Category: Sleep

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Trauma-Related Nightmare Type Linked to Higher Suicide Risk

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Adding to the robust literature linking nightmares to suicide risk, a new study offers an important distinction for clinicians: of the 3 nightmare types identified by researchers, only trauma-related nightmares are linked to a greater risk of suicide (Youngren et al., 2024). Idiopathic and complex nightmares (comorbid with sleep and breathing problems) do not lead to higher suicide risk.

The study is important for a couple of reasons. First, it supports the theory of differing nightmare types and their resulting effects on mental health. Second, it provides guidance for clinicians who treat trauma, nightmares, and suicidality. The study also found that those who suffer from trauma-related or complex nightmares are more likely to seek treatment than those who experience idiopathic nightmares.

The study used a sample of 3,543 veterans who had previously attempted suicide. The main goal of the study was to examine the relationship of nightmare type to both suicide reattempt and treatment utilization. Multiple logistical regression analysis showed that when controlling for anxiety and depression, only trauma-related nightmares significantly predicted suicide re-attempts.

The authors speculated that the difference in nightmare content for trauma-related nightmares may account for their greater links with suicide. Trauma-related nightmares tend to be more direct replication of traumatic events, and are more easily recalled than other types of nightmares. Therefore, those who have frequent trauma nightmares are more likely to re-experience their traumatic memories. This can lead to life-threatening despair on its own. And it can also create higher levels of distress that interfere with sleep. Insufficient and poor-quality sleep have been clearly linked to suicide, with or without nightmares.

The authors advocate for nightmare treatment: “Regardless of the mechanism, our findings support treating nightmares to potentially reduce suicide risk.” They note that although prior studies how shown that both psychotherapy and medication failed to reliably help with PTSD-related nightmares (e.g. Peppard et al., 2013; Raskine et al., 2013), the outcome picture is altered when nightmare type is considered. According to a Youngren (2021), when nightmares are divided by type: “trauma-related nightmares appeared to decrease after nightmare-specific therapies such as ERRT, whereas complex nightmares did not.”

This is good news for clinicians. Nightmares directly related to trauma are most highly linked to suicide risk and also appear to be the most amenable to treatment. More good news – although previous studies suggest nightmares are vastly undertreated, the current study shows that those with trauma-related nightmares are more likely to seek treatment than those who suffer from idiopathic (less dangerous) nightmares.

Also noteworthy: the term ‘complex nightmares’ to denote nightmares associated with sleep-disordered breathing (SDB) is a new one. Such nightmares can also be trauma-related, but are associated with poorer dream recall. More research is needed to understand the distinctions between these complex states and their implications for treatment.

Overall this important study is yet another reason for clinicians to ask about nightmares, especially for those patients with suicidal ideation or previous attempts. Another step is to determine whether the dreams depict memories of specific traumatic events. If so, nightmare treatment is not only warranted, but according these recent finding, may reduce both the nightmares and the risk of suicide.

 

Don’t miss our 1-hour seminar on critical information for therapists about nightmares and suicide, including current research and how to help. We are currently offering a 30% discount! Click here to avail the promo!! 

References

Youngren, W. A., Bishop, T., Carr, M., Mattera, E., & Pigeon, W. (2024). Nightmare types and suicide. Dreaming, 34(1), 1.

Youngren, W., Balderas, J., & Farrell-Higgins, J. (2021). How sleep disordered breathing impacts posttrauma nightmares and rescripting therapies. Dreaming, 31(1), 20–31. https://doi.org/10.1037/ drm0000161

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Sleep Paralysis… curse or blessing?

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A first encounter with sleep paralysis (SP) is usually terrifying. But for those who experience it often and learn to stay calm, it can be entryway to lucid dreaming and extraordinary states.

Ryan Hurd, a sleep paralysis expert, has experienced hundreds of episodes himself and offers a road map for those who experience it. The following is a summary of his book, Sleep Paralysis, A Guide to Hynagogic Visions & Visitors of the Night.

In Hurd’s initial encounter with SP at age 14, all he wanted to do was wake up from the nightmare: first a ring, then a menacing voice that said, ‘Darkness rules!’ A pervasive felt sense of evil. The strong feeling of being pushed down forcibly into sleep. He was left feeling crazy, haunted and reticent to talk about his experience. It was classic a SP episode, and it deeply influenced the course of his life. He later became both a dream researcher, lecturer and lifelong lucid dreamer.

 

Symptoms of Sleep Paralysis

Hurd said the symptoms of SP are “near universal” and “noted throughout history and across cultures.” An episode might include one or more of the following:

Inability to move;
a feeling of great weight on your chest, abdomen and/or throat;
hearing buzzing or crackling sounds, or voices;
difficulty breathing;
heart racing;
extreme fear;
out-of-body experience;
electrical current or shock;
seeing lots of spiders or insects;
sensing, seeing and/or bring touched by an apparition or presence;
full awareness and a sense that what is happening is very real.

Isolated SP is common – about 40% of people experience it at least once in their lifetime (and a full 75% of post-secondary students). Alarming as it is, SP is a normal part of sleep, not pathological or a sign of psychosis.* It happens most often from sleep deprivation or disrupted sleep cycles (ie shift work, jet lag, late-night partying). It is an intrusion of REM/dreaming during the transition from wake-to-sleep or sleep-to-wake. In essence, your dreams are being superimposed onto the waking state. This is why the visions that arise can feel so real.

