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To Sleep, Perchance to Dream...
BY KIMBERLY TROTTER, MA, RPSGT, ASSOCIATE EDITOR
s a sleep technologist, I am forever getting asked by patients, “can
you seen my dreams in the brainwaves?” not to mention when
people find out what I do, they always want to tell me about a weird
dream they had, and want me to interpret it! It sure does make for interesting party conversation.
A
As a past member of the Association for the Study of Dreams (ASD),
I have had the opportunity to learn about dream research, different
types of dreams, dream content analysis and theories on interpreting
dreams. This knowledge has served me well when being queried by
patients about their dreams. This article will serve as a primer to sleep
technologists on dreams.
When Do Dreams Occur?
Believe it or not, dreams occur in both REM and non-REM sleep. The
likelihood of remembering REM dreams is higher than recalling non-REM
dreams. You will have the best REM dream recall if you wake up during
REM sleep. REM dreams tend to be more movie-like and with action and
emotional tones. One of the reasons non-REM dreams are recalled so
infrequently is because of their content. Non-REM dreams are very
benign, with little visual content and mostly made up of mundane themes
and thought processes. Within a REM period, one can have many different dreams, lasting from seconds long, up to the whole REM period
(which, as any good sleep tech knows, can be from a few short minutes
up to 45 minutes or more!). These dreams tend to be epic movies, with
intense emotion and lots of drama.
In Living Color?
How many people dream in color versus black and white? Actually
most dreams start out in color, however, color is one of the first details
you forget once you awaken after a dream. A study was done in the late
70’s where the researchers were trying to manipulate color in dreams
by instructing subjects to wear red goggles continuously for 5 days1.
The dreams reported after wearing the goggles mimicked the colors
seen through the goggles. This and other similar research show that
the dreamer experiences color in dreams the same way they do in their
waking life.
Taking Leave of Your
Senses?
Sense of sight, hearing, smell, touch,
taste and even equilibrium can be experienced in dreams. Those falling dreams
can be very realistic! The presence of
senses in dreams is consistent with the
waking experience. For example, a person
blind from birth will not have visual Kimberly Trotter
dreams. Someone blind after birth, which
experienced sight, will have limited visual dreams, and so on. External
stimulation of the senses can influence dreams, but in a limited capacity. Research from the 1960’s, when REM was first discovered, shows
an incorporation rate of 15-21% depending on the sense stimulated1.
Researchers used water spray in the face for tactile stimulation, taped
the eyes open and aimed a strobe light at them for visual stimulation,
and used sounds for auditory stimulation. In my early career as a psychology student in a research sleep lab in the 80’s, we tested olfactory
stimulation incorporation into REM dreams by presenting different
smells to the subject during REM sleep, including a dirty ashtray, orange
wedge, food mold and coffee. The incorporation rate was similar to the
earlier research done in the 60’s2.
Different Types of Dreams
Nightmares: Frightening REM dreams that you wake up from
sweaty, heart pounding and out of breath; maybe you’ve even screamed
yourself awake. These dreams occur most frequently at the end of the
sleep period and are the longest, most intense dreams. These types of
dreams have nothing to do with the psychological wellness of the dreamer. Nightmares are a normal part of sleep. Nightmares become less frequent with age with an average of 4-8 nightmares for college students
and 1-2 nightmares per year for people age 25 and over1. However, in
less than 5% of adults, nightmares are a frequent occurrence. Dr.
Ernest Hartmann, who has studied nightmares his entire career, has
coined the term “Thin and Thick Boundaries”3. A dreamer with Thin
Boundaries is psychologically fragile, creative, imaginative and extremely open to experience. These are the people who are more likely to have
nightmares. Some people seek out help to understand or lessen the
occurrence of nightmares. This can include psychological counseling and
dream interpretation. One common technique of dream interpretation is
called “Dream Re-entry”4. This is where the dreamer imagines the
dream while in a meditative state, and can either change the direction
of the dream or ask the “monster” of the nightmare what it wants, striking up a dialog to get information and stop the nightmare.
Lucid Dreams: Most of us experience dreaming as “the real thing”
not even thinking it could be a dream, but real in all ways. Then we wake
up. Lucid dreaming is where you know you are dreaming while it is happening. Some people are adept at lucid dreaming and others need training to learn how to become lucid during dreams.
There are many books written on lucid dreaming and how to train
yourself to become lucid while dreaming. I am going to give you the
“readers digest” version, in consideration of space.
continued on page 44
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Dealing with Difficult Patients in a
Sleep Center
that exist can be minimized and you and your patients can settle down
for a peaceful evening in the sleep center. #
continued from page 17
References
Proctor, S (2006) “Bad Intentions — Violence Threatens ER Caregivers Every Shift”, Advance
for Respiratory Care Practitioners 19 (4): 27-28
Amin, Mohammed. Personal interview. 6 March 2006
Maczaj, Marta. Telephone and email interviews. Feb.-March 2006
Peters, Mel. Email interviews. March 2006
Sandberg, Mark. Email interviews. March 2006
“For safety reasons, it is important to ensure that a technologist is
not isolated in the sleep center and has been familiarized with the sleep
center’s emergency medical and ‘manpower’ protocols. Emergency protocols need to be in place for both hospital-based and free standing centers. For medical emergencies, the protocol will be clear. The steps to
take in a ‘behavioral’ emergency are usually not as clear, but should
serve to de-escalate the situation by listening to the patient, by clarifying
what the problem is, and by trying to solve the problem or arranging for
someone else to solve the problem,” said Maczaj.
