Text of PowerPoint slides used by Dr. Leibowitz at February 2, 2005 A.W.A.K.E. meeting.

1. Sleep and Dreams
Scott Leibowitz, MD
Stanford Sleep Disorders Center,  Stanford, CA

2. Sleep and Dreams
“Dreams are real while they last. Can we say more of life?”

3. Sleep and Dreams
98% of what the brain does is outside of conscious awareness (vision, visuospatial relationships and navigating through the world, fine and gross motor movements, etc…).

4. States of Consciousness
Wake
Non-REM sleep
REM sleep
Brain activity during each state of consciousness is unique and helps to understand the accompanying mental activity.

5. What is Dreaming?
Mental activity while we are asleep that can be described during waking consciousness.
Prior to the discovery of the various stages of sleep in the 1950’s, the prevailing scientific attitude was that the brain essentially shut down and remained in a passive state during sleep.
Rather, while there is a slowing of brain activity during sleep there is also a regular activation akin to waking consciousness where most vivid dreaming occurs.

6. Overview of Sleep
Sleep is a progressive slowing of brain wave activity until REM sleep occurs. A sleep cycle is defined as progression through the various stages of sleep through the end of a cycle of REM sleep. Normally, this occurs about 5 time a night.
Stage 1 (3-5%)
Stage 2 (45-50%)
Stages 3 & 4 (Slow Wave or “Deep Sleep”) (25%)
REM sleep (25%) (REM sleep paralysis)

7. When do we Dream?
In a normal brain, everyone dreams, every night.
All mammals dream (or at least experience REM).
Can occur at any stage of sleep and has been found to occur throughout the night.
Dreams during different stages of sleep tend to have different characteristics with dreams.

8. Dream Characteristics
Sleep-onset dreams tend to be more thought-like and simple, without characters or a plot-line, perhaps about an activity or interaction that had occurred that day, with little emotional content.
NREM dreams tend to have emotion without extensive plot development (non-progressive)
REM dreams are usually vivid, bizarre, hallucinatory and delusional, with extensive plot lines and characters.
-REM sleep has been repeatedly found to be the stage of sleep most highly correlated with dreaming (>70- 80%).
A caveat to this is that bizarre REM-like dreams can and do happen outside of REM. Hobson. Dreaming. Pg 8.

9. Theories of Dreaming
Why we dream, what we dream, and from where dreams originate, is and has historically been, a contentious topic of debate.
To date, there is no consensus as to the exact origins of dreams and the purpose it serves…..

10. Theories of Dreaming
Typically have addressed three questions:
How are dreams produced?
The function or purpose of dreams?
Meaning of dreams?

11. How dreams are produced
As sleep ensues, activity in nearly all parts of the brain slow, but the area that slows the greatest is the prefrontal cortex region (responsible for logical thinking, problem solving, planning).
Also, norepinephrine and serotonin levels (help us focus attention and solve problems when we are awake) taper off .
Acetylcholine turns on and REM sleep occurs.
Dopamine may be what is directly responsible for dreaming. Mark Solms

12. How dreams are produced
When REM sleep begins, all the areas that were turned off in NREM sleep gear up except one; the logical, reasoning portion of the prefrontal cortex.
So, effectively, your brain is activated save the portion that controls logic and reason.

13. How dreams are produced
This is why our dreams seem so real but appear to be a hallucinatory world, much like that of a waking schizophrenic.
In fact, brain imaging studies have shown that the functional anatomy of dreaming is almost identical to that of a schizophrenic psychosis, except that for dreamers, the visuospatial system is highly charged while the audioverbal system is highly charged in schizophrenics (i.e. hearing voices).
Solms and Turnbull’s The Brain and the Inner World, pg 213

14. How dreams are produced
While dreaming, most importantly, the limbic system, responsible for the brain’s long term emotional center is highly active during REM sleep…effectively driving the boat of your dream (stimulated 15% above waking levels).
The amygdala, a structure in the brain responsible for the “fight or flight” response, is part of the limbic system that is highly active during sleep.
The amygdala is also an important structure in memory, particularly long term emotional memory.

15. How dreams are produced
With the emotional memory center of your brain driving the boat and the logic and reason part of your brain not even a passenger, it is no wonder dreams will frequently have an emotionally charged, hallucinatory, even psychotic nature to them.
While dreaming, thoughts are linked through emotion, not logic.

16. How dreams are produced
The visual cortex is shut down but the visual association area is active above waking levels, which is the area of the brain that is involved in creating mental images and recognizing faces.
This is why dreams are so richly visual, but if someone pries open your eyelids and shines a light in your eyes, you won’t see it.

