All About Sleep

Do You Ever Wonder Why You Dream?

It's 6:30 a.m. on a Monday morning and your alarm clock has just sounded. You're forced awake, opening your eyes to a brand new morning. But what happened while you slept? Did you dream? Do you remember those dreams? What did your mind experience while you lay fast asleep?

Richard P. Allen, Ph.D., was online Tuesday, June 13, at 11 a.m. ET to examine sleep cycles and dreaming. He also took questions you may have had about sleep disorders. Allen's board certification is with the American Board of Sleep Medicine. He was the founder and co-director of the Johns Hopkins Sleep Disorders Center from 1978 - 1999. Allen is currently the co-director of the RLS (Restless Legs Syndrome) Center at Johns Hopkins.

Allen earned his Ph. D. in Psychology from the University of Cambridge in Cambridge, England, in 1968. He is a licensed psychologist in the state of Maryland. Allen's current teaching includes a course for juniors and seniors in the Hopkins School of Arts and Sciences: Sleep, arousal and altered states of consciousness (Spring of each year); a Bi-annual lecture to the Abnormal Psychology Course in the Hopkins School of Nursing on Sleep Disorders; Presentation to the Sleep Fellows lecture series, Instruction on scoring and interpreting the polysomnogram for sleep fellows in Neurology; Annual presentation on RLS at the National Sleep Medicine Course (sponsored by the American Academy of Sleep Medicine).

The transcript follows.

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Richard P. Allen, Ph.D.: Hi, welcome to the discussion.

Send in your question and I will try to reply to as many as possible. 

But I will unfortuately not be able to get to all of the questions in this hour.

Look forward to answering as many as I can.

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Rockville, Md.: Hello Dr. I had a sleep study 12 years ago and was diagnosed with sleep apnea. Is it a good idea to have another sleep study every few years, or is once enough? Thank you.

Richard P. Allen, Ph.D.: If you have had any changes in symptoms or in your health or body weight you should definitely have a repeat sleep study. It is sometimes recommended that you have one every few years if you have significant sleep apnea, but you should be guided by your sleep doctor in this regard.

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London, U.K.: Hello Dr. Allen,

Last year, when I began at university, my roommate said that I would talk out loud during nights before major events, like a big test for example. She said that occasionally I would speak to her as well...and frequently the comments were far from friendly. (On one occasion, for example, I asked her if she thought that she was better than everyone else, because she sure acted like it) I could not understand this because we had such a good relationship during the day. What do you think caused this behavior?

Richard P. Allen, Ph.D.: Sleep talking and walking are not uncommon even in adults. They also reflect strange feelings and can sometimes be somewhat combative. These are assumed to relate to the types of emotional stimuli causing the arousal with talking and walking during sleep. They do not have any significance for wake time feelings. Some have reported that people who do this tend to be more pleasant and cooperative in the daytime than most. So maybe this just means you are a really nice person in the daytime.

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Brussels, Belgium: When I was in the army an on a long march, I experienced actual sleeping, while my feet were still marching away. Guess it's what you would call forced sleep walking.

Was I actually asleep and what stage of sleep would that be when the brain seems to let the legs move and the mind rest?

Thank you very much in advance

Richard P. Allen, Ph.D.: Humans, when very sleep deprived, appear to catch sleep with parts of the brain and maybe not all of it ... so you may have been only partly sleeping ...

Other animals, birds and some aquatic mammals, sleep with one half of the brain at a time while the other half is wide awake.

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Greeley, Colo.: Why is it that after you wake up, a very vivid dream escapes so quickly from the mind?

Richard P. Allen, Ph.D.: Memory is very state dependent. What you experience in sleep will be remembered best when you are asleep and least when awake. So if you were to learn something in your sleep you would have to take the test in your sleep.

Dreams may even reoccur when you are asleep but you still cannot recall them shortly after you wake up although, you will remember you had the dream before.

