sign in sign up
<<
Home , Dream, Dream sharing

nyas13447 W3G-nyas.cls July 22, 2017 11:1

NYAS nyas13447-1729007 Dispatch: July 22, 2017 CE: AFL Journal MSP No. No. of pages: 9 PE: Lia Zarganas 1 Ann. N.Y. Acad. Sci. ISSN 0077-8923 2 3 ANNALS OF THE NEW YORK ACADEMY OF SCIENCES 4 Issue: Unlocking the Unconscious: Exploring the Undiscovered Self 5 PERSPECTIVE 6 7 Dreamless: the silent epidemic of REM loss 8 Q19 Rubin Naiman 10 The University of Arizona Center for Integrative Medicine, Tucson, Arizona 11 Address for correspondence: Dr. Rubin Naiman, Center for Integrative Medicine, University of Arizona, 1249 North Mountain, 12 Tucson AZ 85724. [email protected] 13 14 15 We are at least as deprived as we are sleep deprived. Many of the health concerns attributed to sleep loss result 16 from a silent epidemic of REM . REM/dream loss is an unrecognized public health hazard that 17 silently wreaks havoc with our lives, contributing to illness, , and an erosion of . This paper 18 compiles data about the causes and extent of REM/dream loss associated with commonly used medications, endemic 19 substance use disorders, rampant sleep disorders, and behavioral and lifestyle factors. It examines the consequences 20 of REM/dream loss and concludes with recommendations for restoring healthy REM/dreaming. 21 Keywords: dreaming; REM sleep; REM/dream loss; sleep deprivation 22 23 24 25 Lose your and you will lose your . Scientific concern about a possible link between 26 —The Rolling Stones REM/dream deprivation and health first surfaced in the 1960s when researchers found that subjects 27 Introduction 28 selectively deprived of REM/dreaming experienced 29 Awareness about epidemic levels of sleep depriva- weight gain, concentration difficulties, irritability, 2 30 tion has expanded significantly over the past three , tension, delusions, and . 31 decades. As a result, we have witnessed substantial Despite this finding, specific interest in the health 32 increases in the numbers of sleep specialists, clinics, consequences of dream loss faded with the discov- 33 research projects, and even sleep aids. All of this has ery that dreaming also occurred in non-rapid eye 34 been accompanied by an explosion of media atten- movement sleep. REM/dreaming was subsequently 35 tion focused on understanding and managing sleep subsumed under the general rubric of sleep, further 36 loss. diminishing our sensitivity to it. 37 The reciprocal-interaction model of non-REM As independent constructs, approaches to REM 38 and REM sleep suggests that these two core com- sleep and dreaming have become segregated into 39 ponents of sleep are structurally linked through distinct body–mind camps. studies 1 40 ultradian rhythms. Poor sleep, then, is inextrica- REM sleep as an objective neurological process, while 41 bly linked to poor dreaming. We have, however, traditional schools of examine dreaming 42 failed to acknowledge the fact that much, if not as a subjective personal experience. Sleep medicine 43 most, sleep deprivation involves significant degrees reduces dreaming to an epiphenomenon of REM a 3 44 of REM/dream loss. As a result, we remain in denial sleep, denying the personal meaning and value of 45 about the toll REM/dream loss takes on our health dreams, while psychological approaches to dream- 46 and well-being. ing largely ignore the science of REM sleep. 47 Tension between these polarized materialistic and 48 idealistic perspectives is reflected in our collective 49 disjointed attitude toward REM/dreaming. Today, 50 aAlthough REM sleep and dreaming are generally viewed too many of us view dreams the way we do stars— 51 as independent constructs, this paper will use the terms they emerge nightly and seem magnificent, but are 52 REM/dream and REM/dreaming to refer to their overlay. far too distant to be of any relevance to our real lives.

doi: 10.1111/nyas.13447

Ann. N.Y. Acad. Sci. xxxx (2017) 1–9 C 2017 New York Academy of Sciences. 1 nyas13447 W3G-nyas.cls July 22, 2017 11:1

