This Morning’s Dream and Changes to Come

I’ve had a lot of whacky dreams lately.

Nothing particularly awe-inspiring or epiphanic, mind you.  Just a big mish-mash of strange, loosely connected but extremely realistic and visually intense viewscapes and scenarios.  Though there is much that is still unknown about the neurophysiologic mechanisms that drive rapid eye movement (REM) sleep and dream content, there appears to be a deep connection between dreams and mood.  I think it’s safe to say that I’ve been on a bit of roller coaster ride lately:  I’ve decided to make some major changes at work (which explains my recent lapse in writing; sorry!), and though these changes are definitely for the better, executing the change can often be a daunting challenge.  It’s all good, I want to reassure you!  But I think the ultra-vivid quality of my recent dreams probably reflects my inner adaptations to the upcoming work restructuring I’ve decided it’s best to undertake.

Yesterday I awakened at 5 a.m. disappointed that I didn’t get to taste the margarita I had just made for myself in some bar in Cabo San Lucas.

Here’s this morning’s little adventure.

I’m in my car.  It’s a cool, sunny late morning.  I’m hungry and looking for a place to eat an early lunch.  As I drive slowly and silently down this flat, straight suburban road, nondescript shopping malls loom and pass by on my left.  I pass an Olive Garden.  Then a Macaroni Grill.  Then a whole bank of other large, corporate restaurants.  I’m just not in the mood for any of that today.  I’ve eaten at all of these places before.  This morning I need something different, something local, something smaller.

At the end of this row of restaurants there is a place that seems to fit the bill.  Set back a fair ways off the road sits a short, squat, long chrome silver building, designed to resemble the dining car of a passenger train.  I don’t see (or remember) the name of the establishment, but it’s pretty clear it’s a family-owned, greasy-spoon kinda place.  I’m looking for something different, to be sure, but I wonder if there is anything halfway healthy on the menu.  I decide to pull in and take a look at the menu.

I walk inside and take in what is now before me.  The place is much bigger and more stately than its exterior presentation would suggest.  Various strangers sit quietly in their booths, paying me no attention.  The sound of clinking spoons and the smell of coffee and waffles make me smile as I stand for a few minutes looking for a waitress, who is nowhere to be found.  Eventually I decide that I’m expected to seat myself, which I do, at a quiet booth meant for four.

The slow, muffled rhythmic activity of the place continues as I wait in vain for service.  There’s no menu at my table.  Growing impatient, I stand up and look around for one.  I finally see one at an empty booth, so I walk over to take it.  At the moment I arrive at the booth and extend my arm, I realize that on top of the menu there are car keys and a wallet. A split-second later, a sudden, loud male voice booms, “Hey!”  I look up.  A large man in his fifties walks toward me.  He’s clearly pissed off.  He thinks I’m trying to steal his wallet!

I back up a few steps in a defensive posture and tell him I mean no harm, I just want a menu because I can’t find one anywhere.  He calms down and sits.  I walk away, embarrassed, and wander through the aisles of the diner looking for someone to help me.  There’s gotta be some way to order something in this place!  I’m starving at this point.  I ask myself if my body and my primary care physician would forgive me if I have the chicken-friend steak, because I see one coming out of the kitchen and it looks damn good.

And that’s when I awoke.

 

In retrospect, I’m pretty sure that the diner was loosely modeled in my mind after the Quechee Diner, where we ate sometimes on Sunday mornings in my old Vermont days.  But I gotta put more thought into what the rest of this morning’s dream sequence might say about my current frame of mind and how I’m processing the changes that will soon take place.

Have a great holiday weekend, everyone, and dream good dreams tonight.  Cheers, all!

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Sleep Song #4, in Honor of Rush’s RRHF Induction: “La Villa Strangiato”

Today is an important day. Not only is it National Sleep Apnea Awareness Day, it is also the day of the 28th Annual Rock and Roll Hall of Fame Induction Ceremony. Among this year’s well-deserving inductees is my favorite band of all time, Rush.

I won’t bore you with all the reasons why I love Geddy, Alex, and Neil, because seriously I could go on and on and on.  Suffice it to say that I grew up listening to Rush, whose music sparked my creative energies and allowed me to think of and perceive instrumentation and lyrics in new, unconventional ways.  Rush’s music made life even better during good times and pulled me up during bad times.  And my man Neil Peart . . . well, it’s tough to name a better drummer alive today.  Read some of his books and know his history to understand why Neil is a true inspiration to me.