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Alexandria, Va.: Two questions if you have time. First, I had a terrifying dream I forgot my baby at home. I brought my two other children. For the record, I only have two children and no baby right now.

And second, my husband screams in his sleep, wakes up terrified. He and his brothers and sister have done it all their lives.

Any thoughts on that?

Thanks.

Richard P. Allen, Ph.D.: Your husband may be having adult night terrors. If so, it runs in families and is associated with deep sleep -- hard to be awakened and it should occur first in childhood. It is benign, no problem except that it disturbs others and for some, the events lead to sleep loss. If he becomes combative and moves, this may be a different problem but you are not describing that.

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New York, N.Y.: Lately I have been sleep walking several times a week. I usually do something like move my jewelry or some books to a different room or my laptop will be across the room when I wake up. I never remember doing these things. I live alone and am hoping I don't leave my apt. during an episode. I used to sleep walk a lot as a kid but it stopped for years and now that it's started again I am wondering why. Is it a sign of mental illness or just anxiety? How can I get this to stop?

Richard P. Allen, Ph.D.: Sleep walking can return in adult life for several reasons usually unrelated to mental health except you think you're losing your mind when you see what you did in sleep. Usually, it occurs when you have been sleep deprived. Sleep walkers should take care to get adequate sleep at night.  It can also occur more when you are under stress or when you take sleeping medications or drugs for anxiety. The big issue is make sure you have adequate (usually 8 hours) of sleep.

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Washington, D.C.: What's the best way to get your body acclimated to a rapid cycle shift change (i.e. day/night sleep) so you can get decent sleep?

Richard P. Allen, Ph.D.: Changing sleep schedules can be difficult. There are three reasonable guidelines. 1. Arrange to get the proper exposure to sunlight so that your body knows when it is day vs night wherever you are. 2. Melatonin is a signal for darkness and tells your body when a sleep time is approaching so use it accordingly a couple of hours up to shortly before you want to sleep or to extend your sleep if you wake up prematurely. 3. Sleep when you can since sleep loss makes adjustments worse. The exception is sometimes you want to adjust your schedule before travel and may use some mild sleep delay in advance at that time.

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Washington, D.C.: My brother just had several surgeries for sleep apnea. I know I have trouble sleeping and am often tired even after 10 hours of sleep the night before. And my girlfriend says I snore (but she says it is cute). Should I get get checked for sleep apnea? How does one go about doing that?

Richard P. Allen, Ph.D.: If you snore loudly and have significant sleepiness in the day or high blood pressure you should discuss with your doctor visiting a sleep center to be evaluated for sleep apnea. This is particularly true if you are overweight (BMI greater than 26 is bad but if its over 30 you should definitely discuss this with your doctor).

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Tel Aviv, Israel: I have heard that dreams are, in fact, hallucinations. If this is true, I wonder if you could explain how and why this is so.

Thank you very much.

Richard P. Allen, Ph.D.: Dreams are not hallucinations, they involve very different neural activity. There is essentially limited neurological relation between the two.

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Washington, D.C.: Dr. Allen,

Two months ago I lost my younger brother. Since his death, I have only remembered my dreams once. Both were very sad. This is very unusual for me.

Can you explain why it may be happening?

Richard P. Allen, Ph.D.: Emotional trauma often changes the character of our emotions during sleep and this can be expressed in dreams. It is generally considered a normal process that occurs in response to the emotional stress and some think of this as a healthy response to stress.

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Waking up: Sometimes when I wake up suddenly (usually from a nap), I notice that my heart is racing, but only for a few seconds. It calms down straight away. What could be causing this?

Richard P. Allen, Ph.D.: Sudden arousals are often caused by spontaneously occurring autonomic arousal in sleep waking you up. When that happens your heart rate will be fast and you may be sweating or feeling aroused. This caused you to wake up and usually has no clinical significance. If you have other sleep or related health complaints than you should discuss this with your doctor.

