Perchance to Dream

Setting an intention to become more open and receptive to one’s nightmares—before going to sleep, upon waking, and throughout the night—can improve sleep quality, counter fatigue, and stave off premature aging. Nightmares can be rich fonts of self-knowledge, as well as occasions for working through difficult issues—calling upon strategies for interacting with “dream demons” that include learning to “dialogue” and “practice courage.”

But left alone or ignored, nightmares can cause debilitating fatigue and lead to cognitive impairment, as well as play a stronger role in predicting “early death” before age 70 than other risk factors, such as smoking and obesity, according to a Japanese study of 183,000 people who were followed for nearly 20 years. Long-term health risks of nightmares come from prolonged high levels of the stress hormone cortisol, linked to faster cellular aging, and from disrupted sleep.

Reduced nighttime dreaming, most often the result of sleeping for too little time, can also wreak havoc. “Dream loss is the basis of the modern epidemic of depression,” contends University of Arizona Sleep and Dream specialist Ruben Naiman. “We are at least as dream deprived as we are sleep deprived.” Most vivid dreams occur during the REM (rapid eye movement) phase that takes place toward the end of each sleep cycle, with each cycle lasting 90 minutes or so; the REM phase increases in length throughout the night and becomes more intense with each cycle.

Aiming to get seven to nine hours of sleep each night, as well as waking without an alarm clock (which can “snip off the end of an important dream”), are among Naiman’s strongest recommendations. He also advises people to “linger in their morning grogginess, a hybrid state of part wakefulness and part dreaming” to reflect on recent dreams, which can also improve remembering dreams over time; and sharing dreams with others to create a bridge “from the dream world to the waking world, where [they are] easier to manage.”

But talking too much about a nightmare may risk strengthening the neural pathways used in creating the dream and making it “more likely the dream will reoccur,” argues Cleveland Clinic behavioral sleep medicine expert Michelle Drerup. Instead, Drerup cites “significant” research backing image rehearsal therapy (IRT), which asks someone to rewrite their dream to make it less disturbing; create new imagery and different responses to practice during the daytime; and plan how to respond when a nightmare arises.

“Nightmares give us an opportunity to practice courage,” Naiman says. “If you dream of a dragon in the closet, ask yourself what you wish to say to it, or take up a weapon, or turn it into a fruit tree.” In addition to rehearsing the new script, writing down descriptions can help. Other strategies focus on behavior during the dream, such as “conciliatory dialoging” with dream characters—a.k.a. asking friendly questions such as “Who are you?” and “Why are you here?”*

With another approach called “lucidity,” the dreamer reminds themselves they are in a dream and maintains an attitude of “intrepid curiosity” toward the dream content. Naiman’s favorite strategy, shadow work, involves exploring “everything we wish not to be.” He describes a woman whose dream about a shadowy figure slicing her open with a knife reflected ongoing struggles with the fear of opening her heart. His advice: “Even when it’s painful, stay in dialogue with the bad sides of yourself.”

The frequency and severity of nightmares can increase with age, becoming more unpleasant and more disruptive of sleep. In addition, the important work of nightmares—to incorporate fragments of fearful memories and help extinguish fear responses—can weaken over time. In a study by researchers at Boston University and Boston’s Center for Mind and Culture, age-matched participants with the worst nightmares also reported “more frequent suicidal ideation, greater mood dysfunction, and greater PTSD symptomology.”

High-stress periods can give rise to idiopathic nightmares with no clear trigger in contrast to both recurring and post-traumatic nightmares linked to specific negative experiences. During the Covid pandemic, nightmares increased—especially for healthcare workers, with 45% of nurses in a small Wuhan, China study reporting bad dreams. In addition, “nightmare disorder”—frequent, repetitive, and distressing nightmares that affect about 5% of the population—interrupts sleep and can cause daytime sleepiness, as well as anxiety and fear of recurrence that impedes going to sleep at night.

Coping with fatigue, which can worsen with frequent nightmares, benefits from getting more regular and longer hours of sleep. Many sleep prescriptions advise going to sleep at the same time every night and rising at the same hour in the morning, both for people struggling with insomnia and for overall health. A British study of more than 88,000 people followed over five to seven years found “the heart-healthiest” went to sleep between 10-11 pm; higher risks of heart disease were associated with those who went to sleep either earlier or later.

Other schedules for insomniacs focus on eating, such as stopping more than four hours before bed, and avoiding caffeine after a specific time. But rather than trying to remember lists of Dos and Don’ts, Naiman advises that those who have trouble getting to sleep find inspiration in the anticipation of dreams—with his belief that “the simplest yet most challenging aspect of getting to sleep is the surrender of our relentless effort.”

After years of trying to better remember my dreams, I am now working on the before-bed intention to be more receptive, though I have trouble remembering to think about that. Also, I worry too much about oversleeping to try waking without an alarm clock, though I am tempted by the idea of lingering in morning grogginess.

What can help me is reading random one-page “contemplations” from Naiman’s 2014 book Hush—“the best prescription for sleepless patients,” according to Arizona integrative medicine physician Randy Horwitz—such as: “Sleep is the slippery, downhill side of the day… We can only slip, slide, or fall into it.”