1 The silent epidemic of REM sleep loss Naiman 2 3 In , REM/dreaming does play a crucial role Although estimates vary depending on method- 4 in our lives by mediating our neurological health ology, alcohol consumption is unquestionably a 5 as well as our psychological and spiritual well- major public health concern. Approximately 30% 6 being. More recently, growing concern about the of Americans consume one glass of wine with din- 7 consequences of sleep loss has encouraged initial ner nightly, while 20% consume about two glasses. 8 investigations into REM sleep loss. Emerging evi- The top 10% of American drinkers, about 25 million 9 dence suggests that REM/dreaming affects immune adults, consume more than ten drinks per day—the 10 function, , mood regula- equivalent of 18 bottles of wine or three 24-can cases 11 tion, as well as transpersonal, religious, or spiritual of beer weekly.5 12 experiences. The U.S. Department of Agriculture Dietary 13 Although there has been no systematic scien- Guidelines define moderate alcohol consumption 14 tific or meaningful public interest in investigating, as up to one drink per day for women, who gen- 15 let alone addressing it, this paper examines REM/ erally metabolize alcohol less efficiently, and up 16 dream loss by extrapolating data from (1) REM sleep to two drinks per day for men.6 These recom- 17 suppression resulting from substance and med- mendations, however, do not account for factors 18 ication use, (2) prevalence research on primary that modulate alcohol’s impact on sleep and REM/ 19 sleep disorders that interfere with REM sleep, and dreaming. Alcohol consumed earlier in the evening 20 (3) the negative impact of specific behavioral and and with food, for example, is less likely to influ- 21 lifestyle factors on REM/dreaming. It discusses med- ence REM/dreaming, while even a single drink 22 ical, psychological, and spiritual consequences of taken as a nightcap might negatively REM/ 23 REM/dream loss and closes with recommendations dreaming. 24 for restoring healthy REM/dreaming. Cannabis, which is a complex substance with a 25 wide range of effects that depend on the strain, has 26 The causes of REM/dream loss been used for centuries as a psychoactive and medic- 27 REM/dream loss is caused by a range of factors inal botanical. Anecdotal data suggest cannabis is 28 that compromise the quality and/or the extent of becoming popular as a sleep aid. Early research 29 REM/dreaming. These include (1) substances, espe- found that cannabis temporarily increased deep 30 cially alcohol and cannabis; (2) REM-sleep sup- sleep, suppressed REM sleep, and resulted in a REM 31 7 pressive prescriptions and over-the-counter (OTC) rebound upon discontinuation. More recent stud- 32 medications; (3) major sleep disorders, including ies confirm that cannabis can reduce 33 insufficient sleep syndrome; (4) lifestyle factors that latency and that it suppresses REM sleep, resulting 34 8 interfere with REM/dreaming; and (5) indirectly, a in a REM rebound upon discontinuation. Heavy 35 dismissive attitude about the value and meaning of cannabis users were found to have generally dis- 36 dreams. turbed sleep as well as a reduced REM latency indica- 37 tive of prior REM suppression.9 38 Substances Estimates of the extent of cannabis use in the 39 Alcohol and cannabis have been used in sacred ritu- United States vary widely, depending on method- 40 als since time immemorial to delve more deeply into ology, but there is consensus that use has been 41 or expand consciousness. In modern times, how- increasing as a result of decriminalization and med- 42 ever, it appears their primary use is to escape icalization. Cannabis use among American adults 43 by contracting consciousness. Although alcohol and increased from 10.4% to 13.3% between 2002 and 44 cannabis are commonly used by millions to facilitate 2014,10 possibly due to of reduced risk. 45 sleep, both can negatively impact REM/dreaming. Another recent survey found nearly 35 million 46 The myth that alcohol can support sleep is diffi- adults were “regular users,” at least once or twice 47 cult to dispel, largely because there is some truth to monthly.11 The National Survey on Drug Use and 48 it. As a central nervous system depressant, alcohol Health reported that 5.7 million people aged 12 or 49 can reduce sleep onset latency, that is, it can help older used marijuana on a daily or almost daily 50 people fall asleep faster. But, as it is metabolized, basis.12 Many other commonly used licit and illicit 51 alcohol triggers a compensatory adrenergic surge substances, such as nicotine and cocaine, also inter- 52 that significantly disrupts REM/dreaming.4 fere with normal REM/dreaming.

2 Ann. N.Y. Acad. Sci. xxxx (2017) 1–9 C 2017 New York Academy of Sciences. nyas13447 W3G-nyas.cls July 22, 2017 11:1

