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Sleep Disorders

Vivid Dreaming

01/20/2009

Question:

I have always dreamt a lot, always in colour, usually vividly and sometimes I can lucid dream. However, since having my first baby 4 months ago my dreaming has gone from a couple of times a week to every night without fail. I am so tired - even with a good baby who sleeps through the night and has since being 2 weeks old. The baby sleeps in our room, though isn`t any trouble really, once asleep that`s more or less it. Because of sharing the room it`s kept dark and at the optimum temp for the baby.

My dreams are often adventurous, dangerous and physically demanding. Sometimes I recall familiar details from a book I`ve read or a programme I`ve seen. I have even dreamt based on comments or something someone has said to me in the day. I don`t class my dreams as nightmares, though I do wake up a lot of the time abruptly from the dream as I`ve fallen off something, I`m being shot at or something`s going to attack - all part of the adventure I`m in. I hardly ever dream of anyone I know. If I do it`s usually a bad dream - something bad towards me involving them. I rarely see the faces, sometimes it bugs me when I wake up as they are familiar to me, but I don`t know who they are. Usually I am everyone in my dreams, I morph characters and this is what makes me so tired as I experience everything, physically and emotionally.

I am having concentration problems, I struggle to watch half an hour of TV, and often forget what I am doing halfway through a task. I feel lethargic all the time, but do try and walk for an hour or so every day. My diet is healthy as getting back into shape after having my baby. I don`t think I have PND, I don`t display any of the symptoms and I am enjoying motherhood. I feel that I am not at my full potential because of the dreams, it`s exhausting. I am now concerned that it won`t ever stop and I`ll never cope with work and a baby in a few months time!

Thank you in advance.

Answer:

First, I would like to define the following two terms, “Excessive dreaming” and “Vivid dreaming”. Excessive dreaming is a feeling that a dream is never-ending. This includes dreaming about activities that are continuous, trivial, or physical in nature such as repetitive housework, or endless walking through snow or water. Most excessive dreaming is devoid of emotions. This is different from vivid dreaming, where there is an abundance of details that carry high emotional burden. In an extreme situation, stressful vivid dreams are described as nightmares. It appears from your question that you may be having vivid dreams, but not necessarily excessive dreams.

Vivid dreaming may be a normal occurrence or a manifestation of a sleep disorder. The classification of vivid dreams as nightmares is often problematic and currently the International Classifications of Sleep Disorders recognizes vivid dreams that are associated with discomfort or unpleasant emotion as nightmares. The recurrence of the vivid dream, the context of the dream, along with the concern the patient feels are all factors that make a recurrent vivid dream more of a nightmare. Based on the information in your question, it sounds as though at least some of your dreams could be classified as nightmares.

Nightmare Disorder usually involves dreams that have a context of threat to the individual’s survival, well being, or self-esteem. These can be disturbing mental experiences and not always are frightening. There is often discomfort, and unpleasant emotion associated with the dream. It is not mandatory that one awakens from sleep for the dream to become a nightmare. However, awakening from sleep with recollection of the dreams occurs frequently. Sometimes a sense of familiarity with the recurrence of the nightmare makes it somewhat less frightening and subsequently this may be behind your characterization of the dreams has not been nightmares. Nightmare disorder is to be distinguished from Night Terrors during which the patient awakens suddenly with fright and does not have any significant recollection of a dream. Nightmare disorders generally occur in the second half of the sleep.

Conditions that may manifest as nightmare disorder include sleep disruption, effects of medications and drugs, mood disorders, and medical conditions. Antidepressants, and a variety of other medications, can promote nightmares by changing the architecture of sleep and increasing the duration of the dreaming stage (REM sleep). Post-traumatic stress disorder, depression and anxiety disorders have similar effects. Additionally, alcohol, and recreational drugs can promote nightmares via different mechanisms. Sleep disorders may cause excessive dream recall or nightmares by disrupting the architecture of sleep and promoting frequent arousals. These disorders include obstructive sleep apnea and periodic limb movements of sleep. In theory, any medical condition that may cause disruption of sleep and subsequently more awakenings and more dream recall can give rise to recollection of dreams and nightmares, including gastroesophageal reflux and arthritic pain. Absent any other identifiable causes of nightmares, the patient is considered as having a “nightmare disorder.”

Another important cause of changes in sleep duration and architecture, along with changes in daytime function, is female hormonal changes. Hormonal effects can have distinct effects during pregnancy, postpartum, menstrual cycles, and menopause. For example, it is reported that during a normal menstrual cycle, women experience more REM sleep (and subsequently more opportunity at dreaming) in the first half of the cycle than in the second half. Intense hormonal changes occur during pregnancy and affect sleep. However, to date, these hormonal effects on sleep have not been well characterized. Some authors have reported increased sleep time in the first trimester followed by gradual reduction in the following two trimesters. The effect of pregnancy on REM sleep is not yet clearly defined. Clearly, factors other than hormones may also play a major role in sleep during pregnancy. These factors include increased abdominal girth, reflux, respiratory disorders, increased upper airway resistance, pain and discomfort. In the postpartum phase, the effect of withdrawal of the high levels of estrogen and progesterone, along with the rise of another hormone, prolactin, may play an important role in lactating women. Unfortunately, the effect of prolactin on sleep has not been adequately evaluated. Another factor that may increase dream sleep after delivery is the relative sleep deprivation that occurs in the 3rd and 4th trimester, giving rise to rebound sleep and rebound REM stage during the immediate postpartum period. As such, the increased sleep or the increased REM sleep may be associated with excessive dreaming.

To better understand your problem, you need a thorough sleep evaluation. This should include a consultation with a Sleep Specialist to determine if your problems with dreaming may resolve as you get farther out from your delivery or if there are other primary sleep disorders that may be present leading to the vivid dreams. For some patients diagnosed with nightmare disorder, a behavioral treatment called imagery rehearsal therapy can be effective and doesn’t require the use of medications. This technique is a cognitive therapy administered by a qualified therapist who instructs patients on way to alter their dream content.

Until you can seek additional help, some general methods that may help you with your dreams include:

Additional information regarding sleep, and a listing of sleep centers near you, is available from the American Academy of Sleep Medicine.

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University