Massey Research Online - Browsing by Author "Gibson R"

Browsing by Author "Gibson R"

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Balancing sleeping with guardianship: narratives of sleep during informal dementia care
(Bristol University Press and Policy Press, 2024-02-01) Gibson R; Helm A; Ross I; Gander P; Breheny M
Sleep has been recognised as compromised in dementia care. This study aims to represent the experiences and needs of informal carers via sleep-related accounts. Retrospective interviews were conducted with 20 carers concerning sleep changes across the trajectory of dementia care. Key interactive narratives were around: ‘sleep as my sacrifice’; tensions between identities of being a ‘sleeper’ versus ‘guardian’; and ‘sleep as a luxury’. Maintaining healthy sleep and preferable sleep practices is challenging while balancing the responsibilities of dementia-related care. Acknowledging sleep as a sociological practice enables a greater understanding of carers’ nuanced experience and support needs.
Characteristics of atypical sleep durations among older compared to younger adults: Evidence from New Zealand Health Survey
(Oxford University Press on behalf of The Gerontological Society of America, 2023-02-02) Gibson R; Akter T; Jones C; Towers A
BACKGROUND: Understanding and supporting sleep is important across the lifespan. Disparities in sleep status are well documented in mid-life but under-explored among older populations. METHODS: Data from 40,659 adults pooled from the New Zealand Health Surveys was used; 24.2% were 'older adults' (aged ≥65 years), 57% were female, and 20.5% of Māori ethnicity). 'Long', 'short', or 'typical' sleep categories were based on age-related National Sleep Foundation guidelines. Multinomial logistic regression examined predictors of atypical sleep, including sociodemographic characteristics, lifestyle factors, and health status. RESULTS: Prevalence of short and long sleep among older adults was 296 (3.0%) and 723 (7.4%), respectively. Correspondingly, prevalence among younger adults was 2521 (8.2%) and 364 (1.2%). Atypical sleep was more significantly associated with indicators of reduced socioeconomic status and ethnicity among younger rather than older adults. Within both age groups, lower physical activity was associated with long sleep status. Higher physical activity and smoking were related to short sleep status among younger adults only. Within both age groups, atypical sleep was associated with SF-12 scores indicating poorer physical and mental health. Having ≥3 health conditions was related to short sleep among the older adults, while for young adults, it was related to both atypical durations. CONCLUSIONS: Indicators of negative lifestyle and health factors remain consistent predictors of atypical sleep with ageing. However, demographic disparities are less apparent among older atypical sleepers. This study highlights individual and contextual factors associated with atypical sleep patterns which may be important for age-appropriate recognition and management of sleep problems.
Daytime fatigue as a predictor for subsequent retirement among older New Zealand workers
(Elsevier Inc on behalf of National Sleep Foundation, 2021-12) Myllyntausta S; Gibson R; Salo P; Allen J; Gander P; Alpass F; Stephens C
Objectives There is limited information on the role of fatigue on retirement, either independently or in association with poor sleep. The aim of this study was to examine the prospective association between daytime fatigue, measured as feeling tired or feeling worn out, independently and in relation to dissatisfaction with sleep, and subsequent retirement among 960 older workers in New Zealand. Methods Data from 2 consecutive surveys (2008 and 2010) of the New Zealand Health, Work, and Retirement Longitudinal Study were used. Poisson regression was used to investigate whether feeling tired and feeling worn out in 2008, along with dissatisfaction with sleep, were associated with self-reported retirement either due to health reasons or other reasons by 2010. Results The risk for retirement due to health reasons during a 2-year follow-up was 1.80-fold (95% confidence interval [CI] 1.16-2.45) among those who felt tired and 1.99-fold (95% CI 1.34-2.64) among those who felt worn out when compared to those not tired or not feeling worn out after adjusting for several sociodemographic, work characteristics and self-rated health. The risk for retirement due to health reasons was even higher when participant experienced both tiredness and feeling worn out. Dissatisfaction with sleep did not predict retirement due to health or other reasons. Conclusions Our results highlight that workers at risk of subsequent retirement due to health reasons may be identified with rather simple questions on tiredness and feeling worn out even among generally healthy older workers.