1 Naiman The silent epidemic of REM sleep loss 2 3 Medications To varying degrees, most antidepressant medi- 4 The physiological regulation of sleep and cations significantly suppress REM/dreaming. Psy- 5 REM/dreaming is complex. It involves multiple chopharmacological models that view dysregulated 6 neural networks, , and biological REM sleep as a cause of depression believe REM 7 rhythms that are vulnerable to disruption at numer- suppression is critical to the action of these drugs.19 8 ous points. Many commonly used medications are While selective reuptake inhibitors and 9 known to potentially disrupt REM/dreaming. This their sister drugs suppress about one-third of 10 discussion is meant to provide a brief introduction REM/dreams, tricyclic antidepressants cut dream- 11 rather than a comprehensive review of this topic. ing in half, and older monoamine oxidase inhibitors 12 Ironically, many sedative-hypnotics or so-called eliminate nearly all REM/dreaming.20 Despite con- 13 sleeping pills produce an artificial and less restora- tradictory evidence, modern psychiatry generally 14 tive kind of sleep. Prescription as well as OTC vari- clings to the notion that depression is linked to 15 eties typically increase light sleep at the expense of excessive and displaced dreaming.Excessive and dis- 16 deep sleep. They also alter sleep architecture and placed dreaming, however, may well be part of an 17 disrupt REM sleep.13 There is no consensus as to endogenous healing process to restore previously 18 whether the use of very popular “Z-drugs” (zale- suppressed REM/dreams.21 19 plon, zolpidem, and zopiclone) interfere with REM Numerous other medications can directly or 20 sleep. This may be due to differences in dose, condi- indirectly interfere with REM/dreaming. Examples 21 tion, and length of treatment. Anecdotal reports of include cardiovascular drugs, anti-Parkinsonian 22 sleep disruption and earlier research suggest zopi- medications, antagonists, analgesics, cor- 23 clone suppresses REM sleep.14 ticosteroids, stimulants, mood stabilizers, and 24 Benzodiazepines (BDZ) are sedating anxiolytics opiods.22 As more new drugs are developed and 25 that are also used to treat muscle tension and insom- medication use as well as polypharmacy23 continue 26 nia. Because BDZ can feel miraculously effective to rise at alarming rates, we can expect that REM/ 27 when first used, they are among the most commonly dreaming loss will increase as well. 28 prescribed drugs in the world. These drugs increase Widespread use of REM/dream suppressant med- 29 light sleep at the expense of deep sleep, and they ications is unquestionably one of the major causes 30 significantly suppress REM/dreaming.15 of REM/dream loss. From 2006 to 2012, sleeping pill 31 Anticholinergic drugs are a significant factor in prescriptions in the United States jumped from 47 32 epidemic REM/dream loss because they suppress to 60 million. Women, the elderly, and highly edu- 33 the activity of , the primary neuro- cated individuals appear to use more sleep aids.24 34 transmitter mediating REM/dreaming. These med- Despite serious side effects and significant risk of 35 ications are widely used to treat gastrointestinal, dependence, more than 5% of U.S. adults, primarily 36 genitourinary, and respiratory disorders, as well as women and older adults, still use BDZ.25 Likewise, 37 allergies, , and bradycardia. The likelihood despite their questionable benefit and serious risks, 38 of using anticholinergic drugs increases with age the prevalence of anticholinergic drug use ranges 39 as does the anticholinergic burden—a measure of from 8% to 37% in older adults.26 From 1998 to 40 the serious cumulative side effects associated with 2008, antidepressant use in the United States rose 41 increased use.16 These side effects include memory by nearly 400%. Eleven percent of Americans aged 42 loss, confusion, coordination problems, increased 12 or older use these medications, making them 43 heart rate and temperature, and a generalized dry- the third most popular class of prescription drugs. 44 ing effect that causes bladder and bowel retention Adults over 40 and women are significantly more 45 as well as a dry mouth, eyes, nose, and throat.17 likely to use antidepressants. In fact, nearly one out 46 REM/dreaming, which is a kind of fluid conscious- of four women aged 40–59 use antidepressants.27 47 ness, is significantly suppressed,18 and metaphor- 48 ically dried out by anticholinergic drugs. Despite Sleep disorders 49 a growing concern about the anticholinergic bur- Although rarely acknowledged, the most prevalent 50 den, it is remarkable that REM/dream suppression sleep disorders—insomnia, insufficient sleep syn- 51 is never listed as a common side effect of anticholin- drome (ISS), and —are typically associ- 52 ergic use. ated with disordered REM/dreaming. Because most

