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Sleep Disorders

Excessive, Vivid Dreams

01/06/2009

Question:

I have excessive, vivid dreams that disrupt my sleep. They are usually not scary. I am able to sleep for a few hours (about 4 hours) and then the dreams wake me up. I am usually able to fall asleep again, but the sleep is very restless, with more dreaming, and then I am up again in an hour or so. I feel exhausted in the morning and get sleepy throughout the day.

I have tried some sleep hygiene things at home. I have discussed this with my counselor and doctor. I have tried a few medications, such as Benadryl and Elavil. I have also been to a sleep clinic for an overnight and morning/day test. Nothing has helped so far.

I do not drink alcohol. I am only on one medication(Luvox). I have been on Luvox for years and it did not have a negative impact on my sleep. In fact, I used to be a really good sleeper.

Do you have any suggestions?

Thanks for your help.

Answer:

The answer to your question contains parts that have been posted previously at our web site. To answer your question, we should discuss the normal sleep wake cycle.

First, I would like to define the following two terms, “Excessive dreaming” and “Vivid dreaming”. Excessive dreaming is a feeling that a dream is never-ending. This includes dreaming about activities that are continuous, trivial, or physical in nature such as repetitive housework, or endless walking through snow or water. Most excessive dreaming is devoid of emotions. This is different from vivid dreaming, where there is an abundance of details that carry high emotional burden. In an extreme situation, stressful vivid dreams are described as nightmares. It’s not clear from your question if your dreams are truly excessive or vivid, or that you are just awakening frequently with them.

Most of dreams occur during the second half of the night, so it is not usual for you to experience most of your dreams after you have been sleeping for 4 hours. Also, our sleep is composed of repetitive cycles of non-dream and dream sleep (NREM and REM sleep). These cycles occur in 90-minute periods on average. At the end of each cycle we usually wake up, turn over and go back to sleep, without remembering anything. You seem to recognize these awakenings and seem to have them more often than usual. This makes me think that you have a sleep disrupter.

A sleep disrupter can be an environmental or a physiological factor. Environmental factors can be an uncomfortable bed, loud noises, excessive lights, a warm room, a disrupting bed partner, or sharing the bed with pets or children. Physiological factors include periodic limb movement disorders, nocturnal seizures, sleep disordered breathing, or taking substances that affect sleep like tobacco, caffeine and over the counter sleep aids. Medications that can cause vivid dreams are usually the short acting antidepressants. Your medication, Luvox (fluvoxamine), is a long acting antidepressant and should not result is such side effects.

Usually there is no clinical abnormality in people who have excessive or vivid dreams. Also, no specific treatment is indicated. Cognitive therapy, hypnosis, relaxation therapy, and sleep medications have shown no benefit in treating these conditions. However, your symptoms of unrefreshing sleep and daytime sleepiness may indicate the presence of a sleep disorder (sleep disrupter) such as one of the ones described above.

You state that you have undergone sleep testing over a night and the following day. There are many details to the sleep test that need to be interpreted in the context of the clinical situation, as this may often provide clues at to the underlying cause of your symptoms. In some cases, repeat testing is indicated when a certain condition is highly suspected but not found on the initial study. I encourage you to discuss your symptoms and test results with a specialist in Sleep Medicine, or to consider seeking a second opinion regarding your symptoms if you do not get a satisfactory answer.

Until then, some general methods that may help you with your dreams include:

• Assure comfortable, quiet, cool, and dark sleep environment

• Minimize volitional sleep deprivation, and keep a regular sleep/wake schedule

• Minimize alcohol, caffeine, and tobacco use close to sleep time

• Avoid using sleep aids, even those available over the counter

Additional information regarding sleep, and a listing of sleep centers near you, is available at the American Academy of Sleep Medicine website. I wish you restful sleep.

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University