About the Author
Brendan Duffy is a longtime APT member and lives in Port Jefferson, NY. He is the Sleep
Department Coordinator at St Charles Hospital in Port Jefferson. He has coached little
league and travel baseball teams and covers high school athletics as a sports writer for a
hometown Web-based newspaper.
Working with the Security Staff
Many hospitals have security teams and the technologists should be
sure to let this security team know that they are working alone for the
night, or have a patient that is making them feel uneasy. They should
request extra patrols during their shift and try and have the patient see
the security force as they come by to enforce the notion that there is
help available. The security staff can also offer valuable advice as to how
to protect you or how to react to potential danger in the workplace.
Safety Tools in the Sleep Lab
Even when more than one tech is working, it is wise to video record
the evening as soon as the patient is in the room and the tech starts
the set-up. These video records may become very useful in reviewing the
actions or behavior of patients who have acted inappropriately. It is also
helpful to advise the patient as soon as they arrive and are settled in the
room that the video camera is in use during their stay. This not only
alerts them to change into bedclothes in the bathroom, but also delivers
the message to them that their actions while in the room during the setup and sleep study will be preserved on the tapes.
The tech should leave the bedroom door open at all times during
the set-up. Several sleep centers issue alarms that the staff can wear
on a chain and press if they feel threatened by an aggressive or out of
control patient. Other centers employ buzzers under the desks similar
to the bank “panic buzzers”. Once deployed, a team of security officers
responds to the floor and handles the situation with a show of manpower. Such a system is employed at St. Boniface General Hospital’s
Sleep Center.
“The hospital has also supplied us with wireless transponders that
the technologists wear around their neck. Should they feel threatened
they can activate this system which will page a security guard to the
lab to check on them.” said Peters of the safety measures available at
St. Boniface.
Technicians should have an area of the facility with a door that locks
and provides access to a phone or method of calling for assistance.
Patients should also be advised that the tech room is off limits to patients.
It must be clearly stated to patients who “wander” into the control room
that they cannot be in the room as other patient information is being displayed and their presence violates the other patients right to privacy.
With good preplanning, an understanding of the various patient disorders, and an entire team priority on safety in the workplace, the risks
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To Sleep, Perchance to Dream...
continued from page 21
There is a special kind of mask called a Nova Dreamer5 which can
be worn while sleeping that, when in REM sleep, will emit a flashing red
light. The light incorporates into the dream, and you realize you are in a
dream. Ta-da! How this works is this: Let’s say you are in a dream where
you are in your house doing dishes. All of a sudden, there’s a flashing
red light coming at you! Your dream shifts to a train coming right at you!
Then, you reason it out, and remember that you are wearing the goggles, and voila! You know you are dreaming.
Another way to develop this gift is to do a “dream check” throughout
the day6. Repeatedly ask yourself, “Is this a dream?” One of the times
you ask, you will actually be in a dream. Other cues of dreaming include
reading text, and the text continuously changes, or looking at a clock or
watch, and the time keeps changing.
Once lucid, the next step is to not get too excited or you will likely
wake up! After having had a few lucid dreams, and you become relaxed
about the whole thing, then you can either sit back and watch the dream
unfold, or you can take charge and actually direct your dream, including
flying, changing scenery or bringing back a dearly departed loved one to
visit with. Lucid dreams can also help those with nightmares. Once lucid
in a nightmare, you can either change the monster into something less
threatening, or you can ask it why it is bothering you. Once the monster
is resolved, the dream might not come back again.
What’s in a Dream?
There has been much dream content analysis done over the last 30
years. The dream researchers have come up with some similarities in
dream content between men and women of different age groups. Here
are some of their findings1,4.
Men have more dreams of outdoors than women. Women’s dreams frequently take place inside, mostly in houses, whether it be their own currently, or from their past, or a house completely foreign to them. Men’s dreams
contain more references to weapons and automobiles. Men’s dreams present more strangers, or groups of people the dreamer does not know. Sexual
dreams are reported more in men than women. Men are also generally
more active in dreams than women. Women have more dreams with pets,
animals and children. This has been reasoned by researchers to be the
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result of an innate nurturing factor. Another interesting observation is
women age 14-25 tend to have more nightmares and chase dreams, where
a villain is coming after them. These dreams tend to become less frequent
after age 25. Theories about this include the idea that girls and women are
becoming more independent, which may make them feel vulnerable.
ing to tell us anything! They think dreams are made up of random neurons firing in the brain, activating different memories and thoughts. The
mind tries to make sense of it all so it can stay in REM, so it strings
together a crazy story based on those firings.