Ann. N.Y. Acad. Sci. xxxx (2017) 1–9 C 2017 New York Academy of Sciences. 3 nyas13447 W3G-nyas.cls July 22, 2017 11:1

1 The silent epidemic of REM sleep loss Naiman 2 3 REM/dreaming occurs in the latter third of night, Behavioral and lifestyle factors 4 sleep maintenance insomnia and early morning Behavioral and lifestyle factors that artificially rede- 5 awakening, which are the most common forms of fine the boundaries of night and day—namely, our 6 insomnia, likely result in significant REM/dream use of excessive artificial light at night (LAN) and 7 loss. And because REM/dreaming is character- routine alarm clock awakenings—are critical factors 8 ized by heightened physiological , the risk that disrupt REM/dreaming. LAN allows us to delay 9 of awakening during REM/dreaming is increased. times, while alarm clocks assist us in advanc- 10 Much of what sleep medicine refers to as WASO, ing rising times. Together, they shrink the temporal 11 wake after sleep onset, might more accurately be arena of sleep and, especially due to its lower prior- 12 called WADO, wake after dream onset. ity, REM/dreaming. 13 Insufficient sleep syndrome (ISS) refers to a Because of its significant disruption of melatonin 14 voluntary chronic pattern of shortened sleep to rhythms,36 artificial LAN may be the most ubiqui- 15 accommodate personal lifestyle, social, or voca- tous environmental cause of REM/dream suppres- 16 tional expectations or demands. Although it is said sion. Over the past half century, LAN has extended 17 to be “voluntary,” many people who cut their sleep the average length of our days by about four hours. 18 short feel compelled to do so by circumstances. Even relatively dim light can cause the pineal gland 19 Because the prioritizes non-REM sleep over to delay the production and release of melatonin,37 20 REM sleep, shrinking the window of total sleep which regulates circadian rhythms and supports 21 time will inevitably result in a greater reduction of sleep and REM/dreaming.38 22 REM/dreaming. A 2001 National Sleep Foundation poll concluded 23 (OSA) is also associated that more than half of American adults believed 24 with a sharp reduction in REM/dreaming.28 The they “needed” an alarm clock to wake up in the 25 REM atonia, or natural loss of muscle tone that morning. Nearly 70% of young adults aged 18– 26 accompanies REM/dreaming, increases the proba- 29 felt this way.39 Routinely waking up with an 27 bility of upper airway obstructions, which in turn alarm clock repeatedly shears off the endings of 28 short-circuits REM/dreaming.29 Since the severity our most protracted REM/dream periods. Imagine 29 of OSA is strongly correlated with the degree of being abruptly ushered out of a movie theater when- 30 REM/dream loss, it is not unusual to find a total ever a film was nearing its conclusion. 31 absence of REM sleep in patients with severe OSA. Nearly everyone experiences significant overex- 32 Treating OSA can result in an intense rebound of posure to LAN. By 2001, 62% of the world’s popu- 33 previously suppressed REM/dreaming. lation and 99% of U.S. and European populations 34 Sleep disorders are among the most prevalent were living under sky brightness that exceeded base- 35 health concerns in the United States. About 30% line levels.40 Beyond its association with sleep and 36 of adults report “some insomnia problems over the REM/dream difficulties, exposure to LAN has been 37 past year” while 10% report chronic insomnia.30 A linked to increased risk for depression, obesity, and 38 2002 National Sleep Foundation “Sleep in America” cancer.41 The International Dark Sky Association 39 poll found that sleep maintenance insomnia and (darksky.org) has compiled extensive information 40 early morning awakening were more than twice as and data related to prevalence and general health 41 common as sleep onset insomnia.31 Furthermore, and environmental impact of nighttime light pol- 42 epidemiological data suggest that the prevalence of lution as well as recommendations for managing 43 insomnia is continuing to rise.32 Independently of it.42 Disentrainment from night’s natural darkness 44 insomnia, estimates of the prevalence of ISS range allows us to routinely delay our bedtimes and fosters 45 from about 11 to 20%.33,34 ISS is so pervasive that our dependence on morning alarm clocks. Three- 46 it has become a new norm. Finally, estimates of fourths of American adults rely on morning alarm 47 the prevalence of OSA is approximately 3–7% for clocks,43 while 80% of high school students do so 48 adult men and 2–5% for adult women in the gen- on school nights.44 49 eral population.35 Even though there may be some Despite the glaring prevalence of REM/dream 50 overlap between insomnia and OSA, prevalence data loss, epidemiological research focused specifically 51 for sleep disorders that can negatively influence on quantifying REM/dream loss is nonexistent. 52 REM/dreaming is sobering. However, given population estimates of substance

