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Sleep Disorders

Can`t See Properly - Squinting in Dreams

06/08/2009

Question:

I`ve had this problem for some years now, and it is really getting me down. When I`m dreaming I can`t see properly. Everywhere I look, the objects are too bright and they hurt my eyes, making me squint. It`s a most unpleasant sensation, occuring night after night. What`s the reason behind this? How can I deal with it?

I`m 21, female, and have also had experiences of mild sleep paralysis.

Answer:

Hmmmmmm. This is a difficult question as I’m not exactly sure what you are describing. I have not come across the symptom of “objects are too bright and they hurt my eyes,…” during sleep. It’s possible that the problem you are describing could be related to a dream disorder, though it’s also possible it may not be due to a primary sleep problem at all. Additional information will definitely be needed to help you with your complaint, but I can try to provide some information you may find helpful.

Most of dreams occur during the second half of the night as 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.

Some individual may experience 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 vivid, or if something else is going on. Usually there is no clinical abnormality in people who have 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, in your case, it’s important to obtain further information and possibly have you undergo sleep testing to determine if this is something other than a dream- related problem.

Another sleep disorder that could be causing your symptoms might be sleep-related hallucinations. These are usually visual (seeing things), though they can be auditory (hearing things), tactile (sensation of feeling something) or kinetic (feeling of motion or movement). They more commonly occur with sleep onset (known as hypnagogic hallucinations) but can happen with morning awakenings (hypnapompic hallucinations) as well. Sleep-related hallucinations can be frightening and may, at times, be associated with other sleep behaviors such as sleep walking or sleep talking.

The underlying cause of sleep-related hallucinations is not always clear. Factors known to bring these about or increase the frequency of occurrences include younger age, current drug use, past alcohol use, anxiety, mood disorders, insomnia and lack of sleep. Certain medications may also cause this as a side effect. In addition, these hallucinations may be a sign or symptom of another sleep disorder, such narcolepsy, a primary nightmare disorder, migraine headaches, or, rarely, they could be part of sleep-related seizures (epilepsy). Psychiatric disease (such as schizophrenia) should also be included as a possibility, though assuming these hallucinations occur only with sleep, then this would be less likely.

Depending on the underlying cause or factors associated with the hallucinations, they may decrease or resolve with age. Identifying factors associated with the hallucinations (such as alcohol use or lack of sleep) and avoiding these may help to decrease the frequency or intensity of the problem. In cases where this does not occur, specific treatments are available, though the type of treatment will depend upon the underlying cause of the hallucinations.

It’s also possible that your symptoms could be the result of a neurologic problem, such as migraine headaches or a seizure disorder. Again, further information would be required to help determine if your symptoms could be related to one of these disorders.

You also mention that you have some sleep paralysis. Surprisingly, up to 15-40% of young adults experience this at least once in their lifetime and as many as 5-6% have this occur recurrently.

Sleep paralysis is usually described as the inability to perform voluntary movements either at sleep onset or upon awakening. Individuals often report an inability to speak or move the limbs, trunk or head. Breathing is not affected and individuals can recall the event. The episode usually only lasts for seconds up to a few minutes and tends to resolve on its own. Occasionally, the episode will end if the person is touched or spoken to.

Episodes of sleep paralysis can be very anxiety producing. Hallucinations, whether hearing or seeing things that are not present, can accompany the event. All-in-all, the experience can be somewhat frightening. Sleep paralysis can be brought on by lack of adequate sleep, keeping an irregular sleep schedule and being under excessive stress. While most of the time sleep paralysis is not associated with other medical conditions, it can be one of the signs of narcolepsy (individuals with this condition are also very sleepy).

Sleep paralysis usually first appears in young adults and tends to disappear with aging. Other than reassurance and avoiding situations that may bring on the episodes, no treatment is needed in most cases.

It certainly sounds as though your symptoms are quite distressing to you and are having a significant impact on your daily life. It would be a good idea to discuss your problems with your Primary Care Doctor. Referral to a Sleep Specialist may be needed, depending on specifics in your history and examination. Additional testing may be required to help sort out the cause of these problems.

To learn more about sleep or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The website Sleep Education.com also provides plenty of good consumer friendly information. Good luck and here's to better sleep!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University