A recent review paper authored by Rubin Naiman of the Center for Integrative Medicine, University of Arizona, and published in Annals of the New York Academy of Sciences (August 2017), claims that “we are at least as dream-deprived as we are sleep-deprived” and suggests that a “silent epidemic of REM sleep deprivation” is contributing to our growing health-care concerns. The review details the various modern-day factors that cause REM sleep/dream loss and examines the consequences.
To begin, it’s relevant to note that typical sleep follows a cyclical pattern of non-REM and REM sleep: At the beginning of the night, deeper non-REM sleep is prioritized; only later in the night and into the morning does REM sleep increase in duration. It is in these later REM sleep hours that dreaming is most vivid and elaborate. Because of this, "sleep deprivation" often particularly intrudes on late REM/dreaming sleep. While sleep medicine has focused largely on the neurophysiological effects of sleep loss more generally, Naiman suggests that an equally important avenue of research is to assess the role of dreaming itself in the health consequences of poor sleep.
Several factors in modern-day living can negatively affect sleep quality and duration, including the use of recreational substances such as alcohol and cannabis, along with prescription medications and various lifestyle choices that intrude on a healthy sleeping schedule.
Both alcohol and cannabis are commonly thought to aid sleep, and indeed both can act as nervous system depressants and encourage sleep onset. However, the quality and structure of one's sleep throughout the night is then disturbed. Following the initial sedative effect of alcohol, there is a compensatory effect that interrupts REM sleep in the morning, sometimes with a sudden jolt awakening. Cannabis also aids sleep onset, but is then associated with REM sleep suppression. Anecdotally, cannabis users report dream loss during habitual use, which then rebounds upon discontinuation.
Prescription sleep medications act in similar fashion: Many sleeping pills encourage less restorative sleep and even suppress REM sleep. And yet the effects of sleeping pills on actual sleep quality are rarely noted: “REM/dream suppression is never listed as a common side effect of anticholinergic use.” Given the statistics — in 2012, 60 million Americans had sleeping-pill prescriptions — the consequences of REM sleep and dream loss on physical and mental health are critical areas for study.
On a psychological level, REM sleep and dreaming are often cited as functional in emotion regulation, and several psychological disorders are associated with dysregulated REM sleep. In fact, some treatments for depression are aimed at specifically suppressing REM sleep and dreaming. Behavioral treatments may initially focus on restricting sleep for a period of time in an attempt to decrease excessive or irregular REM sleep/dreams. Most antidepressant medications significantly suppress REM/dreaming: SSRIs suppress REM sleep by about a third, tricyclics reduce it by half, and older monoamine oxidase inhibitors cut out nearly all REM sleep. While initial REM sleep restriction may improve someone's mood, it’s not clear how long-term REM sleep disruption can influence emotion regulation.
Often, sleep deprivation has nothing to do with disorders or medication, and is instead a consequence of social and occupational demands. Insufficient sleep syndrome is defined as a "voluntary chronic pattern of shortened sleep," although most people would argue it is not voluntary, as they feel obligated by numerous social, work, and family expectations to cut back on sleep time. Unfortunately, decreased sleep duration interferes primarily with REM sleep and dreaming, since the short hours of sleep will be devoted to deeper non-REM sleep.
Other lifestyle factors that adversely affect sleep quality include our increased exposure to artificial light at night, and the predominant use of artificial awakenings in the morning (aka alarm clocks). Waking up with an alarm clock cuts into REM sleep and intrudes on dream narratives. While most of us accept this as part of a normal morning routine, there’s no saying whether shaking ourselves out of REM/dream cycles each day may have negative effects on our physical or mental health.
Physically, REM sleep loss is associated with increased inflammatory responses, increased risk for obesity, and memory problems. Patients with sleep apnea, which may be associated with a complete loss of REM sleep, are at increased risk for cardiovascular disease, diabetes, obesity, and depression. Again, while these health outcomes are often attributed to sleep loss more generally, Naiman argues that they are also likely linked to dream loss.
On a more abstract level, Naiman writes,
“Our devaluation of REM/dreaming underpins our denial of its loss ... We typically approach and investigate the dream from a biased, wake-centric perspective ... we presume that waking consciousness is the norm and view dreaming as a secondary, subservient state of consciousness ... [yet] REM/dreaming is a deconstructive force that challenges our consensual view of reality ... Dream eyes transcend waking egoic perspectives, opening us to greater social and spiritual consciousness and revealing a numinous world behind the world."
The paper concludes by offering several strategies for restoring the balance of REM sleep and dreaming—namely, eliminating those factors that interfere with sleep, both at an individual and societal level. These include managing substance use, being sure to get enough sleep, prioritizing healthy sleep habits in schools and workplaces, decreasing exposure to nighttime light, and reducing reliance on alarm clocks. In science and health care, more attention and research need to focus on the consequences of REM/dream loss and on increasing public health awareness. Finally, on a personal level, increasing attention to dreaming and participating in dream sharing can encourage more positive attitudes towards our dreaming lives.
Naiman, R. (2017). Dreamless: the silent epidemic of REM sleep loss. Annals of the New York Academy of Sciences.