Question:

I dream excessively every night. The dreams are vivid, like full-length movies that begin as soon as I drift off to sleep and continue right through to morning. Occasionally I have bad nightmares, but not too often. I recall dreaming since I was three years old (I am now 59). I recall only one night during my entire life when I didn`t remember dreaming – when I took a Valium after a very stressful experience. I wake up exhausted, and always have, feeling as though I`ve been “busy” all night. Thank you for any information you can provide.

Answer:

Dreaming is the most intriguing component of normal sleep. Throughout history, dreams were considered as a communication from higher powers or a window to the future. In more recent years, interpretation of dreams has been considered as a way to provide an understanding of the individual personality and tendencies. While none of these concepts has ever proven, dreams and dream recollection remain an area of interest and concern.

Dreaming occurs in a stage of sleep called Rapid Eye Movement (REM) sleep. This stage of sleep recurs several times in a night of normal sleep. Therefore, dreaming occurs every night for most individuals. In contrast, our ability to recall dreams is highly variable and depends on a number of factors. A common cause of dream recall is awakening at a time of sleep that is close to the time of the dream. However, it is not mandatory that one awakens during the night for dream recall to occur. Many individuals report vivid recollection of their dreams in the morning without much sleep disturbance. Some individuals simply have good dream recall and others do not. Sometimes ruminating over dreams and their content and meaning can propagate their recurrence and may create a cycle of recurrent dreams. Of interest, valium, as well many other medications, changes the sleep stages and decreases the occurrence of REM sleep, subsequently decreasing dreaming. Therefore it was normal for you to have less dreaming after taking valium.

When vivid dreams are associated with discomfort, unpleasant emotion, or fear they may be classified as “nightmare disorder.” The recurrence rate of vivid dreams, the context of the dreams, and the concern in the patient that the dreams invoke are all factors that make a recurrent vivid dream more of a nightmare. It is not mandatory that one awakens from sleep for the dream to become a nightmare.

Conditions that may cause excessive dream recall include sleep disruption, effects of medications and drugs, mood disorders, and medical conditions. Hormonal changes in women are also important factors in dream occurrence due to the hormonal effect on REM sleep.

Nightmares can be promoted by the use of certain medications, including antidepressants, by changing the stages 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 stages of sleep and promoting frequent arousals. These disorders include obstructive sleep apnea and periodic limb movement of sleep. Medical disorders that can cause disruption of sleep include gastroesophageal reflux and arthritic pain. Absent any other identifiable causes of nightmares, the patient is considered as having a “nightmare disorder.”

To better understand your problem, you need a thorough sleep evaluation. This should include a consultation with a Sleep Specialist to determine if your if there is a 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:

• Assure comfortable, quiet, cool, and dark sleep environment
• Minimize volitional sleep deprivation, and keep a regular sleep/wake schedule
• Minimize alcohol, caffeine, and tobacco use close to sleep time
• Avoid using sleep aids, even those available over the counter

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.