4 Ann. N.Y. Acad. Sci. xxxx (2017) 1–9 C 2017 New York Academy of Sciences. nyas13447 W3G-nyas.cls July 22, 2017 11:1

1 Naiman The silent epidemic of REM sleep loss 2 3 and medication use, prevalence data for sleep disor- weird and meaningless and discourages us from 4 ders, and the ubiquity of lifestyle factors impinging getting near, let alone going through, the looking 5 on sleep and REM/dreams, it is probable that tens glass. 6 of millions of people experience degrees of clinically Ultimately, the inherently challenging nature of 7 significant REM/dream loss on a nightly basis. dreams themselves is a major factor in our dis- 8 missive posture. “What dreaming does,” said Car- The devaluation of REM/dreaming 9 los Castaneda, “is give us the fluidity to enter into 10 Our devaluation of REM/dreaming underpins our other worlds by destroying our of knowing this 11 denial of its loss. As late as 2001, a century after the world.”48 REM/dreaming is a deconstructive force 12 publication of Freud’s seminal The Interpretation of that challenges our consensual view of reality. Not 13 Dreams, which championed the psychological value surprisingly, most of the emotional content of our 14 of dreaming, a summary of neuroscientific find- REM/dreams is negative if not nightmarish.49 15 ings about the functions of REM sleep boldly dis- The consequences of REM/dream loss 16 missed its importance. The authors stated, “depri- 17 vation of REM sleep in for as much as two As suggested earlier, REM/dreaming mediates 18 weeks has little or no obvious effect on behavior.” immune function, memory consolidation, and 19 Theyconcluded,“...wecangetalongwithoutREM mood regulation as well as transpersonal, religious, 20 sleep....”45 or spiritual experiences. Recent animal50 as well 21 Despite its ubiquitous emotional impact, the as studies51,52 found increased inflamma- 22 experience of dreaming has also been devalued. As tory responses associated with REM/dream depri- 23 suggested earlier, scientific models of REM sleep vation. Other research revealed links between REM/ 24 dismiss the dream as a nonsensical epiphenomenon dreaming deprivation and increased sensitivity to 25 of nightly neurophysiology. Even though we cannot pain53 as well as increased risk for child and ado- 26 prove a negative, such myopic and overly medical- lescent obesity.54 Disturbances in REM/dreaming 27 ized views have permeated our culture. It is espe- have been linked to memory difficulties55 as well 28 cially telling that one of the most common uses of as dementia and Alzheimer’s disease.56 Disrupted 29 the word dream today, as in the American dream, REM/dreaming is the hallmark of REM sleep 30 refers to real estate. behavior disorder, which is associated with signif- 31 Diminished interest in on icantly increased risk for Parkinson’s disease and 32 the part of psychotherapists over recent years46 dementia.57 Patients with untreated OSA are at 33 is also symptomatic of the devaluation of REM/ increased risk for cardiovascular disease, diabetes, 34 dreaming. At the same time, popular approaches to obesity, and depression.58 Although these health 35 dream interpretation have devolved into frivolous risks are typically attributed to sleep loss, they are 36 puzzle games that rely on dream dictionaries to also likely linked to dream loss. 37 reduce dream images to their presumed waking From a psychodynamic perspective, depression 38 world origins. On the basis of the unexamined haslongbeenunderstoodasa“lossofone’sdreams.” 39 tenet, as it is below, so is it above, such approaches Today, a growing body of research suggests that 40 thoroughly strip dreams of their transpersonal REM/dreaming plays a complex role in mental 41 qualities. health and, more specifically, in the regulation of 42 Great philosophers have warned that we rou- mood and . Short-term disruptions of REM 43 tinely mistake the limits of our personal sleep have long been known to increase irritability, 44 for the limits of the universe. Nowhere is this rudi- anxiety, and aggression.59 More recent studies reveal 45 mentary error more evident than in our posture that normal REM/dreams support healthy emo- 46 toward REM/dreaming. We typically approach tional processing, while diminished REM/dreaming 47 and investigate the dream from a biased, wake (both REM sleep and dream recall) is strongly linked 48 centric perspective.47 Much like the ethnocentrism to depression.60 Not surprisingly, the reduced REM 49 of early anthropologists, we presume that waking latency pattern commonly seen in depression is 50 consciousness is the norm and view dreaming as strikingly similar to REM sleep rebound patterns of 51 a secondary, subservient state of consciousness. subjects who have had their REM sleep selectively 52 Wake centrismcasts our dream experiences as deprived.21

Ann. N.Y. Acad. Sci. xxxx (2017) 1–9 C 2017 New York Academy of Sciences. 5 nyas13447 W3G-nyas.cls July 22, 2017 11:1