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St. Louis, Mo.: Sometimes, I wake up screaming in the middle of the night, esp. after a stressful day. I also suffer from sleep paralysis. What can I do to manage it and stop freaking my husband out?

Richard P. Allen, Ph.D.: If you have no other sleep related problem this sounds like night terrors.  Consider two actions 1. ensure you are getting adequate sleep since sleep deprivation makes this worse 2. discuss with your doctor or a sleep doctor the possibility of taking a medication that usually almost stops these events.

Of course, you and your husband could sleep in separate rooms, but who wants to do that?

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Baltimore, Md.: Where can I go to get treated for Night Eating Syndrome? I've been to see a psychiatrist at an eating disorder center but she is not knowledgeable about it at all.

Richard P. Allen, Ph.D.: Most fully accredited sleep disorders centers know about the night eating syndromes (there are two types recognized in the most recent list of sleep disorders). Ask your family doctor or your psychiatrist to refer you to an accredited sleep center (many sleep centers are not accredited and there you are less likely to find the full range of expertise needed to address your disorder).

You can also contact the American Academy of Sleep Medicine on the Web.

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Annapolis, Md.: Fascinating conversation and topic. Question: Husband snores (loudly -- not cute) and occasionally shrieks in sleep (I saw earlier post, thank you). Is it a problem if I wake him in either case? Any good remedy for loud snoring that does not involve surgery? (No BMI issues, may have mild apnea.)

Richard P. Allen, Ph.D.: Again, ensure adequate sleep. Alcohol before bed or late in the evening will make this worse (having beer in the morning is not a good idea for other reasons though). Loud snoring can be positional and there are devices that help people not sleep on their back .. aside from that weight loss even within the normal range of weight may help.  Not much else does except dental appliances -- ask your dentist and surgery.  You might check with your local sleep doctor about this.

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Washington, D.C.: Is there any way to stop myself from talking in my sleep or somehow make sure it happens less? I seem to disturb my roommates with my talking and sitting up in my bed without waking up.

Richard P. Allen, Ph.D.: Sleep more ... (use naps if you need to in order to get more sleep)

Avoid stress...

And if it's really a problem discuss medications with you doctor or sleep alone.

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Virginia: My 42-year-old husband has started snoring loudly every night. He has always snored occasionally, but for the past few months he has done it every night, no matter what position he sleeps in. He has tried the over-the-counter nasal strips, but they did not help. I'm frustrated because he keeps me awake at night, but I'm also concerned about his health. Your thoughts?

Richard P. Allen, Ph.D.: Sudden worsening of snoring may suggest development of significant sleep apnea ... he may need more sleep but this sounds a bit more significant.

If your husband has high blood pressure, is sleepy in the day or is overweight than you should get an evaluation from sleep doctor.

In any case, have him discuss this with your family doctor.

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Washington, D.C.: Many years ago I read an article in Discover about lucid dreaming and how to have some control over ones' dreams. I had the most wonderful flying dream once and want so much to have it again. Is it possible to "direct" ones dreams, even a little bit? I sometimes speak another (unknown) language in my dreams. Is this common?

Richard P. Allen, Ph.D.: Yes, lucid dreaming is possible and there are those who feel they can teach others to do this.

I am not certain about this but I think you can find out more online or in one of the recent books published on lucid dreaming.

Good luck searching for your dreams.

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Washington, D.C.: Hopefully its not too late to submit a question. I'm in my third trimester and have a horrible time sleeping. Not just uncomfortable (I managed around that), but I feel really restless, especially my legs. (of course there are calf cramps but that's another question). Can you offer any advice?

Richard P. Allen, Ph.D.: There are lots of sleep problems during pregnancy including restless legs syndrome ...

There is not much you can do since the medications are not a good idea. Make sure your folate and iron status is good. Improving these may improve your sleep.