17. How dreams are produced
Development of visual imagination are a prerequisite for vivid dreaming.
Studies looking at children’s dreams showed that children younger than age 5 typically consist of brief, bland static images (animals, eating, sleeping, or daytime activities).
Between 5 and 8 years of age, dreams become more complex but it is not to around age 11 where dreams take on the characteristic complex plot lines like that of adults.
David Folkes. Taken from The Mind at Night. Rock, A. pp 31-38.

18. How dreams are produced
Not until the age of 7 can children form visual imagery in waking consciousness, which means they don’t have the capacity to do the same while dreaming.
As children develop greater visuospatial cognitive capacity and imagination and a clearer understanding of “self,” their capacity to dream develops as well.

19. How dreams are produced
“With the emergence of active self-representation, of autobiographical memory, and of a sensed self that lends continuity to experience, the human person emerges. We dream because we have achieved consciousness.” David Folkes. Taken from The Mind at Night. Rock, A. pp 31-38.

20. How dreams are produced
Throughout sleep, the area of the brain that is responsible for putting memories in sequential order and to temporarily store on-going events (short term memory) is turned off.
Also, the chemicals involved in memory formation (NE and Serotonin) are lacking and therefore we typically don’t remember our dreams unless we wake up during or right after a dream. J. Allan Hobson (taken from The Mind at Night. Rock, A. pg 20.)

21. How dreams are produced
Dr. Allen Braun has theorized that dreams are imprinted in our brain which is why we sometimes will see something in our waking day which reminds us of a fragment of a dream from the previous night that we have no true recollection of.
Taken from The Mind at Night. Rock, A. pg 52.

22. How dreams are produced
Brain structures involved in long-term memory formation and retrieval are more active than when we are awake (i.e. your kindergarten teacher riding next to you on the way to the football game).

23. How dreams are produced
So, the structures that we rely on in our brain for our waking construct of reality are only partially turned on during dreaming sleep, with the rational, logical part of our brain turned off.
The chemicals which help us to focus attention and stay on track are in short supply.
Additionally, we rely upon internal input (i.e. our brain), rather than external input (i.e. our senses…sight, smell, etc) for our mental construct during dreaming.

24. How dreams are produced
It is important to remember though that dreams are like thoughts; from whence they originate, no one knows….

25. Why we dream
No one knows for sure:
Evolutionary Theories
Memory and Learning Consolidation Theories
Brain development & neural networking
Mood regulation theories
Maintaining and redefining self

26. Why we dream
One theory suggests that dreaming has evolved as a time to rehearse out behaviors that are essential to survival during waking hours.
Most frequent drama reported during dreaming, across all cultures (including small tribal societies) is being pursued by someone or something. Tore Nielson; Taken from The Mind at Night. Rock, A. pg 68.

27. Why we dream
That dreams, at least in part, are actually genetically encoded survival-related data inherited from lower species.
A “virtual reality” testing ground to simulate threatening scenarios in a safe place.
Hence, REM-sleep paralysis evolved.
-Antii Revonsuo; Taken from The Mind at Night. Rock, A. pg 71.

28. Why we dream
Infants are in REM sleep about 50% of the time.
What is likely happening is that REM sleep is actually help development of neural circuitry that will help pass along this genetically encoded information.

29. Why we dream
Memories are formed by activating specific, interconnected brain cells (neurons) that tie together a memory. When a memory is replayed, it reactivates the firing pattern of those same neurons and causes an anatomical change in which the connections grow stronger the more they are replayed….transforming short term memories to long-term ones.

30. Why we dream
Memory consolidation during dreaming evolved as the brains of mammals evolved to higher cognitive functioning with increased ability to plan and decision-make.
Allowed integration of lessons learned while awake without requiring larger brain matter to facilitate the processing of the information (i.e. enormous prefrontal cortex)
Jonathan Winson; Taken from The Mind at Night. Rock, A. pg 68.

31. Why we dream
Crick and Mitcheson propose the idea of “reverse learning”, a memory reorganizing, where extraneous information makes its way into dream material on its way out of the memory stores….
Francis Crick and Graeme Mitchison. The Function of Dream Sleep.

32. Why we dream
As we sleep, our brains are working hard to save the experiences that we will carry around with us for the remainder of our lives by replaying variations of the event…while less important events receive little attention, thus paving the way for forgetting. Daniel Schacter

33. Why we dream
Rosalind Cartwright theorizes that dreaming plays a part in mood regulation, helping us process negative emotions so that we wake up in a better mood than when we went to sleep.
Studies have showed that 2/3 of emotions in dreams are negative.
By playing out negative emotions during dreaming, we are working through, resolving, and integrating these emotions so that we are better equipped to deal with the source of our conflict in our waking lives.

34. Why we dream
Support for this theory was found in the difference of dreams in a study of people going through marital breakups. Those who were able to recover and get on with their lives had significantly different dreams than those who remained mired in depression.
Rosalind Cartwright. Taken from The Mind at Night. Rock, A. pg 102.

