October 19, 2017
Combining REM sleep neuroscience with the psychology of dreaming may help treat depression and more, researcher says.
Rubin Naiman, PhD, clinical assistant professor of medicine and the sleep and dream specialist at the University of Arizona (UA) Center for Integrative Medicine, formed this philosophy over decades as both a psychologist and sleep medicine physician.
Poor sleep, Naiman says, “is inextricably linked to poor dreaming,” the loss of which is caused by a host of factors, some of which are self-inflicted, that are “wreaking havoc on the public health by contributing to illness, depression, and an erosion of consciousness.”
In “Dreamless: The Silent Epidemic of REM Sleep Loss,” a comprehensive data review recently published in the Annals of the New York Academy of Sciences, Naiman explores the causes of rapid eye movement (REM) sleep disruption and contends many common health concerns attributed to sleep deprivation, such as obesity, cardiovascular disease, and memory loss, may be rooted in a lack of REM dreaming.
Yet most sleep physicians continue to devalue dreaming by discounting its relevance in patient outcomes.
“I began to realize that most of my colleagues in sleep medicine had as much disregard for dreaming as my psychology colleagues had for the science of REM sleep,” he says. “So, my interest, for years, has been in trying to triangulate the dream: Let’s see what dreaming is like if we look at it from both the neuroscience of REM sleep and the psychology of dreaming.”
Generally speaking, people sleep in stages that make up 90-minute cycles. Most adults experience 4 to 6 cycles per 7 hours of sleep. With each cycle, we experience less deep sleep and more REM sleep, and so we typically dream more in the early morning hours. Hence, REM sleep occurs after deeper, restorative, non-REM sleep, which is prioritized by the body.
In reviewing the data, Naiman focused on medication and substance use, common sleep disorders, and behavioral and lifestyle factors in REM sleep and dream loss. Emerging evidence, he says, suggests REM dreaming “mediates immune function, memory consolidation, and mood regulation, as well as transpersonal, religious, and personal experiences,” while too little may increase inflammatory response.
In the United States, Naiman notes, major factors in REM sleep and dream loss are commonly used—and in some cases, abused—substances, including medications, alcohol, and cannabis.
While a glass of wine with dinner or occasional marijuana use is probably fine, he warns it is unclear what impact newer hybrid varieties of cannabis may have on REM dream loss. Marijuana “is very seductive, because some strains can help people fall asleep,” he says. “But in the long run, just like alcohol, it interferes with REM sleep.”
Many common prescription and over-the-counter (OTC) medications also suppress REM sleep, including hypnotics and anticholinergic drugs. Worse, in Naiman’s view, at least in terms of dream loss, are antidepressants. Naiman, for one, says the drugs are over-prescribed: “I believe depression can actually be a healing response that can help us achieve a natural balance of REM sleep. [Antidepressants] are necessary in cases of severe depression—because if you relieve the pressure to dream altogether, you will see immediate relief. But if you take an aspirin to cut a fever, while you may feel better, you are actually undermining the endogenous healing response.”
Though rarely acknowledged, common sleep disorders like insomnia, insufficient sleep syndrome, and sleep apnea cause REM dream loss, Naiman says. Behavioral and lifestyle factors also play large roles, especially excessive light at night and routine alarm clock awakenings. “The solution to all of this is lifestyle change. And that is easily said, but not easily done,” Naiman says.
Meanwhile, a national emphasis on “dream promotion” is needed “to call attention to the fact that we are not dreaming well, and that dreams are important,” Naiman says. “We know, for example, that melatonin increases REM sleep. But we need to very systematically [examine] what ‘dream promotion’ does to waking life. And more specifically, is it possible that restoring REM sleep may help treat depression?”
A lot could be accomplished via the mainstream press, which in recent decades has become quick to report on news surrounding sleep deprivation, Naiman says, as well as social media and public health education campaigns funded by government agencies and professional organizations in sleep medicine. Dream promotion, however, really begins with the provider-patient relationship, he says.
“I think it is critical that sleep docs start paying attention to their own dreams and to the dreams of their patients. They need to not only focus on increasing sleep time and sleep continuity, but also on making sure there is a healthy restoration of REM sleep, so their patients understand it is important,” he says.
“We don’t ask patients about dreaming if we don’t pay attention to our own dreams,” concludes Naiman, who has been teaching medical students to see the value in dreaming for the past 15 years. “I will often tell them, ‘You know, even if you only have a couple of minutes, just ask your patient, ‘Are you dreaming?’”
Updated October 19th 2017
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