One of Rush’s greatest pieces is “La Villa Strangiato (An Exercise in Self-Indulgence),” from the 1978 release Hemispheres (which still stands as my single favorite rock album of all time).  It is Rush’s first completely instrumental studio recording, though in subsequent years live performances would occasionally feature some vocals from Geddy Lee and, sometimes, various humorous comments from guitarist “Lerxst” Lifeson.  In my strong opinion, this song is a masterpiece.  It is mind-blowingly complex, an auditory nirvana for music geeks such as myself.

Why is “La Villa Strangiato” a sleep song?  It was inspired by one of Alex Lifeson’s dreams.  The song is comprised of multiple movements, which coincide with the recalled dream imagery:

I: “Buenas Noches, Mein Froinds!”
II: “To sleep, perchance to dream…”
III: “Strangiato Theme”
IV: “A Lerxst in Wonderland”
V: “Monsters!”
VI: “The Ghost of the Aragon”
VII: “Danforth and Pape”
VIII: “The Waltz of the Shreves”
IX: “Never Turn Your Back on a Monster!”
X: “Monsters! (Reprise)”
XI: “Strangiato theme (Reprise)”
XII: “A Farewell to Things”

Posted here is a relatively recent live version of the song.  If you’re a modern music fan, however, I strongly encourage you to get your hands on the original 1978 studio version, put on your Big Beat headphones, and get lost in Lerxst’s dream for 9 minutes.  You’ll be glad you did.

Congratulations to my brothers in Rush for finally, FINALLY!, getting the recognition they deserve from the Rock and Roll Hall of Fame.  Buenas Noches, Mein Froinds!

 

To Dream of Drowning

 

It’s a sleep experience shared by many:  awakening abruptly from a dream, wet with sweat, grateful that you’re not actually drowning.

Our recalled dreams often consist of imagery that is unpleasant.  Visual images can range from monsters to some amorphous figure coming after you.  Just as frightening, however, are the formless, soundless sensations you may feel given the place and circumstance you’re in during the dream.

One dream element that I often hear about in clinic is the feeling of drowning or suffocating.  This sensation is described by my patients in many various ways:  the imagery can be very specific, such as swimming in the middle of the ocean, sharks and fish surrounding the dreamer as he or she is slowly but surely pulled under the surface, or vague and nonspecific, such as the general feeling of air escaping the lungs and throat.  The feeling of asphyxiation may be associated with imagery of water submersion, a premature burial, perhaps, or hands or rope constricting one’s throat.  Common to these different scenarios, however, are the terror felt upon abruptly arousing from the dream and substantial relief upon realization that it was a dream.  Sometimes patients suddenly sit bolt upright out of breath, or even jump out of bed and run to an open window to get some air, because the sensation of breathlessness is so intense and uncomfortable.

Such dreams may occur out of nowhere and for no discernible reason.  However, there is a sleep disorder that can often cause people to awaken abruptly from a dream with the sensation of air hunger.  Obstructive sleep apnea is a breathing disorder in which one’s upper airway collapses or closes down episodically during sleep.  One thing that is important to know is that sleep apnea is often made worse in the setting of rapid eye movement (REM, or dream) sleep.

There are a couple reasons why this is the case.  We humans naturally breathe more erratically during REM sleep.  In addition, during REM sleep most of your body muscles are temporarily paralyzed (otherwise we’d all be in bed physically enacting our dreams); under normal circumstances, there is minimal sustained muscular tone while you’re dreaming.  Your airway therefore may be more prone to collapse, and for longer periods of time.  As such, people with untreated sleep apnea often demonstrate a substantially worsening of the sleep apnea during dream sleep:  in analysis of overnight sleep studies, for example, it’s common to see longer pauses in breathing and dramatically more severe blood oxygen abnormalities during REM sleep as compared to during other sleep stages.

So here is my suggestion.  If you awaken abruptly from dream imagery of drowning or suffocating, such that you feel like you had not been breathing or like you were not getting in enough air, ask your bed partner if you’re snoring loudly, gasping, or sounding like you’re stopping your breathing during sleep.  If there are no bed partners or roommates, ask yourself if you’ve awakened hearing a brief snort or with a brief gasping sensation out of sleep, including without preceding recollection of dream imagery.  Also determine in your mind if you have daytime sleepiness:  a tendency to fall asleep by accident while sedentary during the day or to become drowsy when you shouldn’t, such as while driving.  If you’re experiencing such things, you probably would benefit from seeing a doc like me.  Sleep apnea is an imminently treatable problem, and this frightening sensation of dreaming of being underwater usually evaporates with treatment.