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Alexandria, Va.: I have a comment about my own experience trying to get a good night's sleep over many years. After seeing a therapist to get cognitive-behavioral help with getting to sleep, rather than relying solely on medication, I discovered that I am a highly sensitive person. Apparently, my brain reacts much more strongly to sensory stimuli such as noise, light, smells, etc. than the brain of an average person (about 15 percent of the population is like me), so a lot of the things I was doing to "relax" in the evenings, like watching TV and surfing the Internet, were actually getting my brain ramped up so it was even harder to turn it off and go to sleep. So, now I have a routine that includes relaxing music, low lights, NO violent TV shows or movies, and some light reading, and sleep is coming SO much easier. I just wanted to throw this out there in case any of the chatters were interested. There are a variety of books and Web sites about the topic.

Richard P. Allen, Ph.D.: Yes, cognitive behavior therapy is one of the best approaches to physiological insomnia and in the long run works better than medication.

But it takes a bit of work and a reasonable assistance from a therapist for some others can read about it and do it without a professional.

Try reading first ... then seek other help if needed.

Medications are okay if needed, but there are other approaches to insomnia.

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Rockville, Md.: What is the recommended number of hours of sleep per night for men and women who are 35 to 45 years old, in general?

Also, what is the current recommended number of hours of sleep per night for teens ages 13 to 19?

You wouldn't believe how many varied answers these questions get in conversation.

Medical health professionals still need to do more P.R. and public awareness about just how much sleep people need every night.

Thanks for the information.

Richard P. Allen, Ph.D.: We have no firm guidelines only wide ranges of what seems to be required.

The rule is that everyone should sleep as much as needed to make sure they are wide awake and refreshed for the whole day - including awake during the midday drowsy period. 

Less than five hours of sleep is likely to be a significant problem.

More than 10 hours is also likely to indicate a problem.

In between is hard to judge.

The general rules is seven to eight for those over 30, more for those younger.

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Washington, D.C.: My husband tells me that when I sleep I am constantly move my feet, swishing them back and forth throughout the night and oftentimes at a brisk pace. I am not aware that I do this, nor experience any ill effects. However, it does disturb his sleep and awakens him frequently. Is there a cause for this or anything I can do to prevent it?

Richard P. Allen, Ph.D.: Yes, you can talk to your family doctor about this. If you have no problems in the daytime with being able to sit still or rest then you may not want to take any medication, but there are medications that reduce these movements and they work quite well. Again make sure you have adequate sleep and good, regular sleep habits.

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Rockville, Md.: Once, some years ago, I got up at night and did what people usually do when they get up at night. I noticed a spot in my vision near the center. It had the look of a ball of yarn made of glowing materials. When I got back in bed, this expanded and became the visual part of a dream. (I go to sleep quickly.)

Is this a part of dreams that we know very much about? I have never known a persistent dream before this.

Richard P. Allen, Ph.D.: It sound as if you may have been dreaming the entire time.

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San Antonio, Tex.: Hello Dr. Allen, I was wondering if there is a concept of "catching up" on sleep over weekends. Leading a busy graduate student life, I don't get to sleep my regular hours of sleep and tend to sleep- in over weekends. Does that help the body? Thanks!

Richard P. Allen, Ph.D.: Yes, when you are sleep deprived, allow your body to sleep more after the sleep deprivation is over. It may take several nights of longer sleep before your bodily drive for sleep is back to normal.   Let the long sleep continue until you no longer feel a need for it.

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Fairfax, Va.: I have neighbors who do aerobics at 4:40 in the morning. The shaking wakes me up. This morning when I was yanked away from the dream world, I remember smelling something in my dream. Do we "use" our senses in dream?

Richard P. Allen, Ph.D.: Yes, and we incorporate external stimuli from the environment around us in the dream content.

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Ferndale, Mich.: What is the best way to treat insomnia unrelated to stress or medical illness?   I have had trouble sleeping since I was a child and while I have periods of being able to fall asleep quickly and stay asleep, I can usually only keep it up one week or so and then am back to the struggle.

Richard P. Allen, Ph.D.: Consider cognitive behavior therapy but first have a good sleep evaluation by an expert.