There are many different theories of dream interpretation. Here are
the most popular1,4.
Whether you believe in one dream interpretation style or theory or
another, most people think dreams can be of some benefit if remembered. Dreams have been used for troubleshooting and problem solving,
whether the actual dream itself is remembered or not.
Freudian: Sigmund Freud started interpreting dreams while his
patients were on the couch, talking about their thoughts and dreams during Freud’s psychoanalytic psychotherapy sessions. Freud’s theories are
based on the assumption that dreams purposefully disguise their meaning.
Many dreamers keep a dream diary7, which can be useful in keeping
track of your dreams, the content over time and how it changes, problem solving or for creative ideas. Stephen King uses his dreams to come
up with many of his novels, and many artists are inspired by their dreams.
Freud developed a very complex theory on dreams which includes Day
Residue: daytime events that influence the following night’s dream; and
Wish Fulfillment: dreaming of something you subconsciously want to happen. Freud used dream work (dream analysis) to understand the patient’s
unconscious desires and fears. His book, The Interpretation of Dreams,
uses dream items most frequently seen in his patients. He defines them
generally, based on his psychoanalysis of these patients and their dreams.
A dream diary doesn’t have to be written in every night. It can be used
when the dream is very intense and you want to have time to review and
interpret it later. A dream diary can be used not only for text but for
sketches, as well. Jotting down interesting occurrences in waking life
along with a dream can be helpful in getting a message out of the dream.
What does it all mean?
Jungian: Carl Jung was a student and friend of Freud’s until they had
a falling out due to a disagreement of the meaning of dreams. Jung
struck out on his own and developed his theory of dream interpretation
based on “a spontaneous self-portrayal, in symbolic form, of the actual
situation in the unconscious”. According to Jung, archetypes were frequently seen in dreams. The most common Jungian archetypes are the
wise old man, the great mother, the trickster, the divine child and the
shadow. Jung believed that these archetypes represented collective content, rather than personal content, and these archetypes were usually
seen as guides to the dreamer.
Personal Symbolism7: This type of dream interpretation involves writing your dream down and reciting it to yourself or someone else, BUT pretending that the person you are reciting the dream to has no idea what
you are talking about. This forces the dreamer to break down and
describe each facet of the dream, including emotional content. Once the
dream is broken down, then the dreamer must look at their “waking life”
and see if there are any similarities to the dream. Here’s an example:
“I dreamed I was at a circus, watching all the activity and the animals.” Seems like a pretty rudimentary dream, huh? If the dreamer
breaks down the dream, here’s how it can look. Remember, the dreamer is reciting it to someone who doesn’t know what a circus is.
“A circus is where there are three rings, and there’s always something going on, so you never get to see it all, because there’s too much
going on. The circus is noisy and dirty, with peanut shells all over the
floor, and scary, crazy clowns everywhere.”
The dreamer would then look at their life and see if there’s anything
where “there’s too much going on, so you never get to see it all”, or
some feeling or place where it’s “noisy and dirty”. Once there is a connection between waking and dreaming life, there may be a solution to a
problem within the dream.
Random Neuron Firing1,4: There are some scientists who think
dream theory and interpretation is useless, because the mind is not try-
Dreams are elusive, mysterious, scary and comforting. I enjoy listening to other people’s dreams and helping them figure out if there’s
hidden meaning, as well as analyzing my own dreams. I hope you have
found this article interesting and useful for yourselves as well as your
inquisitive patients, family and friends. For more reading on dreams,
please see references below. Pleasant dreams! #
References
1. Carskadon, M. (1993) Encyclopedia of Sleep and Dreams. MacMillan.
2. Trotter, K., Dallas, K., and Verdone, P. (1988). Olfactory Stimuli and Their Effects on REM
Dreams. Psychiatric Journal of the University of Ottawa, 13 (2):94-96.
3. Hartman, E. (1984). The Nightmare. Basic Books.
4. Van de Castle, R. (1994) Our Dreaming Mind. Ballentine.
5. Nova Dreamer Website (2005): http://www.lucidity.com/novadreamer.html
6. LaBerge, S. (1986). Lucid Dreams. Ballentine.
7. Delaney. G. (1981). Living Your Dreams. Harper and Row.
About the Author
Kimberly Trotter, MA, RPSGT, is the Practice Manager for the University of California at San
Francisco (UCSF) Sleep Disorders Center, Pulmonary Function Lab and Pulmonary
Department at Mount Zion Hospital. She is a past APT Board Member, Association for the
Study of Dreams former member, and a longtime sleep technologist. She is also an A2Zzz
Magazine Associate Editor.
Fellow Sleepy
Sleepy is the little fellow
Who runs around in your brain
Pushing your to sleep or not to sleep buttons
There’s a button in the middle
That may give you trouble
So, it’s a good idea to stay clear of it
The name of the button is Drowsy
If, at times, he pushes this one
You can very easily get a wowsie
—Author Unknown
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