Have a good day and stay dry, everyone!

 

My Recurring Nightmare . . . Read If You Dare

Many people have recurring nightmares, and I’m no exception. The science of this phenomenon is still very young; there is little understood of why dreams recur, or indeed why or how we dream at all. As I mentioned in yesterday’s entry, the prevailing dream research indicates that a majority of dreams have negative or unpleasant content or connotations. As such, unfortunately, having bad dreams over and over is quite common.

I thought I’d indulge a little today and describe my own recurring dream. I’ve had this same dream once or twice per year for the past two decades or so. There’s no monsters, no bad guys, no bogeymen, but it’s absolutely terrifying nonetheless, every single time. Without fail I awaken abruptly at the same point in the dream, drenched in sweat, sometimes literally yelling out in horror. Are you sure you want to join me on my journey back into Hell? Read on.

I’m back in college at the University of Kansas. I’m an underclassman. I’m two-thirds through the fall semester. I’m on an old green and biege campus bus. It’s a bright, beautiful, crisp Kansas autumn morning. The sky is brilliant blue, and white early morning light shines effortlessly through the windows, warming my face. I’m in the back. Nondescript fellow students surround me, sitting and standing silently. I close my eyes, relaxing, taking in the cold smell of diesel and giving in to the comforting, slow side-to-side sway of the bus as it snakes slowly up Naismith Drive into the main body of the campus.

After a couple minutes of reflection, my thoughts turn to the activities of the day. I recognize that I am still enrolled in a course that I need to cancel. It’s an upper-level calculus course, and I haven’t bothered to go to a single class. I haven’t studied a thing for it and I haven’t even shown up for any of the tests. I know, therefore, that I must be failing it. I’m not worried, however: I’ve known all along this semester that I can cancel the class without consequence or penalty, as long as I cancel prior to the deadline. I don’t remember which exact day is the last day I can cancel the class without an “F” showing up in my transcript, but I’m sure the cancellation date is still some time in the future. Or is it?

I wonder now when that deadline is. I’ve got a couple minutes of ride time before the bus drops me off at Hoch Auditorium, so I casually open up my light grey nylon backpack and retrieve my “timetable,” the KU academic semester catalog that describes all the courses and schedules. I look for the deadline to cancel courses. Finally I find the date in bold letters near the bottom of the page. $#!@ me, the deadline was YESTERDAY!

My heart pounds relentlessly now as I take in what this means. I’m on the verge of panic. I’m trying to keep it together, but I can’t see straight. There is an explosion of manic thoughts in my head. I’m going to fail this course now even if I start going to class faithfully and ace every test. An “F” in my undergraduate transcript will immediately put an end to my hopes to go to medical school. I want to scream, but I don’t want to attract attention. I fidget nervously in my seat, wishing the bus would move up the hill a little faster, but it’s crawling. I’m going to have to miss my class now; I have to stop off at Strong Hall, KU’s main administration building, and find some authority in front of which I can plead my case. All the while, I am thinking of what kind of alternative career plan I can come up with that might still provide me a good and happy life. Will an engineering school accept me with an “F?” Pharmacy school? A chemistry post-graduate program, perhaps? These thoughts make the bus feel like it’s going one mile per hour.

 

Finally I’m dropped off at Strong Hall. My panic and adrenalin send me flying out of the bus and storming down the concrete walk toward the front door of the building. I blast my way inside, unable to think clearly about where to go. I run, out of breath, to a counter built into the wall on the left in the front foyer. There’s an older woman behind the counter; large, imposing gold-colored steel bars separate her from me as I rush over, blustering incoherently that there was some mistake, I need to cancel my calculus course immediately, please please don’t put a failing grade on my transcript. She stares at me, blankly and silently, as I jump up and down like a maniac. I don’t know if she understands what I am saying, but looking at her impassive face one thing is starkly apparent as I blather on: whatever my problem is, she could . . . not . . . care . . . less.

It is at this point in which I awaken suddenly, sitting up bolt upright in bed, sweating and tachycardic, thanking God it was a dream. I’ve had this same dream dozens of times now. Its theme, sequence and outcome are virtually identical each time, but each time it feels new, the horror absolutely fresh.

