Q&A with Carlos H. Schenck, M.D., sleep and dream researcher and author from the Minnesota Regional Sleep Disorders Center and the University of MN.
- What is the importance of dreams to sleep?
Although the recall of dreams is not necessary for obtaining optimal quality of sleep, for many people dreaming can be very beneficial for the sheer enjoyment of them (especially interesting dreams in vivid color and rich sound: some people describe their dream experiences as being similar to going to a movie theater), or to solve problems. Also, since most people have around 4 cycles a night of Rapid-Eye-Movement (REM) Sleep, which is the sleep stage with the most prolonged and vivid dreaming with plot development, most sleep and dream researchers believe that the vast majority of people do dream, even if some people cannot recall their dreams.
2. What are symptoms of dream based sleep disorders?
There are several dream-based sleep disorders that are mainly related to REM sleep: A) REM sleep behavior disorder, in which there is simultaneous enactment of vivid dreams that usually are confrontative and combative, and can result in injury to the dreamer and/or bed partner. B) Nightmare Disorder (recurrent nightmares, i.e. unpleasant dreams that cause distress for the dreamer upon awakening, and at times also during the daytime). C) Sleep paralysis (SP), in which there is muscle paralysis, which at times is associated with dreaming during the transition from being asleep to awakening, or during the transition from being awake to falling asleep. SP can sometimes occur with Hypnagogic Hallucinations or Hypnopompic Hallucinations, which are vivid and usually frightening dream-like hallucinations in the transition from being awake to falling asleep, or in the transition from being asleep to awakening. These abnormal experiences are often present in the primary sleep disorder of Narcolepsy, in which there is excessive daytime sleepiness and sleep attacks, at times associated with the sudden-onset of dreaming. D) Dream-interruption insomnia in which there is an awakening after a dream episode during REM sleep that at times can be prolonged and that can be repeated during some or most of the approximate 4 REM sleep periods during the night. E) Adult Sleepwalking and Sleep (Night) Terrors that arise from the deepest stages of Non-REM sleep can be associated with dreaming or fragments of dreams, which usually have less plot development than REM sleep dreams (normal dreams, or dreams found in the disorders described above).
3. What should someone do to get treatment for dream related sleep disorders?
Is there non-pharma therapy available? Being evaluated by a sleep expert is the necessary first step to determine the diagnosis. A sleep laboratory study is necessary for diagnosing REM sleep behavior disorder, for which medication is the most effective therapy. In general, medications are the first-line therapy of SP and Hypnagogic/Hypnopompic Hallucinations, although specialized cognitive-behavioral therapies may be effective, which may also be used for dream-interruption insomnia. A behavioral sleep specialist could be consulted for these latter conditions. Sleepwalking and sleep terrors can be managed by non-pharmacologic therapies, such as hypnosis, stress management, cognitive-behavioral therapy, with medication reserved for the most severe cases or to otherwise treatment-resistant cases.
4. General statement about sleep, quality of life, and/or impact when someone does not get good restorative sleep.
Sleep is a “24/7” phenomenon, which means that regularly obtaining a sufficient quantity and a good quality of sleep will enhance most aspects of cognitive/behavioral/emotional/interpersonal functioning during the daytime waking hours–i.e. enhance the quality of a person’s life. On the other hand, a person who does not usually obtain good restorative sleep will experience adverse effects in the same domains of functioning just described–and will experience many negative consequences from sleep deprivation and poor quality of sleep.
5. Quote: is there specific words, phrase, or subject that you would like to be quoted?
“Everyone with poor sleep should honestly assess their lifestyle and daily habits, including the use and timing of caffeine and alcohol, evening activities, and the presence of stress in their lives, in order to identify what can be modified or changed in order to obtain better sleep. Consultation with the primary care doctor can be useful (to review medications and any medical disorders that could have a negative impact on sleep), along with a referral to a sleep specialist, including a behavioral sleep specialist, or counselor for stress management therapy. People should not have to live with poor sleep. Also, primary sleep disorders, such as REM sleep behavior disorder or Narcolepsy, can affect people who can have normal and health-promoting lifestyles. These people should not unnecessarily “guilt-trip” themselves for having done something wrong, when in fact they have a primary sleep disorder.
6. Any other information, statistics, or references to studies that you would like to include?
The National Sleep Foundation in the United States has a lot of useful information on its website.