Estimating direct N2O emissions from sheep, beef, and deer grazed pastures in New Zealand hill country: accounting for the effect of land slope on N2O emission factors from urine and dung
(Elsevier, 2015-03) Saggar SK; Giltrap DL; Davison R; Gibson R; de Klein CAM; Rollo M; Ettema P; Rys G
Nearly one-half of New Zealand's ruminant livestock graze on hill country pastures where spatial differences in soil conditions are highly variable and excretal deposition is influenced by pasture production, animal grazing and resting behaviour that impact the nitrous oxide (N2O) emission factor from excreta (EF3). New Zealand currently uses country-specific EF3 values for urine and dung of 0.01 and 0.0025, respectively, to estimate direct N2O emissions from excreta. These values have largely been developed from trials on flat pastoral land. The use of the same EF3 for hill pasture with medium and steep slopes has been recognised as a possible source of overestimation of N2O emissions in New Zealand. The objectives of this study were to develop and describe an approach that takes into account the effects of slope in estimating hill country N2O emissions from the dung and urine of ruminant animals (sheep, beef cattle, and deer) across different slope classes, and then compare these estimates with current New Zealand inventory estimates. We use New Zealand as a case study to determine the direct N2O emissions between 1990 and 2012 from sheep, beef cattle and deer excreta using updated estimates of EF3 for sloping land, the area of land in different slope classes by region and farm type, and a nutrient transfer model to allocate excretal-N to the different slope classes, and compare the changes between these hill pastures-specific and current inventory estimates. Our findings are significant - the proposed new methodology using New Zealand specific EFs calculated from a national series of hill country experiments resulted in 52% lower N2O estimates relative to using current inventory emission factors, for the period between 1990 and 2012 and reduces New Zealand's total national agricultural N2O greenhouse inventory estimates by 16%. The improved methodology is transparent, and complete, and has improved accuracy of emission estimates. On this basis, the improved methodology of estimating N2O emission is recommended for adoption where hill land grasslands are grazed by sheep, beef cattle and deer.
Examining the structure validity of the Pittsburgh Sleep Quality Index among female workers during New Zealand's initial COVID-19 lockdown.
(Springer Nature, 2024-04) Helles M; Fletcher R; Münch M; Gibson R
Sleep is important for good physical and mental health. The COVID-19 pandemic lockdown created a unique context that impacted psychological and social drivers for sleeping well. The Pittsburgh Sleep Quality Index (PSQI) is a widely used measurement tool assessing subjective sleep quality. The traditional model of the PSQI (a one-factor model), whilst validated and used across different populations, has also been questioned with regards to data fit and representativeness of its global score in different social and work-related circumstances. Examination of the structure validity of the PSQI in the unique context of the pandemic has been scarce. This study determined the PSQI structure validity amongst employed women considered to experience increased stressors during the pandemic lockdown. The subjectively reported PSQI data from 498 female workers (mean age 44.6 years) collected during New Zealand's first national COVID-19 lockdown (April, 2020) was used. Confirmatory factor analyses compared the original one-factor model of the PSQI with the two- and three-factor models used by Jia et al. (2019) within this pandemic context. Results showed that the two-factor model provided a superior fit of the PSQI data compared to the original one-factor or a three-factor model. These findings suggest that a sub-score of the PSQI with two factors appears to be better at describing the sleep quality of healthy working women during the constrained situation of the pandemic lockdown compared to a single global sleep quality score. This indicates the importance of considering the validity of subjective sleep measures when used within unique social contexts and stressors.
Exploring older care recipients' sleep status as a predictor for informal carer distress: evidence from New Zealand's interRAI home care assessment data.