 

Ways to Manage Sleep Paralysis

Most people who experience SP occasionally simply want the hellish experience to stop. Hurd has found the following series of responses to be the most helpful:

  • Identify to yourself that you are having an eposide of SP
  • Surrender, don’t fight it (or it intensifies)
  • Wiggle your toes or clench a fist to break the paralysis
  • Focus on calm, steady breathing
  • Wait patiently for the episode to end, usually after a minute or two

Some people experience multiple episodes of sleep paralysis, or have a series of false awakenings. If you are worried about falling asleep and back into another episode, Hurd suggests you wake up more fully before going back to sleep:

  • Expose your eyes to bright light for a least a minute
  • Get up and do 10 minute of exercise
  • Write about the encouter in your journal

Then go back to sleep! Do not make things worse with even more sleep deprivation. To prevent SP, good sleep hygiene is essential… things like sleeping and waking at the same time every day, sleeping in a cool, dark, quiet place that you feel safe in, avoiding caffeine, alcohol and strenuous exercise too close to bedtime.

 

Get to Know the ‘Stranger’

For those who have learned to relax and go with the SP experience, and are brave and curious about the presence that appears to them, Hurd suggests turning toward the apparition with openness and trust (with the caveat that not all of the figures that appear are benign). However, if it feels available to you and safe enough, he suggests you relax, trust, be curious, ask what the stranger wants. These actions can transform the presence into something helpful and healing.

He notes that many tales of hauntings and magical creatures may in fact stem from sleep paralysis. A major clue is the timing of the visitation – if the presence appears at the edges of sleep, it is likely a hypnagogic hallucination. Vampires, the legend of the Sea Hag, ghosts, out-of-body experiences and even alien abductions may be attributed to sleep paralysis. It can also be a doorway to lucid dreaming and deeply spiritual encounters.

 

Sleep Paralysis as a Doorway to Extraordinary States

Despite his initially terrifying experiences with SP, Hurd now sees these as a “blessing in disguise.” If you recognize the state you are in as SP, you are already dreaming while awake, and can use this to co-create the kinds of dreams you would like to have. He suggest that once you have come to terms with your personal beliefs and have learned to relax into an SP state, you can “focus on the kinds of dreams you want to have and watch them materialize around you.”

He describes how you can use SP as an entrée into out-of-body experiences, lucid dreaming, creativity and spiritual growth.

Hurd even suggests ways to encourage SP (and of course do the opposite if you want to prevent it): Sleep on your back; take a nap when you are sleep-deprived or have jet-lag; or wake up 2 hours before your usual time, and nap later. When you nap while sleep-deprived, there is pressure to make up for a lack of REM sleep, and this intrusion of REM can induce the mixed state of SP.

The key message in all of this is that the valence of the visions which appear to us in a hynagogic state are dependent on the degree of safety we feel. The more frightened we are, the more terrifying the images that visit. It is an example of how we co-create dreams. If we stay calm, we can engage with the dream state while maintaining lucid awareness. Hurd notes that those new to lucid dreaming often treat it as a “virtual playground’ and invite fantasy experiences like flying or sex. But deepening into the experience can lead to truly extraordinary visions and “even a taste of enlightenment.”

 

Don’t miss our 1-hour seminar on critical information for therapists about nightmares and suicide, including current research and how to help. We are currently offering a 30% discount! Click here to avail the promo!

 

Reference:

Hurd, Ryan (2011). Sleep Paralysis, A Guide to Hynagogic Visions & Visitors of the Night. Los Altos, CA: Hyena Press.

*Symptoms of typical isolated sleep paralysis are not considered harmful – unless they include sleep apnea, narcolepsy or other parasomnias. If you have any concerns, consult a sleep medicine professional for diagnosis and treatment.

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Night Moves: Understanding Dream Enactment and REM Behavior Disorder

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By Dr. Leslie Ellis

Our scariest nocturnal experiences may not be the greatest cause for concern. Those who experience sleep paralysis wake up while still in a dream state, unable to move a muscle. This is often accompanied by the sense of a malevolent presence in the room, even right in bed! Believe it or not, the experience of paralysis is a normal part of our sleep cycle, our body’s way of protecting us from enacting our dreams. When our circadian rhythm is off, we can wake up before sleep paralysis has switched off which can be terrifying if you don’t understand it.

But this is not the worst thing.

What can be more ominous and dangerous is when sleep paralysis does NOT happen as it should, and instead, the dreamer enacts their dream scenarios. In rare cases, murders have been committed during such episodes. Comedian Mike Birbiglia suffers from this condition, called REM (rapid eye movement) Behavior Disorder, or RBD. His wild nocturnal experiences are a frequent subject of his highly popular shows, and the basis of an award-winning movie, Sleepwalk With Me.

In one sketch, Mike describes how he dreamt of being the target of a guided missile with coordinates set specifically on him. His dreamtime logic told him to jump out the window so the explosion would detonate outside, away from his platoon. He actually did this, despite the fact that he was on the second floor of a motel, and the window was closed. He landed, cut up, on the grass, got up and kept running… until he slowly realized, with relief at first, that he was in his underwear, bleeding, on a cold January night. He was dreaming, not actually being attacked! He was lucky his injuries were not worse. His doctor diagnosed him with RBD, and he now sleeps in a neck-high sleeping bag with mitts on to prevent him from unzipping it and potentially hurting himself.

 

About RBD

There are many ways to treat RBD, but one of the most important things to do is ensure the nocturnal safety of both the person who has it, and their bed partner, if they have one. Mike’s sleeping bag is not a bad idea. Sleep medicine experts suggest removing all sharp objects and weapons from the bedroom, padding the floor, lowering the mattress, placing a pillow between you and your bed partner, or even sleeping in separate beds.

Let’s back up a step though. Just what is RBD, what are its causes and what can you do?

RBD is now thought to be the initial symptom of neurodegenerative disease, and it most often affects older men. Up to 90% of those with idiopathic RBD (ie that is not a side effect of medication or other known causes) go on to develop neurodegenerative disease, usually Parkinson’s or dementia with Lewy bodies. Research suggests that RBD is the manifestation of an otherwise covert disease already present in the brain, rather than simply being associated with an increased risk of future development of disease. While treatments exist, there are no known therapies to slow the rate of degeneration – although the disease process itself can be very slow. Exercise has been shown to be neuroprotective, and a recent study shows it may help with RBD. Risk factors such as smoking, alcohol use and depression can be addressed. RBD is also associated with concussions, hyposomnia, arthritis, pesticide explosure, constipation and family history of neurodegeneration. It can be also brought on by use of anti-depressants, and in this case, stopping the medication can stop the RBD.