1 The silent epidemic of REM sleep loss Naiman 2 3 Could it be that the psychodynamic view of Restoring healthy REM/dreaming 4 depression as “a loss of one’s dreams” has a lit- Because REM/dreaming is an innate, natural pro- 5 eral underpinning? If REM/dream loss is, in fact, cess, its restoration is largely about identifying and 6 an etiological factor in depression, it is yet another eliminating factors that inhibit its natural flow. 7 reason to be cautious about the use of antide- Ideally, these factors should be addressed at both 8 pressant medications that suppress REM sleep. individual and community levels. Ten basic recom- 9 Given its role in mood regulation, we should rec- mendations for restoring and promoting healthy 10 ognize REM/dreaming as a form of endogenous REM/dreaming follow. Engaging in practices that 11 that deserves support and encour- enhance REM/dreaming can help effect positive 12 agement in the management of depression. changes in our experience of, and attitudes toward, 13 Most investigations of REM/dreaming focus on REM/dreaming. 14 its impact on ordinary . Transper- 15 sonal perspectives raise questions about the way Managing substances and medications 16 REM/dream loss might erode the breadth of our Evaluating how specific substance and medication 17 consciousness, potentially dampening , use patterns might be compromising REM/dreams 18 impairing social connection, and compromising our is a critical first step. Reliance on REM/dream 19 spirituality. Four decades of clinical dream work has substances and medications should be addressed 20 taught me that REM/dreaming is essentially another with healthcare providers. Integrative mental 21 way of seeing—a kind of transpersonal dream eye- health approaches offer effective alternatives to 22 sight. By providing us with a novel, wide-angled conventional antidepressants64 and other REM- 23 view of ourselves and the world, dream eyes restore suppressant psychiatric medications.23 24 our peripheral .61 And because night dreams 25 are embedded in sleep, dream eyes afford us an Optimizing sleep 26 opportunity to perceive through slumber-sedated To dream well, we must sleep well. Just as the body 27 lenses. Even when gazing at the nightmarish, dream prioritizes fluids over food, the brain prioritizes 1 28 eyes are less judgmental, more empathic, more open. sleep over dreams. Even though both are essential, 29 Dream eyes also transcend waking egoic perspec- obtaining a quota of healthy dreams requires that we 30 tives, opening us to greater social and spiritual con- first learn to optimize our sleep. In addition to stan- 31 sciousness and revealing a numinous world behind dard recommendations, it is essential 32 the world. that we reduce excessive exposure to LAN by dim- 65 33 From this perspective, epidemic REM/dream loss ming lights and using blue blocker technology, 34 not only hurts the individual but also can have a and that we establish earlier bedtimes to remedy 35 deleterious effect on collective consciousness and dependence on alarm clocks. 36 spirituality. Montague Ullman addressed this con- Using 37 cern in his classic essay The Significance of Dreams in For people who wish to boost their awareness and 38 aDreamDeprivedSociety,writing, “Dreams reveal recall of REM/dreaming, there are many recipes 39 the state of connectedness of the individual to his available that use botanicals and nutraceuticals to 40 or her past, to others, and to the supports and promote dreaming.66 Melatonin supplementation 41 constraints of the social order.”62 Not surprisingly, is also a simple and generally safe way to optimize 42 dreaming has long been referred to as the language of both sleep and dreams67 if used properly.Unfor- 43 . In his book BigDreams:TheScienceofDream- tunately, there is limited expert guidance available 44 ing and the Origins of Religion, Kelly Bulkeley traces for melatonin use. Generally speaking, 0.3–1.0 mg 45 the roots of human spirituality and global sacred of a time-released formulation is best. Nootropics 46 traditions to REM/dreaming.63 that support healthy levels of acetylcholine can also 47 From a transpersonal perspective, then, REM/ function as oneirogens. 48 dream deprivation involves a fundamental loss of 49 peripheral vision, context, and perspective. It rein- Participating in REM/ 50 forces wake centrism by limiting our focus, atten- Sharing dreams with a partner, family, or friends will 51 tion, and vision to the ordinary waking world of deepen our regard for dreaming as well as enhance 52 practicality, survival, and materialism. intimacy. This can be done one-on-one or through

6 Ann. N.Y. Acad. Sci. xxxx (2017) 1–9 C 2017 New York Academy of Sciences. nyas13447 W3G-nyas.cls July 22, 2017 11:1

1 Naiman The silent epidemic of REM sleep loss 2 3 community-based groups or dream circles. Dream Disorder (RDD) as a legitimate clinical concern that 4 groups are especially useful in exploring lucid, requires professional attention would also support 5 precognitive, mutual, and other special forms of related public health, clinical, and research initia- 6 dreaming. Interpreting dreams as a part of the shar- tives. Such a diagnosis would need to account for 7 ing process is optional. Interpreting the dreams of REM sleep as well as subjective dream loss. 8 people we are close to is generally not advisable, Funding meaningful research 9 and because common dream dictionaries downsize Studies are needed to carefully quantify the extent 10 the dream, such books are best avoided. Talking of REM/dream loss in the general population as 11 with children about dreams will encourage them to well as among specific groups, such as children, the 12 establish a positive attitude early in life. 13 elderly, and psychiatric patients. Additional research 14 Engaging in work to determine the long-term effects of REM/dream 15 Occasional are a normal part of dream- loss would be helpful. Also, investigating the effec- 16 ing and can provide valuable insight into our tiveness of individual and public health interven- 17 psychological and spiritual lives. The Talmud rec- tions to promote healthy REM/dreaming is essential. ommends retelling a to several people to 18 Providing public health education help dissipate its hold. Chronic nightmares, how- 19 Campaigns to alert the public and health pro- ever, usually require professional support. Depend- 20 fessionals to the silent epidemic of REM/dream ing on a practitioner’s orientation and training, that 21 loss, its symptoms, and its treatments are essential can range from expressive to sup- 22 in addressing this problem. Many existing groups pressive medications. 23 could contribute meaningfully to the effort, includ- 24 Experimenting with the waking dream ing governmental health and mental health advo- 25 In contrast to lucid dreaming, which is about bring- cacy organizations as well as specialized advocacy 26 ing waking awareness into the night dream, the wak- groups, such as the National Sleep Foundation, the 27 ing dream is about bringing awareness of dreaming American Academy of Sleep Medicine, the Society 28 into the waking day.68 Not to be confused with the of Behavioral Sleep Medicine, and the International 29 , which usually has an escapist motive, the Association for the Study of Dreams. 30 waking dream is about practicing using our dream In conclusion: what dreams may (not) 31 eyes while awake. Actively engaging in the waking come 32 dream practices can benefit personal growth as well 33 as creative and artistic endeavors. If the Rolling Stones are correct in suggesting that 34 losing our dreams means losing our , we are Supporting dreamscape environmentalism 35 in trouble. Dream loss is epidemic, as is depression In his book The Inner Reaches of Outer Space,Joseph 36 and countless other human woes that arguably may Campbell highlights the striking parallel between 37 be rooted in limited, dream-deprived perspectives. our sense of the inner (dream) world and the outer 38 One of the main reasons we are losing our dreams (real) world.69 Today, in parallel to the destruc- 39 is that we do not value them sufficiently. Restoring tion of the planet’s natural environment, we are 40 healthy REM/dreaming, then, will require a shift witnessing what appears to be a decimation of the 41 in social consciousness. and clinicians, in dreamscape, the dream’s territory. Dreams are being 42 particular, need to offer more regard for the sub- overly medicated, lucidly manipulated, and tech- 43 jectivity of the dream. Whether we believe dreams nologically hacked in service of wake-centric pur- 44 are personally meaningful or not, we must recog- poses. Those who believe in the presence of a shared 45 nize they are healthful. And, we must also realize dreamscape believe this poses a danger to the quality 46 that, because we cannot prove a negative, arguing of our dreams. 47 against the meaningfulness of dreams is not a scien- 48 Establishing a clinical dream loss diagnosis tific position; it’s a personal philosophical stance. 49 Establishing a new diagnostic category for REM/ Nowhere is the classic body–mind problem more 50 dream loss would help to more clearly document, challenging than in the REM/dream arena. How do 51 further legitimize, and effectively intervene with we integrate the physiological picture of REM sleep 52 the problem. Designating REM/Dream Deficiency with the psychological experience of the dream?