(BMJ Publishing Group, 2023-10-24) Gibson R; Abey-Nesbit R; Gander P; Parsons M
OBJECTIVES: Understanding factors affecting informal carers' well-being is important to support healthy ageing at home. Sleep disturbances of care recipients are increasingly recognised as affecting the well-being of both parties. This research assesses the relationship between indicators of care recipients' sleep status and carer distress, as well as carer distress with subsequent admission to residential aged care, using prospectively collected Home Care International Residential Assessment Instrument (interRAI-HC) assessment data. PARTICIPANTS: Data were sourced from 127 832 assessments conducted between 2012 and 2019 for people aged 55 years or older who had support from at least one informal carer. The majority (59.4%) of care recipients were female and 59.1% were defined as having cognitive impairment or dementia (CIoD). SETTING: New Zealand. DESIGN: Logistic regression modelling was used to assess the independent relationships between indicators of care recipients' sleep status (difficulty sleeping and fatigue) and primary caregivers' distress (feeling overwhelmed or distressed). Kaplan meier curves illustrated the subsequent relationship between caregiver distress and care recipients' transitions to aged residential care. RESULTS: Care recipients' sleeping difficulty (32.4%) and moderate-severe fatigue (46.6%) were independently associated with caregiver distress after controlling for key demographic and health factors included in the assessment. Distress was reported by 39.9% of informal caregivers and was three times more likely among those supporting someone with a CIoD. Caregiver distress was significantly associated with care recipients' earlier admission into aged residential care. CONCLUSIONS: Indicators of sleep disturbance among care recipients are associated with increased likelihood of carer distress. This has implications for managing the overall home-care situation and long-term care needs, as well as the well-being of both parties. Findings will inform research and development of measures, services and interventions to improve the sleep and waking health of older people, including those with CIoD and family caregivers.
From diagnosis to long-term management: the experiences of older New Zealanders with obstructive sleep apnoea
(Royal New Zealand College of General Practitioners, 28/06/2018) Gibson R; Campbell A; Mather S; Neil A
INTRODUCTION: In New Zealand (NZ), access to public sleep services is limited to people deemed with the highest need. The prevalence of obstructive sleep apnoea (OSA) increases with age, but the symptoms and the treatment pathway is expected to differ for older compared to younger patients. This study explored the experience of older people regarding diagnosis and treatment services for OSA in order to inform considerations required in primary health and sleep services. METHODS: Patients who were initiated on Continuous Positive Airway Pressure (CPAP) therapy at the age of 65 years or older were invited to one of three 1.5-h focus group discussions. In total, 16 patients attended; nine were accompanied by their spouse or partner. Discussions were semi-structured and explored experiences with the OSA pathway, from diagnosis through to long-term management. RESULTS: Thematic analysis highlights the key symptoms of OSA. Patients’ experiences with diagnostic and treatment services were generally positive. However, there was an overarching need for greater knowledge and follow up regarding OSA and CPAP therapy. Most patients were happy with CPAP treatment. Issues associated with long-term use, comfort and daily management were highlighted, and strategies used to overcome them discussed. DISCUSSION: Focus groups reported similar experiences, positively endorsing the health value of OSA diagnosis and CPAP therapy. Mechanisms and resources are required at a primary healthcare level in order to raise awareness around sleep and aging, OSA and CPAP. This would aid earlier and more appropriate diagnosis and management of OSA and help overcome some of the gaps identified in this study.
Improving continence management for people with dementia in the community in Aotearoa, New Zealand: Protocol for a mixed methods study.
