Patients often ask me if I can interpret their dreams, especially those that reoccur. They also question the purpose of dreaming. Many are aware that they dream but don’t often remember the content.  Are they supposed to remember their dreams? Patients also note that they tend to dream more frequently right before they wake and wonder why this happens.

To be honest, we know very little about why we dream. We do know that humans dream most nights, whether they remember their dreams or not. Researchers typically are not interested in the dream content itself but more on what the impact of dreaming has on a patient physiologically or psychologically. It is still not clear whether dreaming only occurs during rapid eye movement (REM) sleep, as was once thought, or if dreaming also occurs in non-REM (NREM) sleep stages.

Evidence suggests that dreaming is probably where we consolidate, integrate, and analyze our memories of the day. There have been 2 interesting features discovered in research. The first is that intentional memorization is often incorporated into subsequent dreams, and the second is that what is incorporated is not remembered exactly as memorized. The brain seems to extract certain words or phrases and then incorporates them into an unrelated scenario that is semantically connected. For example, when asked to remember the word “fish” in a sentence, subjects may remember it as “seashore”.

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Many patients note that they dream more vividly right before they wake. The reason for this is simple — this is the longest period of REM sleep that we experience each night. The first REM period occurs about 90 minutes after we fall asleep and is usually relatively short. Afterward, each period of REM gets longer and longer until the last, where we experience the “movie-like” dream.

Dreaming is also referred to as sleep mentation, which is the experience of any mental activity during sleep. Dream reports are often collected through home dream journals, psychotherapy sessions, and questionnaires. Evidence has shown that talking to a patient about their dreams can be clinically useful.

Researchers often use rating scales to analyze dreams. The most commonly used rating scale is the Hall and Van de Castle coding system. Dreams are usually broken down into 5 basic dimensions: (1) degree of vividness and distortion; (2) degree of hostility and anxiety; (3) degree of initiative and striving; (4) level of activity, and (5) amount of sexuality. However, these tests are time consuming and newer word and phrase searches have been developed. One program called DreamBank calculates frequencies and percentages of dream reports. It touts over 20,000 dream reports.

Dreaming appears to be an important part of our lives. We are still not sure why we dream, but patients certainly feel that dreams are significant and are curious about their meanings. As the study of dreams continues, we may find that what we dream at night impacts our daytime lives.

Sharon M. O’Brien, MPAS, PA-C, is a practicing physician assistant and health coach in Asheville, NC. 


  1. Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine. 6th ed. Elsevier Health Sciences. 2016.