disease, hypertension, and diabetes.
The current study “was created to test the hypothesis that nightmares may contribute to age-related diseases by the cellular aging process. Premature mortality is the ultimate outcome of accelerated aging,” Otaiku said.
Accelerated Cellular and Whole-Body Aging
The current analysis included data from the Midlife in the United States (MIDUS) study (n = 1660 US adults; 54% men), the Osteoporotic Fractures in Men Study (n = 1427 US adults; 100% men), the Wisconsin Sleep Cohort Study (n = 1109 US adults; 54% men), and the UK Biobank (126,866 UK adults; 40% men).
All participants completed baseline questionnaires, which included reporting how often they had trouble sleeping due to bad dreams in the past month. On these responses, participants were categorized into three groups — less than monthly, monthly, or weekly.
UK Biobank data provided blood test data on telomere length as an indicator of cellular aging. In the MIDUS study, blood samples were analyzed to derive three epigenetic markers of whole-body aging: DunedinPACE, GrimAge2, and PhenoAge. Mortality data were available for all studies.
Participants in the US cohorts were followed for over 19 years, while those in the UK Biobank cohort were followed for more than 2 years.
The study’s outcome measures included the rate of cellular aging at baseline, assessed via telomere length; the rate of organismal aging at baseline, based on a composite of three epigenetic markers; and evidence of premature aging in both the pooled US cohort and the UK Biobank cohort.
Results showed a significant association between the frequency of distressing dreams and accelerated cellular aging. The telomere length difference Z-score was 0.09 for those with monthly occurrences compared with less than monthly and reached statistical significance at 0.046 for weekly occurrences (P for linear trend < .001).
“In other words, the more frequent the nightmares, the shorter the telomeres,” Otaiku said.
Distressing dream frequency was also linked to accelerated organismal aging — referring to the overall aging of the body’s systems. The epigenetic aging index difference Z-score was 0.02 for monthly occurrences compared with less than monthly, and a significant 0.52 for weekly occurrences (P for linear trend < .001).
More Harmful Than Smoking, Obesity, Hypertension?
In the pooled US cohort, 126 premature deaths occurred before age 70 over the 19-year follow-up period. The hazard ratio (HR) for premature mortality was 1.27 among those who experienced monthly distressing dreams, rising to 3.03 for those with weekly occurrences (P for linear trend < .0001).
“Those with weekly nightmares had threefold higher risk for premature death,” showing again that the higher the frequency, the higher the adverse outcome was, said Otaiku.
In the UK Biobank cohort, 51 premature deaths were recorded over the 2-year follow-up period. The HRs for premature mortality were 1.43 for monthly distressing dreams and 2.65 for weekly occurrences compared with less than monthly (P for linear trend = .004).
In addition, 34.2% of the association between distressing dreams and mortality was accounted for by aging, Otaiku noted.
After adjusting for genetic, environmental, and lifestyle factors, distressing dreams remained significantly associated with cellular and organismal aging and premature mortality risk (P for linear trend for all, <.05).
“Strikingly, the effect size of frequent nightmares was greater than that of current smoking, obesity, and hypertension combined,” Otaiku said.
“The associations were independent of and stronger than traditional risk factors for aging and mortality — and are unlikely to be explained by reverse causality,” he added.
Otaiku noted that it could be the accelerated aging that explains the link between distressing dreams and later development of neurodegenerative diseases. He added that future studies are now needed into whether treatment of these dreams could reduce the risk for mortality.
‘Awesome, Interesting’ Research
During the post-session Q&A, an audience member noted that patients often report more frequent or intense nightmares after starting certain medications and asked whether Otaiku had examined the impact of specific drug classes.
Otaiku responded that his study included access to medication data, and he controlled for the use of antidepressants, antipsychotics, and antihypertensives such as beta-blockers.
“Even when I controlled for these in my analyses, nightmares were independently linked to these outcomes. Individuals with nightmares do report more psychotropic medication use, but the link between nightmares and these outcomes is independent of their use,” Otaiku said.
Session moderator Anne M. Morse, DO, Geisinger Medical Center, Danville, Pennsylvania, described the study as “awesome and so interesting.”
“It definitely made me start to think about whether or not there could be any orexigenic link [involved] just because we see nightmare disorders so frequently in narcolepsy and conditions like that,” Morse said.
Orexin is a neuropeptide thought to contribute to the regulating and maintaining of sleep/wakefulness states.
Otaiku reported no relevant financial relationships. Morse reported several financial disclosures, including serving as a consultant and/or on a Scientific Advisory or Data Safety Monitoring Board for companies such as Jazz Pharmaceuticals, Avadel Pharmaceuticals, Harmony Biosciences, Alkermes, Takeda, and Eisai.