(Public Library of Science (PLoS), 2023-07-18) Burholt V; Peri K; Awatere S; Balmer D; Cheung G; Daltrey J; Fearn J; Gibson R; Kerse N; Lawrence AM; Moeke-Maxwell T; Munro E; Orton Y; Pillai A; Riki A; Williams LA; Harding A
BACKGROUND: The number of people living with dementia (PLWD) in Aotearoa New Zealand (NZ) was estimated at 96,713 in 2020 and it is anticipated that this number will increase to 167,483 by 2050, including an estimated 12,039 Māori (indigenous people of NZ) with dementia. Experiencing urinary incontinence (UI) or faecal incontinence (FI) is common for PLWD, particularly at the later stages of the disease. However, there is no robust estimate for either prevalence or incidence of UI or FI for PLWD in NZ. Although caregivers rate independent toilet use as the most important activity of daily living to be preserved, continence care for PLWD in the community is currently not systematised and there is no structured care pathway. The evidence to guide continence practice is limited, and more needs to be known about caregiving and promoting continence and managing incontinence for PLWD in the community. This project will seek to understand the extent of the challenge and current practices of health professionals, PLWD, caregivers and family; identify promising strategies; co-develop culturally appropriate guidelines and support materials to improve outcomes; and identify appropriate quality indicators so that good continence care can be measured in future interventions. METHODS AND ANALYSIS: A four-phase mixed methods study will be delivered over three years: three phases will run concurrently, followed by a fourth transformative sequential phase. Phase 1 will identify the prevalence and incidence of incontinence for PLWD in the community using a cohort study from standardised home care interRAI assessments. Phase 2 will explore continence management for PLWD in the community through a review of clinical policies and guidance from publicly funded continence services, and qualitative focus group interviews with health professionals. Phase 3 will explore experiences, strategies, impact and consequences of promoting continence and managing incontinence for PLWD in the community through secondary data analysis of an existing carers' study, and collecting new cross-sectional and longitudinal qualitative data from Māori and non-Māori PLWD and their caregivers. In Phase 4, two adapted 3-stage Delphi processes will be used to co-produce clinical guidelines and a core outcome set, while a series of workshops will be used to co-produce caregiver resources.
"It's Just [Complicated] Sleep": Discourses of Sleep and Aging in the Media.
(Oxford University Press, 2023-12) Breheny M; Ross I; Ladyman C; Signal L; Dew K; Gibson R
The media are influential in shaping beliefs and attitudes on aging and health-related behaviors. Sleep is increasingly recognized as a key pillar for healthy aging. However, the role of media representations of sleep is yet to be assessed with regard to discourses of aging. Texts from New Zealand's main free online news source were collated using key words "sleep" together with "aging," "older," "elderly," or "dementia" between 2018 and 2021. Contents of 38 articles were interpreted using critical discourse analysis. Discursive constructions described an inevitable decline of sleep with aging, including impacts of both physiological decline and life stage transitions; sleep's role as both a remedy and risk for ill health and disease; and the simplification of solutions for self-managing sleep juxtaposed alongside recognition of its complexity. The audience of these complex messages is left in the invidious position of both pursuing sleep practices to prevent age-related decline, whilst also being told that sleep degradation is inevitable. This research demonstrates the complexity of media messaging and the fraught options it offers: good sleep as both a reasonable achievement to strive for and as impossibly idealistic. Findings mirror two predominant health identities available to older people, as responsible for resisting aging or as falling into inevitable decline. This reveals additional expectations around appropriate time use and behaviors with aging. More nuanced messaging that goes beyond sleep as a resource for health and waking productivity is recommended. Acknowledging the complexity of sleep, aging, and society could be the starting point of such adaptation.
Kei te moe te tinana, kei te oho te wairua–As the body sleeps, the spirit awakens: exploring the spiritual experiences of contemporary Māori associated with sleep
(Informa UK Limited, trading as Taylor & Francis Group, 2024-08-13) Haami D; Gibson R; Lindsay N; Tassell-Matamua N
For Aotearoa New Zealand Māori, sleep and wairua (spirit) are closely intertwined. During sleep the wairua awakens and journeys across multiple dimensions of time and space to attain the tools and knowledge the individual needs to navigate waking life. While this function of sleep is understood within Mātauranga Māori (bodies of knowledge regarding everything within the universe) (Hikuroa D. 2017. Mātauranga Māori—the ūkaipō of knowledge in New Zealand. Journal of the Royal Society of New Zealand. 47(1):5–10.), it has yet to be explored within psychological sleep research. This qualitative study contributes to addressing this gap by exploring nine Māori participants’ personal experiences of wairua during sleep. A whakapapa thematic analysis identified two interconnected layers. The first layer contributed to a spiritual explanatory framework for sleep, developed to encompass participants’ beliefs regarding wairua, which were utilised to interpret their sleep experiences. The second layer describes these interpretations, comprised of three central themes: (1) Tohu/Guidance; (2) Ako/Space and time for learning; and (3) Tau/Attaining a state of stability, peace, and purpose. These findings suggest that the spiritual experience of sleep supported participants in navigating their waking lives safely, purposefully, and meaningfully, contributing to Indigenous and Māori scholarship regarding the spiritual and cultural purpose of sleep, and with important implications for clinical, social, and academic approaches to understanding and supporting sleep.
