Dreaming and
Insomnia: A Substrate Hypothesis
J. F. Pagel, MS/MD, is an
Associate Clinical Professor at the University of Colorado School
of Medicine specializing in Sleep Disorders and Behavioral Sleep
Medicine. He has published more than eighty scientific articles
and reviews. His book chapters include: Pediatric Sleep Disorders,
The Neuropharmacology of Nightmares, and Drugs that Induce
Sleepiness.
Abstract
Study Objectives: Assess
whether polysomnographic (PSG) variables associated with insomnia
are associated with changes in reported dream and nightmare recall
frequency in a grouping of clinical sleep laboratory patients
reporting insomnia.
Subjects: Individuals
undergoing full night polysomnography in the sleep laboratory
(N=289), Age range (12-83), Gender ratio 142 females / 147 males.
Interventions:
Retrospective intake questionnaire and interpreted PSG data of
patients referred to the sleep laboratory for clinical evaluation
of sleep disorders primarily obstructive sleep apnea (OSA).
Data analyzed included: Sleep Latency (SL); Total sleep time (TST);
Sleep efficiency (SE); Wake after sleep onset (WASO); Arousal-wake
index; REMS, Stage 1&2, and Stage 3&4 times; Epworth; Apnea-hypopnea
index (AHI), and Periodic Limb movement index (PLMI).
Results: An associated
decline in dream recall frequency is present at significant levels
in at least one of the study groups for increased SL, decreased
TST, decreased SE, increased WASO, increased Stage 1&2, and
decreased REMS minutes. Different variables were noted to effect
the reported frequency of nightmare compared to dream recall. For
individuals with OSA (AHI > 15) dream recall is significantly
higher for those individuals reporting insomnia.
Conclusion: A decline in
polysomnographic sleep quality is associated with a decline in
reported dream or nightmare recall frequency. A quality in the
substrate of sleep beyond the a REMS=Dreaming association is
required in order for dreaming to occur.