Ann. N.Y. Acad. Sci. xxxx (2017) 1–9 C 2017 New York Academy of Sciences. 7 nyas13447 W3G-nyas.cls July 22, 2017 11:1

1 The silent epidemic of REM sleep loss Naiman 2

3 There is, in fact, growing interest in triangulat- & W.C. Dement, Eds.: 444–451. Philadelphia, PA: Elsevier 4 ing a new body–mind view of REM/dreaming.70 Saunders. 5 From a clinical perspective, integrative medicine has 14. Kim, Y.D., H.Y. Zhuang, M. Tsutsumi, et al. 1993. Compar- ison of the effect of zopiclone and brotizolam on sleep EEG 6 been evolving a model of patient care that success- by quantitative evaluation in healthy young women. Sleep 7 fully balances effective interventions with regard for 16: 655–661. 8 patient experience.71 15. Saddichha, S. 2010. Diagnosis and treatment of chronic 9 insomnia. Ann. Indian Acad. Neurol. 13: 94–102. 10 Competing interests 16. Campbell, N., M. Boustani, T. Limbil, et al. 2009. The cogni- tive impact of anticholinergics: a clinical review. Clin. Interv. 11 The author declares no competing interests. Aging 4: 225–233. 12 17. Lieberman III, J.A. 2004. Managing anticholinergic side 13 References effects. Prim. Care Companion J. Clin. Psychiatry 6(Suppl 14 2): 20–23. 18. Hornung, O.P., F. Regen, H. Danker-Hopfe, et al. 2007. The 15 1. McCarley, R. & J. Hobson. 1975. Neuronal excitability mod- ulation over the : a structural and mathematical relationship between REM sleep and memory consolidation 16 model. Science 189: 58–60. in old age and effects of cholinergic medication. Biol. Psy- 17 2. Dement, W. 1960. The effect of dream deprivation: the need chiatry 61: 750–757. 18 for a certain amount of dreaming each night is suggested by 19. Wang, Y.Q., R. Li, M.Q. Zhang, et al. 2015. The neurobiolog- 19 recent experiments. Science 131: 1705–1717. ical mechanisms and treatments of REM sleep disturbances in depression. Curr. Neuropharmacol. 13: 543–553. 20 3. Hobson, J.A. 1992. The brain as a dream machine: an activation-synthesis hypothesis of dreaming. In Essential 20. Vertes, R.P. & K.E. Eastman. 2000. The case against memory 21 Papers on Dreams: Origins to Present. M.R. Lansky, Ed.: 452– consolidation in REM sleep. Behav. Brain Sci. 23: 867–876. 22 476. New York: New York University Press. 21. Naiman, R. 2011. Circadian rhythm and blues: The interface 23 4. Ebrahim, I., C. Shapiro, A. Williams & P. Fenwick. 2013. of depression with sleep and dreams. PsychologyToday. 24 Alcohol and sleep I: effects onnormal sleep. Alcohol. Clin. com; Accessed April 22, 2017. https://www.psychology today.com/blog/mindful-sleep-mindful-dreams/201103/ 25 Exp. Res. 37: 539–549. 5. Cook, P.J. 2007. Paying the Tab: The Costs and Bene- circadian-rhythm-and-blues. 26 fits of Alcohol Control. Princeton, NJ: Princeton University 22. Schweitzer, P.K. 2000. Drugs that disturb sleep and wake- 27 Press. fulness. In Principles and Practice of Sleep Medicine, 3rd Edi- 28 6. U.S. Department of Agriculture and U.S. Department of tion. M.H. Kryger, T. Roth & W.C. Dement, Eds.: 441–461. Philadelphia: WB Saunders. 29 Health and Human Services. 2015–2020 Dietary Guide- 23. Weil, A. 2017. Mind Over Meds: Know When Drugs Are Nec- 30 lines for Americans. 8th ed., Appendix 9. Accessed Sept, 19, 2016. http://health.gov/dietaryguidelines/2015/guidelines/ essary, When Alternatives Are Better—and When to Let Your 31 appendix-9/. Body Heal on Its Own.NewYork:Little,Brown&Co. 24. Chong, Y., C.D. Fryer & Q. Gu. 2013. Prescription sleep aid 32 7. Roehrs, T. & T. Roth. 2011. Medication and substance abuse. use among adults: United States, 2005–2010. NCHS Data 33 In Principles and Practice of Sleep Medicine, 5th Edition.M.H. Brief:1–8. 34 Kryger, T. Roth & W.C. Dement, Eds.: 1512–1523. St. Louis, 25. Olfson, M., M. King & M. Schoenbaum. 2015. Benzodi- Missouri: Elsevier Saunders. 35 azepine use in the United States. JAMA Psychiatry 72: 136– 8. Schierenbeck, T., D. Riemann, M. Berger & M. Hornyak. 36 142. 2008. Effect of illicit recreational drugs upon sleep: cocaine, 26. Gray, S.L., M.L. Anderson, S. Dublin, et al. 2015. Cumula- 37 ecstasy and marijuana. Sleep Med. Rev. 12: 381–389. tive use of strong anticholinergics and incident dementia: a 38 9. Bolla, K.I., S.R. Lesage, C.E. Gamaldo, et al. 2008. Sleep prospective cohort study. JAMA Intern. Med. 175: 401–407. disturbance in heavy marijuana users. Sleep 31: 901–908. 39 27. Pratt, L.A., D.J. Brody & Q. Gu. 2011. Antidepressant use in 10. Compton, W.M., B. Han, C.M. Jones, et al. 2016. Marijuana 40 persons aged 12 and over: United States, 2005–2008. NCHS use and use disorders in adults in the USA, 2002–14: analysis 41 Data Brief:1–8. of annual cross-sectional surveys. Lancet Psychiatry 3: 954– 42 28. Haba-Rubio, J., J.P. Janssens, T. Rochat & E. Sforza. 2005. 964. Rapid eye movement-related disordered breathing: clinical 43 11. Marist University/YahooPoll. 2017. Weed and the American and polysomnographic features. Chest 128: 3350–3357. 44 Family. Accessed June 2017. https://www.yahoo.com/news/ 29. Peregrim, I., S. Gresovˇ a,´ M. Pallayova,´ et al. 2013. Does 45 american-families-embracing-pot-never-yahoo-news obstructive sleep apnea worsen during REM sleep? Physiol. marist-poll-finds-094433128.html. 46 Res. 62: 569–575. 12. Results from the 2015 National Survey on Drug Use 30. Brown, W.D. 2006. Insomnia: prevalence and daytime con- 47 and Health: Detailed Tables, SAMHSA, CBHSQ. Accessed sequences. In Sleep:AComprehensiveHandbook.T.L.Lee- 48 October 11, 2016. http://www.samhsa.gov/data/sites/default/ Chiong, Ed.: 91–98. Hoboken: John Wiley and Sons. 49 files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSD 31. National Sleep Foundation. 2002 “Sleep in America” Poll. 50 UH-DetTabs-2015.htm. 2002: 1–43. 13. Mendelson, W.B. 2005. Hypnotic medications: mechanisms 51 32. Ferrie, J.E., M. Kumari, P. Salo, et al. 2011. Sleep of action and pharmacologic effects. In Principles and Prac- epidemiology—a rapidly growing field. Int. J. Epidemiol. 40: 52 tice of Sleep Medicine, 4th Edition.M.H.Kryger,T.Roth 1431–1437.