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Portland, Ore.: I have night terrors, waking up screaming and sometimes sleep walk. What therapies are available for this? I'm 59 years old.

Thanks

Richard P. Allen, Ph.D.: If you have these at this age and did not have them before, you should discuss them with your family doctor and probably should seek a referral to a sleep specialist. There are some good treatments for this problem and it is important that you get treated rather than do something that might hurt yourself in sleep.

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Erie, Pa.: I'm a student on vacation and I've found myself in the most horrible sleep pattern. I sleep during the day and am wide awake at night. This sometimes occurs during finals as well. I usually attribute it to napping and being overworked by classes. I can and have changed this pattern back to the regular sleeping during the night schedule, so this isn't a permanent thing, but my questions are:

- am I losing anything by not sleeping at night? Hormone production or some such?

- does my preference to sleep during the day indicate anything that I should be concerned about?

Thank you for your time.

Richard P. Allen, Ph.D.: Occasionally sleeping at odd hours is not seen as a problem as long as you can switch back, the critical thing is to ensure you get adequate sleep.

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Hyattsville, Md.: Sometimes when I am asleep (not dreaming), I feel like a sense of awareness and I try to get up or move but cannot do anything... I try it so hard, nothing happens...And finally, after struggling for while, then I get up. Is this something something normal?

Richard P. Allen, Ph.D.: Sleep paralysis like you describe is not uncommon

and usually has no clinical significance.  It occurs more for women and tends to

run in families.  If you are sleepy in the day or sleep deprived, you should

discuss this with your doctor.

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Anonymous: Are dreams mostly the filing of information in our brains? Do dream analysts overemphasize what things mean?

Richard P. Allen, Ph.D.: Yes, dream analysts overemphasize, but then some also underemphasize the importance of dreams' content.

They have some limited meaning for normal psychological status when awake.

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Bloomington, Ind.: Is it true that you should sleep in total darkness to maximize your body's melanoma-producing mechanisms?

Richard P. Allen, Ph.D.: It won't matter much unless you sleep with your eyes open or have very bright lights on you.

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Southern Maryland: Hello - thanks for today's topic. My mother suffers from narcolepsy. She had a very difficult time being diagnosed and treated - most doctors just blew her off. She found a neurologist who worked with her and got her medications under control. This Dr. recently retired. Any suggestions for finding a specialist? This disease seems to be very misunderstood. Would she benefit from a teaching hospital or a specialized sleep clinic? If yes, how do we find such places? She lives in Dayton, Ohio. THANKS

Richard P. Allen, Ph.D.: Contact the American Academy of Sleep Medicine.

There are some improved drugs newly available for treatment of narcolepsy.

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Portland, Ore.: Margaret Thatcher said she only slept four or five hours a night and after a time, she didn't miss the sleep.

Can we train our bodies to work well on a reduced sleep schedule?

Do high achievers (like her) typically sleep less than the rest of us?

Richard P. Allen, Ph.D.: We have certain sleep needs and when do not meet them our body will start catching short naps.

I understand that was true for the iron lady of Britain also.

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Alexandria, Va.: Is it true that lifelong insomnia (starting at childhood) is very resistant to treatment?

Richard P. Allen, Ph.D.: It can be very difficult to treat but not impossible.

Consider seeking a sleep specialist.

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Harrisburg, Pa.: About how much sleep does a nine year old require? Is there harm in letting a nine year old stay up as late as she wants, even if it is often until midnight? If so, what is that harm?

Richard P. Allen, Ph.D.: The problem with letting children stay up late is that they do not get enough sleep when they are forced to get up for school ...

Most children really need at least 9 hours of sleep and some a bit more.

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Richard P. Allen, Ph.D.: I am sorry that I could not answer all of your questions but have enjoyed this chat time with you all.

I have to go to clinical work, but wish you all better sleep and pleasant dreams.

Perhaps we can chat again anon.

I am now leaving the chat room.

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