The American Academy of Sleep Medicine (AASM) suggests four medications that can be used to treat RBD: clonazepam, melatonin, pramipexole, and rivastigmine. Each has a different mechanism of action and each has its pros and cons. Of course, seek the advice of a sleep medicine professional about their use. (Howell’s 2023 AASM articles below also provide more detail.)

 

Options for Managing RBD

First, be sure to get a proper diagnosis. Sleepwalking and night terrors are also characterized by movement and intense vocalization during sleep. However, these happen during the first half of the night, during deep sleep versus REM, are not recalled by morning, and are more common in children. RBD episodes are dream enactments, most common in older people and can usually be remembered.

While RBD that is not associated with drug use or secondary to a medication condition may not be curable, it can be managed in various ways. Keeping safe is a priority because although those with RBD can go for long periods without an episode, dream enactments are always possible.

One partial solution, aimed at keeping those with RBD safe, is a bed alarm system (ie the Posey Sitter Select). Using pressure pads under the shoulders, and optional tether, the system detects when the user starts to get out of bed, and play a custom voice loop that tells something like: go back bed, you are dreaming. A small study found this device not only prevented injury but reduced overall dream enactments, possibly because it reduced the dreamer’s worries about hurting themselves or their partner.

In my practice, I have worked with the nightmares of those with RBD, reasoning that if one has fewer intense or violent dreams, enactments will be less frequent and dangerous as well. This has been the case with several patients, although like all RBD treatments, it is not a perfect solution, but rather can become part of an overall management strategy. Lifestyle changes, embracing the joys of life, befriending and potentially developing more control of one’s dream life are some positive responses to RBD. Or, like Mike, you can find and express some of the humor inherent in this otherwise potentially serious condition.

 

References:

Management:

Howell, M., Avidan, A. Y., Foldvary-Schaefer, N., Malkani, R. G., During, E. H., Roland, J. P., … & Ramar, K. (2023). Management of REM sleep behavior disorder: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine, 19(4), 769-810.

Howell, M., Avidan, A. Y., Foldvary-Schaefer, N., Malkani, R. G., During, E. H., Roland, J. P., … & Ramar, K. (2023). Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 19(4), 759-768.

Helpful adjunctive treatments:

McCarter, S. J., Boeve, B. F., Graff-Radford, N. R., Silber, M. H., & St. Louis, E. K. (2019). Neuroprotection in idiopathic REM sleep behavior disorder: a role for exercise? Sleep, 42(6), zsz064.

A device to protect from dream enactment behavior (DEB) and bed injury

Howell, M. J., Arneson, P. A., & Schenck, C. H. (2011). A novel therapy for REM sleep behavior disorder (RBD). Journal of Clinical Sleep Medicine, 7(6), 639-644A.

Risk factors:

Xiang, Y., Zhou, X., Huang, X., Zhou, X., Zeng, Q., Zhou, Z., … & Guo, J. (2023). The risk factors for probable REM sleep behavior disorder: A case-control study. Sleep Medicine, 110, 99-105.

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Dreamweaving: Introducing a Method for Collective Dream Experiencing

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Dream groups are a beautiful way to deepen into a dream, gathering a wider range of impressions and perspectives than we receive when we dive into our dream material alone or with a partner. I have led dream groups in many forms for decades, and love how the universality of dream images ultimately hold meaning and depth for all. Still, there is typically just one or two dreamers whose material is explored in any given session. I have been wanting to develop an experience that is more collective, where every member feels like an equal participant. With the help of my long-term Dream Circle of graduates from my embodied experiential dreamwork program, I recently created just such a method: Dreamweaving. The following is a brief account of the method, a process to invoke dream images to share, experience and weave into a tapestry.

Dreamweaving in Brief

Briefly, the method begins with an invocation, an internal experiential process for each group member to invite a short dream or fragment that seems to want attention. For example, if a group member has a big dream they want to share, the process invites them to find the particular image from the dream that intrigues them most. Once we have all been visited by a dream image, each member shares it, and we have a brief clarification process in which group members can ask the dreamer to say a little more about their image. This is not interpretation, but a deepening of the collective experience of the image, and an invitation to follow our curiosity.

Once all the dream pieces are offered and briefly explored, the group is invited to take a step back and take the entire dream collage in. Then, one by one, each dream member in turn can offer a prompt that invites an experiential exploration of any aspect of the collective dream that feels the most generative and intriguing to them. All members are invited to participate in the experiencing process, which could be a re-entry into a dreamscape, character or element, a dreaming forward from any image or dreamscape, or a conversation with a dream element. Then participants are invited to briefly offer a sense of what they experienced. Over the course of the session, the dream images come alive, and interweave until it really does begin to feel like a single, collective dream experience.