8 Ann. N.Y. Acad. Sci. xxxx (2017) 1–9 C 2017 New York Academy of Sciences. nyas13447 W3G-nyas.cls July 22, 2017 11:1

1 Naiman The silent epidemic of REM sleep loss 2

3 33. Morita, Y., T. Sasai-Sakuma, S. Asaoka & Y. Inoue. 2015. 52. Mullington, J.M., N.S. Simpson, H.K. Meier-Ewert & M. 4 Prevalence and correlates of insufficient sleep syndrome in Haack. 2010. Sleep loss and inflammation. Best Pract. Res. 5 Japanese young adults: a web-based cross-sectional study. J. Clin. Endocrinol. Metab. 24: 775–784. 6 Clin. Sleep Med. 11: 1163–1169. 53. Roehrs,T.,M.Hyde,B.Blaisdell,et al. 2006. Sleep loss and 34. Hublin, C., J. Kaprio, M. Partinen & M. Koskenvuo. 2001. REM sleep loss are hyperalgesic. Sleep 29: 145–151. 7 Insufficient sleep—a population-based study in adults. Sleep 54. Liu, X., E.E. Forbes, N.D. Ryan, et al. 2008. Rapid eye move- 8 24: 392–400. mentsleepinrelationtooverweightinchildrenandadoles- 9 35. Punjabi, N.M. 2008. The epidemiology of adult obstructive cents. Arch.Gen.Psychiatry65: 924–932. 10 sleep apnea. Proc. Am. Thorac. Soc. 5: 136–143. 55. Boyce, R., S. Williams & A. Adamantidis. 2017. REM sleep 11 36. Navara, K.J. & R.J. Nelson. 2007. The dark side of light at and memory. Curr. Opin. Neurobiol. 44: 167–177. night: physiological, epidemiological, and ecological conse- 56. Petit, D., J. Montplaisir & B.F. Boeve. 2010. Alzheimer’s dis- 12 quences. J. Pineal Res. 43: 215–224. ease and other dementias. In Principles and Practice of Sleep 13 37. Gooley, J.J., K. Chamberlain, K.A. Smith, et al. 2010. Expo- Medicine, 5th Edition. M.H. Kryger, T. Roth & W.C. Dement, 14 sure to room light before suppresses melatonin Eds.: 1038–1047. St. Louis, Missouri: Elsevier Saunders. 15 onset and shortens melatonin duration in humans. J. Clin. 57. Boeve, B.F., M.H. Silber, C.B. Saper, et al. 2007. Pathophys- 16 Endocrinol. Metab. 96: E463–E472. iology of REM sleep behaviour disorder and relevance to 38. Dijk, D.J. & C. Cajochen. 1997. Melatonin and the circadian neurodegenerative disease. Brain 130: 2770–2788. 17 regulation of sleep initiation, consolidation, structure, and 58. Kimoff, R. 2016. Obstructive sleep apnea. In Murray and 18 the sleep EEG. J. Biol. Rhythms 12: 627–635. Nadel’s Textbook of Respiratory Medicine, 6th ed. V.C.Broad- 19 39. National Sleep Foundation. 2001. 2001 “Sleep in America” dus, R.J. Mason, J.D. Ernst, et al., Eds.: Chapt. 88. Philadel- 20 Poll. Accessed April 14, 2017. phia, PA: Elsevier Saunders. 21 40. Cinzano, P., F. Falchi & C.D. Elvidge. 2001. The first world 59. Cartwright, R. 2005. Dreaming as a mood regulation system. atlas of the artificial night sky brightness. Mon. Not. R. In Principles and practice of sleep medicine, 5th Edition.M.H. 22 Astron. Soc. 328: 689–707. Kryger, T. Roth & W.C. Dement, Eds.: 620–627. St. Louis, 23 41. Fonken, L.K. & R.J. Nelson. 2011. Illuminating the deleteri- Missouri: Elsevier Saunders. 24 ous effects of light at night. F1000 Med. Rep. 3: 18. 60. Ellman, S.J. & J.S. Antrobus. 1991. The Mind in Sleep: Psy- 25 42. International Dark Sky Association. 2003. International chology and Psychophysiology.NewYork:JohnWiley&Sons. 26 Dark Sky Association. http://www.darksky.org. 61. Naiman, R. 2016. Dream Eyes: Dreaming as a Way of 43. Sleep Review. 2014. 57% of Americans Hit the Snooze Seeing. Accessed May 28, 2017. http://www.huffingtonpost. 27 Button; August 27, 2014. Accessed April 5, 2016. http://www. com/entry/dream-eyes-dreaming-as-a-way-of-seeing_us_ 28 sleepreviewmag.com/2014/08/americans-snooze-button- 5794998de4b0b3e2427c7eee. 29 withings/. 62. Ullman, M. 1996. The Significance of Dreams in a Dream 30 44. Ming, X., R. Koransky, V. Kang, et al. 2011. Sleep insuf- Deprived Society. Accessed June12, 2017. http://siivola.org/ 31 ficiency, sleep health problems and performance in high monte/papers_grouped/uncopyrighted/Dreams/significa school students. Clin. Med. Insights Circ. Respir. Pulm. Med. nce_of_dreams_in_a_dream_deprived_society.htm. 32 5: 71–79. 63. Bulkeley, K. 2016. Big Dreams: The Science of Dreaming and 33 45. Purves, D., G.J. Augustine, D. Fitzpatrick, et al., Eds. 2001. the Origins of Religion. Oxford University Press. 34 The Possible Functions of REM Sleep and Dreaming.Sunder- 64. Weil, A. 2011. Spontaneous : A New Path to Emo- 35 land, MA: Sinauer Associates. tional Well-Being. New York: Little, Brown. 36 46. Pesant, N. & A. Zadra. 2004. Working with dreams in ther- 65. Burkhart, K. & J.R. Phelps. 2009. Amber lenses to block blue apy: what do we know and what should we do? Clin. Psychol. light and improve sleep: a randomized trial. Chronobiol. Int. 37 Rev. 24: 489–512. 26: 1602–1612. 38 47. Naiman, R. 2016. Falling for Sleep. Aeon. Accessed: Febru- 66. Dumpert, J. 2013. Meeting in the Dream World: Oneirogens 39 ary 12, 2017. https://aeon.co/essays/the-cure-for-insomnia- and Tips for Better Dreaming. Utne Reader. Utne.com. 40 is-to-fall-in-love-with-sleep-again. 67. Kunz, D., R. Mahlberg, C. Muller,¨ et al. 2004. Melatonin in 41 48. Castaneda, C. 1993. The Art of Dreaming.NewYork:Harper- patients with reduced REM sleep duration: two randomized Collins. controlled trials. J. Clin. Endocrinol. Metab. 89: 128–134. 42 49. Valli, K., T. Strandholm, L. Sillanmaki¨ & A. Revonsuo. 68. Mindell, A. 2002. Dreaming While Awake: Techniques for 24- 43 2008. Dreams are more negative than real life: implica- Hour Lucid Dreaming.Charlottesville,VA:HamptonRoads 44 tions for the function of dreaming. Cogn. Emot. 22: 833– Publishing. 45 861. 69. Campbell, J. 2002. The Inner Reaches of Outer Space: 46 50. Yehuda, S., B. Sredni, R.L. Carasso & D. Kenigsbuch-Sredni. Metaphor as Myth and as Religion (Vol. 2). New World 2009. REM sleep deprivation in rats results in inflammation Library. 47 and interleukin-17 elevation. J. Interferon Cytokine Res. 29: 70. Cartwright, R.D. 2010. The Twenty-Four Hour Mind: The 48 393–398. Role of Sleep and Dreaming in Our Emotional Lives.Oxford 49 51. Ruiz, F.S., M.L. Andersen, R.C. Martins, et al. 2012. Immune University Press. 50 alterations after selective rapid eye movement or total sleep 71. Rakel, D. & A. Weil. 2018. Philosophy of integrative 51 deprivation in healthy male volunteers. Innate Immun. 18: medicine. Integrative Medicine, Fourth Edition.D.Rakel,Ed.: 44–54. 2–11. Philadelphia: Elsevier. 52

Ann. N.Y. Acad. Sci. xxxx (2017) 1–9 C 2017 New York Academy of Sciences. 9 nyas13447 W3G-nyas.cls July 22, 2017 11:1

Query Q1: Author: Please confirm that given names (red) and surnames/family names (green) have been iden- tified correctly.