Patients often ask about the importance of dreaming and will ask me for help interpreting their dreams.One of my patients has a reoccurring dream that her teeth are falling out. This has happened so many times that she has seen her dentist to be sure there wasn’t something wrong. She feels that her dreams give her insight into what is happening with her physical health, but the bigger question may be what is happening with her mental health.
It is tempting to offer explanations, but the truth is we really don’t know why we dream or what dreams mean. You can find many books that will provide an interpretation on some basic themes, but whether they are accurate remains to be determined.
We have been taught that dreams only occur during REM sleep, but they also occur in non-REM sleep, too. REM sleep periods are often longer, with the longest periods occurring just before we wake. This explains why we remember REM dreaming better.
Most of us have had the dream of showing up late to take a test, probably while we were in school. In dreams, there appears to be a reactivation of your memories and emotions from experiences earlier in the day. One thought is that we use our dreams to store our memories and thoughts, as a sort of off-line learning process.
Emotional experiences are common in our dreams, with anxiety and anger being the most frequent. Erotic dreams occur about 1% of the time in the few studies that have been conducted on the topic.
For most patients, dreams are pleasant. But there are some who will complain of bizarre dreams, nightmares and reoccurring dreams. When a patient reports unpleasant reoccurring dreams, consider further questioning, as this could be a manifestation of post-traumatic stress disorder.
In general, it is important to ask patients whether they are dreaming when interviewing them about their sleep, because this can offer insight into whether they are getting enough. For example, patients who have undiagnosed obstructive sleep apnea typicall report that they are no longer dreaming. When I hear a patient say this, I can surmise that he or she may be waking prior to REM sleep frequently, thus preventing dreaming.
Another important question is whether a patient dreams during naps. This can be indicative of narcolepsy, as these patients have increased REM sleep and short REM sleep latency.
Current dream research focuses less on the meaning of dreams and more on the neurochemical and biological function of dreaming. When patients ask about what their dreams may mean, ask them to try to interpret their own dreams, as they may have more insight into their own mental health than they realize.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.