Here are the steps in brief:

  • Invocation
  • Dream sharing and deepening
  • A round of experiential prompts, with a brief sharing of experiences after each prompt

 

The Invocation

I always start my dreamwork sessions with an experiential inward journey to invite group members to find, embody and explore a dream or daydream image that is alive for them in the moment. The following is the transcript of the first Dreamweaving invocation, slightly edited (ellipses… indicate a long pause):

We’ll start with our usual way by just getting comfortable in your body, in your chair. Settle in, feel the ground underneath you, and do what you normally do with your body to prepare to go inward… Start by clearing some space, setting aside any distractions and opening yourself to the world of dreaming. As you’re clearing space, broaden your perception a little bit. Rather than being just with your own inner landscape, see if you can broaden it and feel into the group. We’re trying to expand our awareness and pick up what we can of the group dreaming…

When you feel settled, clear and connected, I’m going to ask you to invite an image or a dream snippet. You’re welcome to have an image arrive spontaneously right now. Or you can bring in an image from a dream that wants to visit. It could be a fresh one, a dream you’ve had recently or one from the past. Just invite what wants to come forward right in this moment. And welcome whatever arrives… You’re going to spend a bit of time with what came. First, start to notice the setting or the dreamscape that this image is situated in. Go ahead and flesh out the environment… Notice the temperature, the weather, what’s on the ground, what’s in the sky… Now begin to situate yourself in the dreamscape at whatever distance or wherever in this dream feels like the right place to be… And when you feel yourself there in the dreamscape, let this image play forward a little by finely observing the image that you’re with or letting it carry forward if it’s in motion or has a story that’s unfolding. Again, just see what the image wants…

Notice as you do this, as you’re following this image, what it brings up in your body. Feel into what kind of a felt sense arises as you interact with this dream image. Don’t do anything except notice what the felt sense is like, be friendly and curious with it… and before we turn away from this, just take a minute with your dream image and ask in a very open ended, invitational way if there’s anything this particular image wants to share, or wants you to share with this group. Just if it comes easily, don’t force it…

So we’re going to start to take our leave. Although we can keep the image with us if it feels good to do that, but start to come back to the dreamscape… and then back into your body sitting in the chair. Feel yourself back in the room. And when you’re ready, you can bring your attention to the screen… but take whatever time you need to exit. Don’t rush this. If you want, I’ll just give you a couple of minutes to jot anything down you want to record. We’re going to hear a lot of dream images. And so if you want to solidify what just came, feel free to write it down…

 

Tapestry of Dream Images

Some of the images that were offered by the group included a woman wearing a green sweater and holding the group safely; a sad little boy in blue pajamas; a forest bath; a beautiful and well-worn leather saddle; a violin on a table and a door to a stage; and dolphins shape-shifting into moose. I asked the group members to feel into the dream images and invited us all to experience where our curiosity would lead. By way of example, I started us off as follows:

What I noticed was that there are a lot of images of support, and invitations to go somewhere, move somewhere, do something. So I’m tempted to gather up the supportive image, like the support at the back of my neck in the forest bath, sitting on the horse in the saddle, and inviting the woman who is a safe guide for all of us… just kind of feeling into those supportive images and then going forward. Interestingly, of all the invitations, the place that calls to me is the open door to the stage with the violin. There’s an orchestra waiting… so I’m just going to give us all a few minutes to share this experience of gathering up the supportive images and then going forward onto the orchestra stage with the violin… we’ll have a few people offer what they experienced, but starting with the person who offered the prompt (me in this case).

Being in a saddle is a comfort zone for me. And I felt into the woman in the forest bath with the support at the back of my neck. Then I picked up this beautiful violin which was alive. I don’t play the violin but I just knew how to play it. As I went into the room with the orchestra, it was so quiet you could hear a pin drop. I wasn’t playing the violin, it was playing through me, a beautiful solo. And then when I stopped and said something to the group, it was like everybody knew that now we’re going to play together. The orchestra starts and it just flows. It was a really beautiful experience.

This chiming in of the orchestra feels like an apt metaphor for the way the dream group members joined in the process of weaving these images and carrying them forward. The invocation brought a beautiful mix of dream images. Then the experiential prompts deepened our collective sense of these images, and the whole experience seemed to be carried along by our collective imagination. Here are a couple of comments from group members:

“I loved how this process gave us more permission to take each other’s dreams and try them on.  If I view it entirely from a personal perspective, I had the feeling that each person’s dream offered me a reflection of a different aspect of myself.  Although these aspects may be conscious (and of course some may be unconscious) I may not normally spend as much time experiencing them as this process allowed me to do.”

“As somebody who has a really rich and detailed imaginal world, both in waking and dreaming life, it feels beautifully intimate to weave our dream images together, to be impacted by other people’s imaginal content, and to hear the ways that the imagery I share is impacting others. I know we do an element of that in all dream groups, but it feels like there’s something different that happened today… it feels like more of a weaving of a shared tapestry.

 

Dreamweaving is one of the methods I will be teaching in the class I am offering early in 2024 on Leading Dream Groups. As I fine this method, there will be more offerings, so stay tuned!

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Dreams of the Dead: Normal or macabre?

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In my daydreams, my grandmother and I sit on beach chairs and look out at the ocean. We’re on a deserted beach like something from Pirates of the Caribbean. She’s always there, contentedly sitting in a low-slung Adirondack chair amongst the grass tufts and dunes. When I drop in, she often tells me to slow down…

The secret is out: most of us maintain a conversation with deceased loved ones, in the form of dreams, sense of presence and/or some form of direct communication (telepathy, imagination, visitation…?) This recent finding by the Pew Research Centre is corroborated by the work of grief dream researcher Joshua Black, who says that dreams of the deceased tend to ease the process of grieving, offering messages of comfort and assurance.

Black became interested in grief dreams when he had a visitation in a dream about his father three months after his death. His dad had died suddenly, plunging Black into grief he described as numbness, “as if all the color had drained from the world.” In the dream, Black said his dad had an uncharacteristic lightness about him. “It was the first time I saw him peaceful.”

In the dream, Black got to tell his dad he missed and loved him. After that, the color returned to his world, and Black decided to devote his life’s work to researching dreams of the deceased. The desire to maintain continuing bonds with the dead is a key factor in such encounters and this is what Black continues to study.

For example, in 2020, he investigated the question: “Why are some dreams of the deceased experienced as comforting, while others are distressing?” In his study with 216 participants whose partner had died, he and his colleagues found that bereavement dreams appear to serve at least three distinct functions: they can assist with processing trauma; they can serve to maintain a bond with the deceased; and/or they can help regulate emotion. Taken together, these functions may “actively facilitate adjustment to bereavement.”