As you can see, there are no monsters in my nightmare—just me and my own stupidity and foolishness. I feel some vague anxiety even now just thinking about it. The terror and dread come from a place completely different from some rated-R slasher flick: where innocent aspirations and diligent work intersect harshly with reality. This experience never actually happened to me, blowing off a course that I couldn’t get out of. I suppose the recurring nature of the dream exposes some of my deepest personal fears: watching helplessly as the prospects for my future slip through my hands, and loathing myself for getting myself into trouble due to my own irresponsibility. I think it also suggests part of what drives me to be the person who I strive to be every day.

Write me with your recurring dreams. I’m curious to know of them. What are they, and how do they affect you?

Nightmares vs. Night Terrors

Hello everybody!  I’m writing this brief entry tonight to address something a lot of people, particularly parents of young children, can be confused about:  the difference between nightmares and night terrors.  I’ve heard people use these terms interchangeably, but they represent entirely different clinical entities.  Herein I provide a simple distinction between the two.

 

Night terrors–also known as “sleep terrors” or “pavor nocturnus“–are very memorable for parents.  Here’s a typical scenario.  Your child goes to bed the way she usually does at night.  Later that night, suddenly, from her bedroom comes a loud, blood-curdling scream that scares the hell out of you.  You jump out of bed and run to your daughter’s bedroom.  You find her sitting up in bed, appearing awake and dazed, eyes wide open in fear.  She may or may not respond to you.  She appears distressed and freaked out, sweating and breathing hard; she may move her arms and legs nonspecifically but frenetically as well, compounding your concern as you observe her.  She seems panicked and inconsolable, almost possessed.  After several minutes, though, she calms down, lies down again, and returns to sleep.  The next morning, when you ask her about the event, she tells  you she has no idea what you’re talking about:  she recalls nothing of what happened.

Here’s a nightmare.  You hear your child crying or crying out for you in the middle of the night.  You enter his room.  He’s clearly awake and clear-headed, and answers your questions appropriately and quickly.  He may hug you for comfort.  You ask him what happened.  He tells you he had a terrible dream; a monster was out to get him, for example, or he was about to be pushed off a cliff by someone mean.  He has good recollection of what he was dreaming about.  After some reassurance, he eventually feels comfortable enough to return to bed, and the following morning he may or may not recall the full details of the disturbing dream, but he does remember that he had a terrible dream that caused him substantial distress.

The reason why it’s important to recognize the difference between these two clinical entities is because both can concern and frighten parents, particularly night terrors.  As frightening as they may be to watch, however, they are in and of themselves generally benign in nature and prognosis.

Night terrors represent a type of parasomnia (sleep-related unusual movements or behaviors) typically occurring out of deep non-REM sleep.  As such, dreams are not recalled, and the child is usually completely amnestic of the event.  Though some adults may experience night terrors, they are by far most common in children 3-12 years of age.  As scary as these events are for parents, they are usually not indicative of an underlying abnormality or medical problem, and children with night terrors usually outgrow them over time.  In some children, sleep deprivation or other reasons for going to bed particularly fatigued or sleepy may play a role in the likelihood of night terrors occurring, so make sure that your child gets proper amounts of sleep and sleeps in reasonably predictable, regular schedules night after night.

Nightmares are simply particularly unpleasant and/or frightening dreams.  They occur out of rapid eye movement (REM) sleep, and are usually recalled–and often recalled well–upon abrupt awakening from dream sleep.  For whatever reason, 2/3 – 3/4 of human dreaming is emotionally negative in nature (I had a distinctly negative dream early this morning, for example, though I wouldn’t classify it as a nightmare; hence I’m writing this entry today!).  Most people don’t need specific treatments for nightmares, and how to treat recurring nightmares is controversial.

I think I’ll write a little about recurring nightmares some time soon.  It might be cathartic for me.

Have a good evening, everybody.  I hope your dreams tonight are positive and pleasant.

Hung Out With My Dad Last Night . . . In My Dreams

I wasn’t planning on writing about what I’m going to share today, but your dreams come upon you when they do.  My father appears in my dreamlife now and then, perhaps once a month or so.  Though sometimes he is a silent, peripheral character somewhere in the background of the strange moving pictures that are my dreams, there are times in which he plays a starring role, such as he did unexpectedly last night.  I awakened briefly from deep non-REM sleep around 3 a.m. this morning and fell back to sleep, and then my movie promptly started.  Here’s what happened.