Non-pharmacological interventions a feasible option for addressing dementia-related sleep problems in the context of family care
(BioMed Central Ltd, 2021-05) Gibson R; Dowell A; Jones L; Gander P
Background Sleep disturbances are challenging symptoms associated with mild cognitive impairment or dementia (MCIoD). This study assessed the feasibility of sleep monitoring and non-pharmacological interventions to improve the sleep of New Zealanders with MCIoD and their family carers. Methods A 5-week multi-modal intervention consisting of timed bright light therapy, physical activity, and sleep education was piloted. Sleep was monitored for a week at baseline and conclusion of the trial using actigraphy, diaries, and questionnaires alongside additional health and wellbeing information concerning both care recipients and carers. Results Fifteen pairs participated, 9 completed the trial. Patterns of attrition and participant feedback are discussed. Case studies showed that six of the care recipients had minor improvements to sleep efficiency. Some also had improved subjective sleep ratings and quality of life. Changes did not clearly translate to family carers. However, five of them also showed some improvements in sleep status and mental health. Health deterioration of care recipients may mask the effects of the intervention. Conclusions It is feasible to use non-pharmacological sleep interventions for people with MCIoD and their family carers. Given the limited treatment options, further consideration of such interventions in future research and clinical practice is warranted. Trial registration As this study was to assess the feasibility of proposed methods, it was an observational study without case-control groups nor a medical-based intervention, clinical registration was not required. A future full version of the trial would be registered with the Australian New Zealand Clinical Trails Registry.
Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand.
(BioMed Central Ltd, 2022-03-16) Lord S; Teh R; Gibson R; Smith M; Wrapson W; Thomson M; Rolleston A; Neville S; McBain L; Del Din S; Taylor L; Kayes N; Kingston A; Abey-Nesbit R; Kerse N; AWESSoM Project Team
Background Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanāu (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing. Methods Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whānau (family) centred initiative (Ngā Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum. Discussion AWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age. Trial registration The At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875).
Sleep as a social and cultural practice in Aotearoa: a scoping review
(Taylor and Francis Group, 2024-09-22) Ross I; Signal L; Tassell-Matamua N; Meadows R; Gibson R
Traditionally, sleep science is grounded in biology, physiology, and medicine. But socio-cultural considerations provide a crucial lens into sleep health. Exploring the sociology of sleep in Aotearoa New Zealand (AoNZ) could broaden our understandings and better represent sleep-related practices among our diverse communities. This scoping review represents the pre-existing literature concerning sleep as a social or cultural practice in AoNZ. The initial search (via Discover and Scopus) search yielded 2,442 results. Of these results, 113 manuscripts were characterised of interest, but only 20 were directly related and included in the review. This literature was presented in relation to Meadows’ (2005) modes of ‘sleep embodiment’ including sleep practice norms, the pragmatics of sleep and social roles, individual experiences and feelings related to sleep, and the visceral need for sleep. The findings highlight the progress of sleep literature in AoNZ. This covers diverse sleep practices, perspectives and experiences of sleep and sleeping, as well as the broader socio-cultural factors and unique AoNZ context that influence sleep. However, gaps in the field of local sleep research are also identified. Findings lay the foundation for further research in AoNZ to explore sleep-related discourses and practices that will ultimately broaden existing perspectives.