The recent Pew Research Centre study found that more than half of U.S. adults were visited in their dreams, or in some other way, by a dead family member. A third said they ‘felt the presence’ of a deceased relative, 28% said they told the dead relative something about their life, and 15% experienced the deceased communicating to them.

It turns out to be quite normal to have an ongoing relationship with loved ones who have passed away. Dreams, inner conversations and visitations are the typical forms this can take. A full 53 percent of the 5,079 surveyed said they experienced at least one of these interactions in the past year. This experience is more common to women than men, and greater amongst those who are moderately (but not highly) religious.

A question that arises is whether the dead have indeed spoken, through dreams or telepathy, or whether we are creating a personal representation of the loved ones we have lost when we dream about or speak to them. This depends greatly on what you believe about the nature of death and the possible continuity of consciousness beyond it. I like to think the dead really visit, similar to what those in Latin countries believe happens during the Day of the Dead rituals and celebrations.

Many cultures believe the deceased maintain communication with loved ones – and it is this belief that is at the centre of the Day of the Dead celebrations. During this period, which actually lasts several days, it’s believed that the border between living and spirit worlds dissolves, and souls of the dead return to feast and play with their loved ones.

Regardless of belief around the true nature of communication from those who have passed away, we know that maintaining a connection with the dead is common, and that it helps with the passage of grief and beyond. I still talk to my grandmother in my imaginal journeys, I feel her presence when I’m gardening and sometimes, just when I need it. I am heartened to discover that I am not alone in these comforting encounters.

 

Black, J., Belicki, K., Emberley-Ralph, J., & McCann, A. (2022). Internalized versus externalized continuing bonds: Relations to grief, trauma, attachment, openness to experience, and posttraumatic growth. Death studies, 46(2), 399-414.

Tevinton, P. & Corichi, M., 2023. Many Americans report interacting with dead relatives in dreams or other ways, Pew Research Center. United States of America. Retrieved from https://policycommons.net/artifacts/4775476/many-americans-report-interacting-with-dead-relatives-in-dreams-or-other-ways/5611706/ on 30 Aug 2023. CID: 20.500.12592/wcfmq3.

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To Sleep Better, We Need to Surrender to Our Dreams

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A podcast review by Dr. Leslie Ellis

The main reason people don’t sleep is that they have a bad relationship with dreaming. – Dr. Rubin Naimin

 

I was so inspired by a recent conversation between Nikos Patedakis and Dr. Rubin Naiman on the Dangerous Wisdom podcast, I want to share some of their surprising and inspiring ideas —such as how befriending dreams can be the key to getting a good night’s sleep.

 

Sleep and dreaming are a different, and wider form of consciousness than waking. Many with sleep troubles fear falling into sleep and dreams because it means letting go of our accustomed waking state and the sense of self that comes with it, according to Naiman, a psychologist, author, Fellow in the American Academy of Sleep Medicine and clinical assistant professor of medicine at the University of Arizona’s Andrew Weil Center for Integrative Medicine.

 

We need to change how we think about sleep

Naiman consults internationally about sleep and dreams and believes patients with sleep problems are thinking about sleep in the wrong way. “The statement, ‘I can’t sleep’ makes no sense… because the presumption is that the part of me that I call ‘I’, the waking self, should be able to sleep, and it can’t. That’s where people get stuck, they try leverage waking to get to sleep.” In fact, our very efforts to fall asleep tend to engage our waking selves more deeply.

 

So how does he suggest we descend into sleep then? It’s more of an accident than a deliberate effort, and it takes a willingness to descend into a different state where our sense of self and ego are not as central, and there is a greater breadth of consciousness available. Naiman said that over the previous few decades, our collective consciousness has shrunk, in part a product of spending more time narrowly focused, indoors, and looking at various screens rather than the natural world. So when we begin to fall asleep, and dreaming begins to widen our horizons, we may feel overwhelmed.

 

Naiman said: “Sleeping and dreaming both require a fundamental willingness to allow consciousness to expand, but this may be something many are not comfortable with. A contraction of consciousness allows for the kind of focus essential to survival in the waking, material world. The problem is that if we stay there, we think that’s all there is.” He goes on to lament the current epidemic of sleep loss, which he says is actually dream loss, and that attention to dreaming is a glaring omission in modern sleep medicine.

 

“The main reason people don’t sleep is that they have a bad relationship with dreaming.” Naiman cites evidence that when those with sleep troubles are first letting go into the kaleidoscope of dreams and a dissolution of waking consciousness, they react to that “as if it were a stampede coming from the horizon.”

 

Psychedelics as an appetizer for expanded consciousness

Dreaming is a different order of consciousness, one that is both feared and repressed, but also sought after. Because we are being deprived of the mind-expanding properties of dreaming, we hunger for it. Naiman says this may be why there is such a resurgence of interest in psychedelics: “We have forgotten how to expand consciousness through sleep and dreams, so it makes sense we are fascinated that a molecule or mushroom can do that. I’m not opposed to that, but these are the appetizers, not the main course.”

 

Patedakis views mind-altering substances as a bridge but not the final destination: “You need to learn what your mind can do. And then you need to learn how to do it within yourself.” Both speakers advise proceeding gradually into wider ways of seeing and being because plant medicine can bring overwhelm and disorientation to those not prepared for a direct experience of expanded consciousness. As a culture, we have been taught to fear or dismiss such things.

 

Academic focus on the material world ‘distorts and impoverishes’ our self-understanding

Naiman quotes Gary Schwartz and a group of scholars lamenting the nearly absolute dominance of the material over the subjective in academic study. This has “led to a severely distorted and impoverished understanding of ourselves and our place in nature.”