It’s the dead of night.  Everything is still.  I’m walking down a dimly lit, gently sloped paved driveway carved through a wooded thicket, tall green trees on either side.  It’s a casual, peaceful walk, which I’m taking with my dad, who strides next to me on my right.  We’re having a conversation.  He tells me, in his characteristically direct and blunt manner, that I need to stop walking with my hands in my pockets.  “It doesn’t look good to do that,” he tells me.  I consider his words.  I’m a little taken aback by this reprimand; I don’t put my hands in my pockets anyway, and they aren’t even in my pockets now!  But he’s my dad, and one thing I’ve always known is that he cares for me more than anything and just wants the best for me.  I assure him that I will do my best to keep my hands out in the open.

We enter a home.  It’s not our home, but it feels like it should be, and we enter it as if it is.  The hallways are dark.  We approach the light at the end of the main hall.  It’s the kitchen, small and modest, reflecting the home’s rustic nature, darkened wood throughout, including the furniture and walls.  Dad and I walk instinctively toward the rectangular dinner table inside.  The only light in the room emanates from the small chandelier above us.  It shines like an orange halo around the table, creating a hazy effect on the rest of the kitchen.  I stand behind what must be my designated chair near the wall; Dad stands behind his near the kitchen entrance opposite me.  We look down at the mounds of white rice on plates at the table.  There is a plastic bottle of furikake (a Japanese seasoning made of sesame seeds and dried seaweed bits) on the table.  Still standing, Dad takes the bottle, shakes some seasoning on his rice, and slips the bottle in his right pants pocket.  I watch this and laugh, asking him why he’s putting the furikake in his pocket.  He answers that he wants to bring it with him on his upcoming trip to New York, sheepishly pulling it out and placing it back on the table.  It’s news to me that he will be traveling soon.

I look to my right, where the kitchen counters and sink are.  There’s Mom.  She is facing away from us and toward the counter, cutting up vegetables.  Dad walks over to her.  They are silent together as Mom continues her work.  I follow and slowly wedge myself between them.  “I wish you wouldn’t go,” I tell Dad plaintively as I stand snuggling with my parents, feeling the warmth of both of them close to me.  “Please don’t go.  Please, Dad.  Don’t go.”  Mom smiles silently as I speak, looking down at her cutting board.  I understand that Dad doesn’t have a choice; he has to go away.  Nonetheless, it is satisfying to tell him his presence is wanted, needed.  I am the only person or thing that disrupts the silence in the room.  There is increasing desperation and welling emotion as I continue to implore him not to leave.  

That’s when I awakened abruptly, about 5:30 this morning, wondering how it felt so real, the surroundings, the house, the immediate presence of my dad, when in my real waking life I know that what happened in the dream could never actually happen.  But for the short, precious time I convened with my dad last night, it did happen.  It was real in the moment.

It’s been a rather emotional morning for me.  This sudden, raw conversion back to reality upon awakening overwhelmed me with sorrow, as it does every time Dad costars in my dreams.

Who knows where all this comes from.  I don’t put my hands in my pockets, as a general rule.  I did, however, gently reprimand one of my boys last week for having his hands in his pockets on the court just before the start of his team’s basketball game, telling him he needs to have his hands out and ready for play.  Dad, who lived to 81, lived his entire adult life with remnants of his old war survival mentality; he would take wads of napkins from fast food restaurants, for example, and stuff them in his pockets to take home in the event of a future napkin shortage in the house.  I think the biggest message, though, is how much I miss my dad every day.  Cancer took him from us almost three years ago.  A dream like this reminds me of how much of a presence he still is in my life and the lives of those in my family, especially my mom.  I have photos, videos, and countless memories, of course, but my abilities to interact with him through those media are limited, if not impossible.  As sad as I am awakening from such dreams, I am comforted by knowing that somehow, until the day I die, I will always at least have this one way, however vague and unpredictable, of still interacting with my father from time to time.  It’s kind of a tragic gift, isn’t it, to dream like this.

There will be more to say about my dad, a great man, in future posts, in part because he had REM behavior disorder, an important sleep disorder to discuss.  For now, I need to recover from last night’s proceedings.  However painful it was to awaken, it was good to hang out with Dad again.

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