Has COVID-19 disturbed your slumber?

Have you found yourself or your family members experiencing unusual or extra vivid dreams during the COVID-19 pandemic? You are not alone. We talked to Christopher Fahey, M.D., a fellowship-trained, board certified sleep medicine specialist and neurologist, to learn more about our dreams. Dr. Fahey practices in our new Kildeer Outpatient Care Center.

Q: Why do we dream?

Dr. Fahey: We don’t know for sure why we dream. There are many theories as to the purpose of dreaming. There is even a theory that dreams have no “purpose” at all…that they are just random activations of memories and emotions that your brain is trying to make sense of. Some psychological theories proposed by Sigmund Freud suggest that dreams reflect our unconscious mind and that by analyzing dreams we can better understand hidden emotions, anxieties and desires. More modern theories revolve around how dreams strengthen certain types of memories, including semantic (our general world knowledge) and procedural (our ability to understand how to do things). Other theories hold that dreaming is important in terms of the regulation of mood and coping with troubling emotions or thoughts. Some maintain dreaming has primarily a protective function to defend us from potential scenarios that may be harmful for us, which may be why dreams tend to revolve around more negative than positive emotions. Finally, some theories claim that dreaming is important in the creative process, allowing us to make new connections that we don’t seem able to make during the wakeful state.

The important thing to understand is that many of these theories are not mutually exclusive. Dreaming could be important for all of these reasons, some of these reasons or none of them at all.

Q: Does everyone dream?

Dr. Fahey: Most likely everyone does dream. There are some people who report rarely or never dreaming. One study looked at patients with a condition called REM (Rapid Eye Movement) Behavior Disorder, in which people act out and kick during REM sleep, the stage of sleep most commonly associated with dreams. Although some of these patients reported they never dreamed, they physically acted as if they were dreaming, similar to the other patients who did recall dreaming. This may imply that people who don’t report dreams are simply not remembering them, rather than that they don’t exist.

Some studies indicate perhaps up to 95 percent of our dreams are forgotten. Dreams during the latter part of the night, when REM sleep tends to be the longest, are much more likely to be remembered than dreams during earlier REM periods. People who sleep poorly, either in quantity or quality, may be experiencing less REM sleep or shorter REM periods and may be less likely to recall their dreams. There is evidence the content of the dream also plays a role in whether we recall it. More vivid or bizarre dreams are more likely to be remembered than more mundane ones. Finally, certain personality traits may be associated with a higher likelihood of remembering dreams. Those who tend to be more creative may have a higher chance of remembering their dreams compared to those who are more practical.

Q: Do you see a correlation between dreams and the COVID-19 pandemic?

Dr. Fahey: Many people (including myself) have been reporting having dreams that relate to the current pandemic. This may have to do with the saturation of COVID-19 related information; it has been is the lead story on the news and a leading topic of conversation for months now. Further, there is quite a bit of emotional weight behind this shared experience. Many people are worried about their own health and their loved ones’ health, careers and finances, social life and/or the change to their everyday lives. If the purpose of dreaming is to work through this emotional threat, it would be understandable that we are having similar dreams.

As more people are working from home, laid off or furloughed, many are sleeping in longer. We are experiencing those longer REM periods mentioned above and are much more likely to remember these highly emotionally charged dreams.

Q: Can events in our “awake life” affect the content of our dreams?

Dr. Fahey: Absolutely! In fact, dreams most commonly reflect events in a person’s life as well as their memories. Often times, the more emotionally charged the event or memory, the more likely it may be to appear in our dreams. Even seemingly mundane events can also later be incorporated into dreams. One study had participants play the video game Tetris for hours on end and then woke them out of sleep. The majority reported images from the game occurring in their dreams. Interestingly, in this same study, patients who had damage to their memory centers also played the games. These patients also reported dreaming of falling Tetris pieces at the same rate as the other participants with normal memories. However, they had no recollection at all of having played the game!

Q: Why is a consistent sleep schedule important?

Dr. Fahey: We have two processes which help us fall to sleep. One is our homeostatic drive to sleep. This is the process that builds throughout the day. The longer we are awake the sleepier we tend to become. The second process is our circadian drive to sleep. This is our bodies’ internal clock which tells us when the appropriate time to go to sleep is and when the appropriate time to wake is. When our sleep and wake times are erratic, our bodies don’t know which way is up, and it can cause trouble getting to sleep when we want to or feeling sleepy or fatigued during periods when we don’t want to. This may have an impact on our mood, concentration and even our general health.

Q: Why do children seem to be having more nightmares or sleep disturbances?

Dr. Fahey: During the pandemic, children have also had their lives turned upside down, just like adults. Many of them are not going to school during a time where they typically would be, are not seeing their friends or grandparents as often. They may also be experiencing stress regarding their family’s health and their parents’ financial or job situations. This disruption in school and social routine can lead to significant anxiety and subsequent nightmares and disruption of sleep.

Q: What are some healthy habits that might have a positive effect on our dreams?

Dr. Fahey: Lifestyle modifications that encourage good sleep can reduce the likelihood of nightmares and have a positive impact on dreams. This has been demonstrated to be true particularly in children and young adults.

Healthy habits include:

• Keeping a regular sleep-wake time
• Keeping an environment conducive to good sleep (quiet, dark and a lower temperature)
• Exercising regularly (preferably at least four hours prior to bedtime)
• Avoiding caffeine, alcohol or nicotine prior to bedtime
• Avoiding light emitting devices (television, phones, tablets, etc.) for at least one hour before bedtime
• Scheduling ‘worry time’ away from the sleep period, to write down or reflect on what is causing anxiety and to try to work through those worries

If disturbing dreams or nightmares are becoming recurrent and problematic, there is a treatment called imagery rehearsal therapy which can be helpful. This involves writing down the bad dream, then changing the dream to something more positive, then writing this new changed dream down, and then finally rehearsing the new changed dream in one’s mind five to 20 minutes daily.

Rest easy, friends. We are getting through this together!