 

Even those who practice mindfulness and other potentially consciousness-shifting activities often do so to become better in their waking life. They want to know what their dream means so they can apply it to their personal situation, missing entirely that dreaming reflects a much larger perspective, one that takes us beyond ourselves into a wider, more spiritual realm.

 

Dreaming as antidepressant

Naiman also speaks of the psychological importance of dreaming. “It processes, sifts, digests and assimilates waking experience. If we are not dreaming, we’re not assimilating, and we’re not being nourished by our waking experiences.” This could explain the well-known link between dream loss and clinical depression. Ironically, the medications to treat depression erode dreaming even further because most antidepressants suppress REM sleep.

 

The answer to the epidemic of depression and sleep loss, according to Naiman, is not to medicate the problems but to turn toward our dream lives and allow them to help us become more comfortable with a wider sense of who we are. “If we have a better relationship with the dream world, we definitely sleep better,” says Naiman.

 

Expanding Liminal Space, Extending Sleep

Building a bridge between waking and sleeping by dwelling in the in-between, the gradual transformation inward as night falls, is a natural way to drift into sleep. “In nature, sleep actually starts when the sun goes down and there is a beautiful, gradual transformation of consciousness through dusk, and also again through dawn.” Naiman suggests that we surrender to the night and to the dark, allow it to naturally expand our consciousness, and view it neither as inferior nor applicable to waking life. In fact, sleep and dream life is the larger vessel in which the narrower consciousness of waking is contained.

 

Below are the links to both Nikos’ interview with Rubin Naiman, as well my conversation with Nikos on experiential approaches to dreams (which is referred to in this interview).

 

Rubin’s podcast episode: https://dangerous-wisdom.captivate.fm/episode/recovering-sleep-and-dreams

Rubin’s YouTube link: https://www.youtube.com/watch?v=X_E4tyFw-8c

Leslie’s podcast episode: https://dangerous-wisdom.captivate.fm/episode/attending-to-our-dreams-dialogue-with-dr-leslie-ellis

Leslie’s YouTube link: https://www.youtube.com/watch?v=7NyYEd3neIg

 

References

Naiman, R. (2017). Dreamless: the silent epidemic of REM sleep loss. Annals of the New York Academy of Sciences, 1406(1), 77-85.

 

For more on experiential dreamwork for clinicians, visit www.drleslieellis.com

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Befriending the old hag: A primer on sleep paralysis

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Folklore, causes and approaches to treatment and prevention

In Newfoundland, they tell stories of her: a terrifying creature said to live in the ocean and torment those who dare to sleep near the shore. In a typical account, a fisherman returns home exhausted from a long day at sea, lays down to rest and starts to drift off to sleep. But as he does so, he feels a heavy weight and can’t move or speak. Sitting heavily on his chest, is the dreaded Sea Hag, a wild woman with ragged clothes, straggly hair and long, sharp nails. She returns night after night until he arms himself with a crucifix and gathers the strength to command her to leave him be, in the name of God.

Tales of the Sea Hag are legendary in Newfoundland, one of the stories now told on the St. John’s Haunted Hike tour. The legend of the Sea Hag emerged as a way to make sense of sleep paralysis, a temporary inability to move or speak during the sleep-wake transition. As legend had it, the only way to defeat the Sea Hag was by invoking the name of God.

The history and folklore surrounding sleep paralysis can be traced back to ancient civilizations, and not understanding it, many cultures attributed it to supernatural forces. The Sea Hag is a variant of the “old hag” dating back to medieval Europe, a demonic entity that would sit on a person’s chest, a way to explain the pressure and immobility of sleep paralysis.

 

What causes sleep paralysis?

An episode can occur while falling asleep (hypnagogia) or in the transition from sleep to waking (hypnopompia). Symptoms include an inability to move, often accompanied by pressure on the chest or back, hallucinations and the sense of doom or an evil presence. Sleep paralysis often occurs during sleep cycle disruptions (ie from shift work, jet lag, insomnia), but can also coincide with mental health issues. This fairly common, mostly benign condition affects about 8% of the general population at some point in their lives.

During REM sleep, to protect us from thrashing around and enacting our dreams, our body goes into a state of muscle atonia. The exact mechanism, which inhibits the motor neurons in the spinal cord, is not fully understood. It is thought to involve a combination of factors, including changes in brain chemistry and activation of inhibitory neurons.

The body naturally shifts out of paralysis upon waking, and external stimuli such as touching or speaking to the person can trigger the shift as well. In sleep paralysis, the shift to the natural ability to move simply happens in the wrong order; we are supposed to wake up after our movement is restored to normal, not before.

 

How to treat sleep paralysis

Lauren was plagued with nightmares as a child, and as she grew older this shifted to frequent, terrifying sleep paralysis. She tried some of the most common ways to treat the problem, including changing her sleeping position, taking melatonin, practicing good sleep hygiene. What finally helped most was to turn toward the experience and relax into it rather than resisting and struggling to move. She reminded herself that she was not in any danger, and that she could still breathe – so she focused on slow, relaxing breaths, and the calmer she got, the less intense the sensations became. Over a few weeks of practicing relaxing into the transition to sleep, she was able to break the cycle.

The way to treat sleep paralysis depends on what may be causing it. While sleep paralysis can affect anyone, those with psychiatric disorders, a history of trauma, sleep disorders and disrupted sleep patterns are more likely to experience it. Therefore, effectively treating trauma, anxiety and/or depression may help those with psychological causes.

Disrupted sleep can come from shift work, sleep apnea, or too much late-night partying. This is why sleep paralysis is not uncommon among post-secondary students who stay up way too late studying or socializing. Sleep apnea also causes disrupted sleep, and sometimes sleep paralysis.