Sleep health in later life: Interviews exploring experiences, attitudes and behaviours of older people
(Cambridge University Press, 21/04/2022) Crestani F; Williams G; Breheny M; Tupara H; Cunningham C; Gander P; Gibson R
Sleep is vital for health and wellbeing across the lifecourse. Ethnic differences have been observed with regards to the prevalence and predictors of self-reported sleep problems. An understanding of sleep experiences with ageing and across ethnicities is required to better support older people. Open-ended interviews were conducted with 23 people living in Aotearoa/New Zealand aged 61-92 years (12 MAori and 11 non-MAori) concerning current sleep status, changes over their lifecourse and personal strategies for supporting good sleep. Participants typically expressed satisfaction with current sleep (usually pertaining to duration) or feelings that sleep was compromised (usually pertaining to waking function). Comparisons to a socially perceived 'ideal' sleep were common, with sleep transitions presented as a gradual and accepted part of ageing. Participants resisted medicalising sleep disruptions in older age. While participants were aware of ways to enhance their sleep, many acknowledged engaging in practices that undermined it. Unique insights from some MA ori participants indicated that sleep disruptions were not so readily pathologised compared to Western views and that sleeplessness could provide opportunity for cultural or spiritual connection. Common narratives underpinning the themes were: 'You don't need as much sleep when you're older', 'Sleep just fits in' and 'Having the time of my life'. Findings provide personal experiences and cultural interpretations relating to sleep and ageing. This provides the foundation for future participatory research to co-design sleep health messages which are meaningful for ageing well across ethnicities.
Sleeping in a bubble: factors affecting sleep during New Zealand’s COVID-19 lockdown
(Oxford University Press on behalf of Sleep Research Society, 2022-05-16) Gibson R; Shetty H; Carter M; Münch M
New Zealand (NZ) enforced a rigorous lockdown in response to the outbreak of COVID-19 in 2020. Infection rates remained remarkably low, yet social and personal routines were affected. Factors associated with reporting worsening sleep were explored using an anonymous online survey launched during New Zealand’s 2020 lockdown. Participants were 723 adults aged 20–85 years (median: 45 years, 82% women). Bed and wake times occurred significantly later compared to pre-lockdown estimates and resulted in shorter social jetlag (15 min). During lockdown, 54.5% were identified as “poor sleepers” [i.e. score > 5 on the Pittsburgh Sleep Quality Index (PSQI)]. Overall, 45% rated their sleep quality to worsen compared to pre-lockdown, 22% reported an improvement. Reports of worsening sleep were significantly related to increased sleep latency, reduced sleep efficiency, and heightened PSQI scores compared to those with better sleep or no change. Subjectively worse sleep was significantly associated with less time engaging in physical activity, less exposure to daylight, and social interactions compared to pre-lockdown estimates (p < .05). Logistic regression models identified significant relationships between having more vivid dreams and worsening sleep. Worse sleepers also had increased likelihoods of reporting poorer mood and they also scored higher for anxiety compared to those with no change or improved sleep during lockdown (p < .05). Pandemic-related restrictions contributed to poorer self-reported sleep which was linked to deterioration of mood. Negative affect was comparatively lower than reported elsewhere. These findings provide unique insights to the psychosocial impact of the initial COVID-19 lockdown in New Zealand, where the disease outbreak remained low.
Trauma or Transcendence? The Relationship Between Near-Death Experiences and Dreaming
(American Psychological Association, 2024-08-01) Lindsay N; Tassell-Matamua N; O'Sullivan L; Gibson R
Near-death experiences (NDEs) are exceptional states of consciousness reported by many individuals who come close to death. Unusual dream phenomena such as more intense and vivid dreams, higher dream recall, and increased lucid dreaming have been purported to occur after NDEs, however, a comprehensive assessment of the dream experiences and attitudes of NDE survivors remains unexplored. Moreover, it remains unknown whether anomalous dream experiences stem from the actual NDE or the traumatic experience of coming close to death. In this study, 138 NDE survivors, 45 participants who experienced a life-threatening event but without NDE, and 129 participants who had never come close to death completed a quantitative questionnaire assessing trauma symptoms and a range of dream-related variables. The NDE group reported significantly more lucid dreams, creative and problem-solving dreams, precognitive dreams, and out-of-body experiences during sleep than both other groups of participants. Furthermore, these experiences appeared to be primarily related to the NDE rather than trauma symptomology. Findings continue to suggest a relationship between nonordinary states and expanded awareness more broadly—whether experienced during sleep or wakefulness—offering further insights into the phenomenon of consciousness in general.

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