The argument rests on a striking mismatch between how clinicians are trained and how most of the world actually experiences sleep. Contemporary sleep medicine remains overwhelmingly grounded in biomedical models that treat sleep as a physiological process to be measured and corrected. Yet the authors point out that dreams, nightmares, sleep paralysis, and nocturnal visions have historically been interpreted through spiritual, moral, existential, and cultural frameworks worldwide. These interpretations are not relics of a distant past. They continue to shape how billions of people understand what happens to them at night, how distressed they become when sleep goes wrong, and whether they ever seek help from a physician at all.

The scale of the phenomenon is difficult to dismiss. According to data cited in the editorial, approximately 75.8 percent of the world’s population is affiliated with a religious tradition, and even among the nearly one-quarter of people who are religiously unaffiliated, many still identify as spiritual or hold spiritual beliefs and practices. Sleep-related spiritual experiences, far from being rare curiosities, appear to be commonplace. In the United States, 53 percent of adults report dreams or other experiences involving deceased loved ones. In Brazil, a nationwide study found that 70 percent of respondents reported at least one precognitive dream. Out-of-body experiences, including those occurring during sleep or in the fragile transitions between sleep and wakefulness, have been reported by up to 20 percent of the population. For many people, these experiences are meaningful or even comforting. But when individuals lack cultural, spiritual, or social frameworks through which to interpret them, the same experiences can become sources of significant distress that drive them into clinics and sleep labs.

Mainstream psychiatry has already begun to respond. In 2025, the American Psychiatric Association expanded the DSM-5-TR code Z65.8, formerly labeled Religious or Spiritual Problem, to Moral, Religious, or Spiritual Problem. The change formally recognizes that moral and spiritual distress or conflict can be clinically significant and worthy of clinical attention, without pathologizing them as psychiatric disorders. The authors argue that this shift is directly relevant to sleep medicine, because a growing body of evidence links trauma exposure, moral injury, and spiritual distress with nightmares, hyperarousal, and insomnia symptoms. A veteran wrestling with moral injury, for example, may present to a sleep clinic with severe nightmares and fragmented sleep, while the underlying spiritual wound remains unexamined and untreated.

Religion and spirituality are also increasingly understood as determinants of sleep health in their own right. The editorial reviews studies reporting associations between religious service attendance, positive religious coping, and spiritual well-being on one hand, and better sleep quality and longer sleep duration on the other. Conversely, religious struggle, spiritual distress, religious doubt, and guilt have been linked to poorer sleep outcomes. The proposed mechanisms are not vague appeals to the ineffable. The authors describe plausible pathways including enhanced coping resources, greater resilience to stress, reduced neural reactivity to negative emotional stimuli, and neurobiological correlates associated with lower risk of depression and improved emotional regulation. In other words, the way people find meaning, hope, and community may leave measurable traces in the stress physiology and emotional regulation systems that govern sleep.

Cross-cultural research makes the case even more vivid. Among Māori communities in Aotearoa, New Zealand, qualitative research conceptualizes sleep as a spiritually significant state in which the wairua, or spirit, awakens, journeys, learns, and provides guidance for waking life. In several African cultural traditions, dreams may be interpreted as sources of guidance, prophecy, or spiritual influence, shaping how sleep disturbances are understood. Among Yoruba communities in Nigeria, nightmares and dreams may be interpreted as manifestations of witchcraft. The authors emphasize that such beliefs are not confined to any single population; they represent a common way that human beings make meaning of sleep. The clinical risk arises when experiences such as sleep paralysis, sensed presence, or vivid dream encounters are interpreted outside their cultural and spiritual context, leading to unnecessary pathologization or stigma.

What would spiritually sensitive sleep care actually look like in practice? The authors are careful to draw boundaries. Integrating spirituality into sleep medicine does not require clinicians to endorse religious beliefs, nor does it involve pastoral counseling or proselytizing. Instead, it involves recognizing when existential, spiritual, or cultural frameworks meaningfully shape a patient’s sleep experiences, distress, coping, and treatment engagement. One practical tool is the spiritual history, a brief evaluation of a patient’s spiritual needs during the clinical encounter, which can surface concerns relevant to sleep health and guide appropriate follow-up and referral. Educational initiatives such as the Interprofessional Spiritual Care Education Curriculum, known as ISPEC, already provide clinicians with training and competencies to address patients’ spiritual needs in clinical settings, and the editorial suggests such frameworks could extend into sleep medicine training.

Institutional models already exist. The Veterans Affairs health system in the United States has integrated spiritual care through interdisciplinary teams that include chaplains, offering support grounded in deep listening, presence, and person-centered care. Related initiatives, such as military spiritual fitness programs, reflect growing institutional recognition that meaning, values, and purpose are components of resilience, well-being, and readiness. Moreover, many patients actively want to discuss spiritual concerns with their clinicians, a preference that current sleep medicine practice rarely accommodates. On the therapeutic side, randomized clinical trials have demonstrated the efficacy of integrating spiritual practices into cognitive-behavioral interventions, suggesting a natural application for behavioral sleep medicine, where cognitive-behavioral therapy for insomnia already stands as the first-line treatment.

The editorial arrives at a moment when medicine more broadly is pivoting toward precision and person-centered care. The National Center for Complementary and Integrative Health has championed Whole Person Health, a biopsychosocial-spiritual framework that recognizes physical, mental, social, and spiritual dimensions of health as interconnected and collectively capable of shaping outcomes relevant to sleep. The authors frame their message as a call to action: greater attention to the influence of religion and spirituality on the practice of sleep medicine could strengthen the therapeutic alliance, improve culturally and spiritually responsive care, and advance more holistic approaches to sleep health. The work was supported in part by the Intramural Research Program of the National Institutes of Health, and the authors note that the findings and conclusions are their own and do not necessarily reflect the views of the NIH.

For a field built on actigraphy, CPAP machines, and sleep diaries, the proposal may seem like an unlikely revolution. But the underlying logic is pragmatic rather than mystical. If three out of four people on Earth belong to a religious tradition, if half of American adults dream of deceased loved ones, and if spiritual distress is now a recognized diagnostic category linked to nightmares and insomnia, then a sleep medicine that ignores these realities is missing information that shapes diagnosis, communication, and treatment adherence. The editorial does not ask clinicians to become theologians. It asks them to ask better questions, to listen for the frameworks through which patients already understand their nights, and to treat the sleeping person not merely as a nervous system to be regulated, but as a whole human being for whom sleep may carry meanings that science is only beginning to measure.

Subject of Research: Integrating spirituality and religion into whole-person, person-centered sleep medicine

Article Title: The need to integrate spirituality into sleep medicine as a dimension of whole-person, person-centered care

Article References: Singh, R., Puchalski, C. M., Moreira-Almeida, A., Merry, B., Rosmarin, D. H., Koenig, H. G., & Jackson, C. L. (2026). The need to integrate spirituality into sleep medicine as a dimension of whole-person, person-centered care. Journal of Clinical Sleep Medicine, 22(1), Article 135. https://doi.org/10.1007/s44470-026-00137-0

Image Credits: AI Generated

DOI: 10.1007/s44470-026-00137-0

Keywords: sleep medicine, spirituality, religion, whole-person care, dreams, sleep paralysis, moral injury, insomnia, spiritual care, DSM-5-TR, cultural psychiatry, person-centered care