Overall, what helps:

  • practice good sleep hygiene, a regular bedtime and ideally a cool, dark quiet bedroom
  • sleep on your stomach or side, not your back
  • reduce stress
  • medication, such as melatonin or antidepressants
  • treat underlying causes: ie therapy for a history of trauma, anxiety or depression, sleep medicine for apnea

 

What to do during an episode

Sometimes, despite one’s best efforts, sleep paralysis will occur. If this happens, following Lauren’s example of relaxing into the process can make a real difference. Once you understand what’s happening, you can tell yourself, it’s okay, I am safe in my bedroom and still in the dream state. If you want to wake up calmly, focus on slow, deep breaths and begin to wiggle your fingers and toes, waiting until the paralysis dissipates. Although it may feel like an eternity, the transition is usually just a minute or two.

If you want to go back to into sleep rather than waking, you might try lucid dreaming. In fact, during an episode, you are in a lucid dream – as defined by being both awake and in a dream state. You might want to experiment with relaxing back into sleep and creating a dream scenario that feels empowering rather than scary. You might imagine into flying away from the source of your fear and into a beautiful landscape. Or you could conjure the presence of an ally or friend.

To give one example, Marian tried many things to alleviate her sleep paralysis before turning to lucid dreaming. She was desperate at this point, and decided to set an intention before sleeping that if she experienced paralysis, she would recognize she was dreaming. It took a few weeks, but after an initial exhilarating experience of flying in her dream, she got more adept at becoming lucid. This coincided with a shift toward better, more refreshing sleep and a whole new relationship to her dreams.

#sleepparalysis #oldhag #seahag #sleepdisorders #nightmares #sleephealth #sleephygiene #sleepmedicine #sleeptherapy #mentalhealthawareness #stressrelief #mindfulness #luciddreaming #sleepresearch #sleepscience

 

In my complete course on nightmares for clinicians, I offer much more information about the origins, theories and treatment of nightmares. Click here to learn more.

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New study shows altered nervous system activity for those with frequent nightmares

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New study shows altered nervous system activity for those with frequent nightmares

In a recent paper on nightmares and the autonomic nervous system (ANS), I described how polyvagal theory might inform clinicians seeking to understand and treat those with frequent nightmares (Ellis, 2022). A new paper, desceribed below, offers further evidence that nightmares are implicated in alterations in the ANS.

 

A free talk on how to apply polyvagal theory to nightmares

For those interested in applying these ideas in clinical practice, consider joining me for the upcoming free presentation Nightmares: How Polyvagal Theory Informs Treatment. I am a guest of Jan Winhall’s free felt-sense polyvagal approach to trauma group hosted by the Polyvagal Institute on April 21.

 

Recent research corroborates the nightmare-ANS link

Tomacsek and colleages (2023) studied a group of 24 frequent nightmare sufferers and 30 control participants, examining heart rate and heart rate variability (HRV) at various sleep stages and in response to emotion-inducing pictures. Increased heart rate and reduced HRV indicate nervous system dysregulation, and are increasingly used as measures in emotion and sleep research (specifically to measure parasympathetic dysregulation).

 

The researchers found a significant difference in the heart rate of nightmare sufferers versus controls but only during the sleep portion of the study “suggesting autonomic dysregulation, specifically during sleep in nightmares.” The researchers also found reduced HRV in the nightmare group during the picture-viewing task, which was intended to create a nightmare-like experience during waking.

 

Dysregulation across sleeping and waking in severe cases

The researchers concluded that the extent of dysregulation during both sleeping and waking may depend on the intensity of disturbed dreaming. The participants in the study were frequent nightmare sufferers, but on the less severe end of the spectrum, with non-traumatic nightmares and no symptoms of posttraumatic stress disorder. Still, they found “trait-like autonomic changes during sleep and state-like autonomic responses to emotion-invoking pictures” and concluded that this indicates parasympathetic dysregulation is present in those who suffer from frequent nightmares. They suggested that ANS dysregulation would likely be more consistent across sleep and waking states in more severe cases.

 

As evidence such is this continues to corroborate a link between ANS dysregulation and nightmares, it will ideally lead to treatment protocols that take this information into account. One of the main tenets that polyvagal theory has brought to trauma treatment in general is the notion that attention to a felt sense of safety and to creating conditions that regulate the nervous system is essential to trauma recovery. My paper offers an articulation of ways to extend this polyvagal-informed approach to trauma treatment. Ideally, specific methods of instilling safety and ANS regulation would be considered an integral part of the treatment of nightmares.

 

Ellis LA (2022) Solving the nightmare mystery: the autonomic nervous system as missing link in the aetiology and treatment of nightmares. Dreaming. https://doi.org/10.1037/drm0000224

Tomacsek, V., Blaskovich, B., Király, A. et al. Altered parasympathetic activity during sleep and emotionally arousing wakefulness in frequent nightmare recallers. Eur Arch Psychiatry Clin Neurosci (2023). https://doi.org/10.1007/s00406-023-01573-2

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Slippery Fish: How to remember your dreams

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When I tell people I work with and write about dreams, often the first thing they say is, “I don’t dream.” Or sometimes, more accurately, “I don’t remember my dreams.”

We all dream what is in essence a feature film worth of dreams every night, but the vast majority of these nocturnal movies are not merely forgotten, but not laid down in accessible memory in the first place. Dreams are like slippery fish: at night they rise from the depths of implicit memory and most of them slip back into this subconscious realm before we have a chance to catch them. But there are some reliable ways to improve your dream recall.

Have you ever noticed that the vast majority of your dreams are not finished? They tend to end right in the middle of something that is striking or scary enough to wake you up. I think this is why dreams tend generally to have such a flamboyant way of expressing themselves – it often takes something quite dramatic for a dream to break through to consciousness. Some dreams are so vivid and engaging, we wake up with their images still resonating in our minds and bodies.

Still, it takes a deliberate effort to recall even some of the most fascinating dreams. Many dreamers have the experience of a stunning dream that wakes them up. They think, “Wow, this is something I will not forget,” only to find that by morning all they remember was the experience of having a big dream but not the dream itself.

Our most vivid, emotionally-toned and complex dreams happen later in the sleep cycle, toward morning. I find that if you are able to wake up naturally and have some time to linger in the dream world before you leap out of bed and start your day, you have a better chance of catching hold of your dream before it slips away. If you lie very still when you first wake up, the dream is more likely to stay with you. And if you rehearse it in your mind a few times and then write it down before you get on with the business of your day, you will find that you have not only captured this dream, but others will come.

The more we pay attention to our dreams, the more they are likely to respond back to us. I have worked with psychotherapy clients’ dreams for about 20 years and found that even those who profess not to dream were able to recall dreams once I started asking about them and talking in depth about the dreams they did bring. At first people who don’t profess to dream much might capture only a snippet or two and not think much of it. But even little scraps of image can reveal themselves to be significant if they are inquired into with deep curiosity and respect.

To sum up, to remember your dreams, begin by taking an interest in them and going to bed with the intention of recalling them. Keep a dream journal by your bedside. When you first wake up, don’t move, but linger in the space in between waking and dreaming and see if you can recall anything at all from the night, even images or fragments that seem tiny. Rehearse what you can recall in your mind a few times – dreams are like slippery fish wanting to escape back into the deep waters of our unconscious. Once you have the dream clear in your mind, write it down, ideally before you do anything else.

If you tell your dreams to someone else, work with them in a group, draw the images they bring you, reflect on them and enjoy them, more will come. You will start to see patterns and appreciate their startling creativity and complexity. They are like an honest friend who is not afraid to tell you the truth, even if it’s painful. They can become your great ally.

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Recurrent Dreams: What are they trying to tell us?

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My main recurrent dream is of falling or diving from a precipitous height down a very steep cliff or slope. I wonder if it reflects all those years in university when I was competing for the diving team and spent hours each day falling fast and with a variable level of control. From a symbolic perspective, it could mean a fall from grace, and coming-down in some way, a loss of control. But these ideas are speculative. I prefer to spend time with the dreams themselves and their unique details – to open up to the dream so the felt sense it brings can unfold.

When someone brings me a recurring dream, I always ask not for general themes but the most recent or representative dream of its type. Recurrent dreams are important to pay attention to. They reflect more disturbed dreaming and I believe, represent themes or issues that are unresolved in some way. The classic version is the recurring nightmare after a trauma that has not been fully metabolized. There is a continuum of increasing severity and clinical concern that Domhoff (1993) identified as: repetition of dream elements, repetition of specific themes, exact repetition of dream content, repeated dream that resembles a trauma and repeated dream that replicates a trauma exactly. The research suggests that recurrent dreams coincide with decreased well-being, and that a positive shift often coincides with the cessation of such dreams.

Most adults have at least one recurring dream in their repertoire. I have been asked about these often lately (hence this blog post). A recent study by Schredl and colleagues (2022) reports that most recurrent dreams are negatively-toned, and the most common themes are ‘failure or helplessness’ and ‘being chased’. Interestingly, this supports my contention that dreams reflect the state of the nervous system – these themes could be seen as reflecting the classic immobility and the fight/flight responses to threat. Schredl wrote, “Overall, recurrent dreams seem to reflect waking life.”

However, for those who wake up many mornings feeling the aftermath of a dream depicting the same familiar challenge or fear, such generalizations are not helpful. In working with such dreams, I ask for details and particulars, and also how the dream situation feels to the dreamer. For example, Patty always had dreams of being trapped in a building, a kind of labyrinth, always being pursued and a sense she would be kidnapped. We entered this dream in her imagination, and she could see, to her surprise, that her pursuers were family members. She reflected that she was often the problem-solver and the emotional ballast for her family and this was a heavy burden. She spoke about setting better limits, making some changes, and as she did so, these dreams began to shift and fade.

Another dreamer I’ll call John always dreamt of being in a minefield, or a spy-like scenario where he had to go through all kinds of intricate traps and obstacles, and was always terrified of making a wrong move and detonating an explosion. These dream situations were like being Indiana Jones on a mission, but without the lightness. In feeling into a particular minefield dream, I asked John to notice the specific emotional flavour the dream brought, and wondered if it felt familiar. It quickly dawned on him that this was exactly what it felt like growing up with a narcissistic father prone to explosions of rage. Indeed, it felt like home was a minefield where it was easy to randomly put a foot wrong. He also reflected on his current relational patterns, and sensed into times with his partner that he felt he was walking on eggshells.

Understanding the possible source of such dreams brings some immediate relief, but insight doesn’t necessarily put an end to them. I have noticed that working through the challenging feelings they represent and then making life changes to address these dynamics is the most effective way to put recurrent dreams to rest – if that’s what’s desired. In my case, the falling dreams usually turn into something more fun than perilous: I am suddenly skiing with great skill, or can fly. Schredl noted that about 25% of recurrent dreams are positive: social, sexual, pleasant, interactive.

For those who have recurrent dreams of the unpleasant or downright terrifying variety, you might want to pause and consider what they could be about. I believe dreams reflect deep emotional processing, and if they repeat, there may be something that needs daytime attention. The further toward the severe end of Domhoff’s continuum (ie. replicative nightmares), the more the dreams are of clinical concern. The good news is that if the dreams and the life situations they reflect are worked with and metabolized, the more likely it is that the unwanted dreams will show up less often, and may even stop altogether.

 

References

Domhoff, G. W. (1993). The repetition of dreams and dream elements: a possible clue to the function of dreaming. In A. Moffitt, M. Kramer, & R. Hoffmann (Eds.), The functions of dreaming (pp. 293-320). SUNY Press.

Schredl, M., Germann, L., & Rauthmann, J. (2022). Recurrent Dream Themes: Frequency, Emotional Tone, and Associated Factors. Dreaming, OnlineFirst, 1