35. Why we dream
Is dreaming a mechanism for us to tap into our creative mind? Problem solve? Break down barriers created by the conscious construct of our waking lives?
Paul McCartney woke up humming the entire song “Yesterday” before it had ever been written (the original lyrics in fact were “Scrambled eggs, oh my baby, how I love your legs…”)
Jack Nicklaus corrected his swing in the 1960’s by having a dream which showed he was holding his club incorrectly.
Donald J. Newman, a mathmatician at MIT, was stuck on a problem and had a dream he was having lunch with John Nash who showed him the answer (Nash was given partial credit for the theory).

36. Why we dream
Perhaps because various aspects of our waking brain are inactive during sleep, so too are various constructs which limit our capacity to “think outside the box”.

37. What do dreams mean?
Civilizations have been hypothesizing the meaning of dreams since the dawn of humankind….but we’ll jump to the 20th century for brevity’s sake.

38. What do dreams mean?
Sigmund Freud wrote The Interpretation of Dreams in 1900 which proposed that dreams spring from subconscious wishes (primarily sexual or aggressive) that the conscious mind (the ego) suppresses during the day.
He described dream interpretation as “the royal road to understanding the unconscious activities of the mind.”
Effectively, the majority of characters and symbols in a dream could be interpreted as an expression of erotic wishes.

39. What do dreams mean?
Carl Jung, Freud’s protégé, split from Freud as he felt that dreams were not just a storehouse of repressed wishes, but rather more importantly, acted as a guide, friend, and advisor.
Jung saw dreams as means of communication, to bring unconscious information to the conscious awareness.
That the content of the dream was most important
Not that symbolism did not exist; if fact, he felt that the dream could touch on the “collective unconscious”, the elements in everyone’s unconscious that derive from the experiences of all mankind, frequently represented by archetypal characters (wise old man….the earth mother).

40. What do dreams mean?
J. Allan Hobson and Robert McCarley theorized in 1977 that dream content arose from the brainstem (which controls turning on and off REM and NREM sleep) and that dream content had “no primary ideational, volitional, or emotional content.”
The resulting dream was the product of the higher cortical structures making the best of the erratic signals it was receiving.

41. What do dreams mean?
This theory was later disproved when it was found that people could still dream despite having damage to their brainstem.

42. What do dreams mean?
So then, what do dreams mean?

43. What do dreams mean?
Dreams likely help us to “contextualize” emotion in visual form which can act as a form of “automatic internal therapy”…
Psychotherapy and dreaming offer the same therapeutic benefit: allowing connections to be made in a safe place
Ernest Hartmann. Taken from The Mind at Night. Rock, A. pp 113-115.

44. What do dreams mean?
“When there is no therapy involved and researchers are just tracing what happens after trauma, people who get better are most likely to be the ones that are having dreams which work through the issue and also tend to be the ones who have good social support.”
Diedra Barrett. Taken from The Mind at Night. Rock, A pg 116.

45. What do dreams mean?
What is likely is that while some dream content may reflect content that correlates to the dreamer’s current waking concerns, represented by thought-like mental activity, other portions may be metaphoric expressions of those concerns, while others may be confabulated…a sort of wing-it, filler content, made up by the left brain, which has been shown to fill in missing data in split-brain experiments in waking people.Summarized by the work of Michael Gazzaniga; Taken from The Mind at Night. Rock, A. pp124-128.

46. What do dreams mean?
So, then, how much stake can we put into the meaning of our dreams?
Depends on the dream!
-To assume that every dream is worthy of interpretation would be to assume that every thought or every word uttered was meaningful.
-most dreams are boring and mundane…
-vivid, emotionally charged dreams are likely worthy of interpretation.
-keep in mind though that some aspects of dream content may just be “freewheeling improvisation” that the brain undergoes when all input from the external world is shut-out and the brain is left to its own devices for input.

47. What do dreams mean?
Universal dream symbols:
To rely on these to derive meaning from dreams is underestimating the brain’s creativity in conjuring up scenes that reflect our daily concerns.

48. What do dreams mean?
There are some consistent symbols though that have been reported:
Water=emotions
Snakes=enemies
Ocean=state of the ocean implies state of your life
Lion=greatness and honor
Death=change

49. What do dreams mean?
From a scientific standpoint, it’s unlikely we will ever be able to conclude definitively what a dream means…but perhaps we can use dreams as an insight into our emotional preoccupations…..Meaning is in the eye of the beholder.

50. Lucid Dreaming
Pioneered by Stephen LaBerge, but practiced by Tibetan Buddhist Monks (called “Dream Yoga”) for more than 1,000 years.
A technique of conscious dreaming…while asleep and dreaming, becoming aware consciously that you are in fact dreaming and potentially controlling the outcome of the dream
Possible therapeutic applications?

51. Sleep Disorders and Dreaming
REM Behavioral Disorder
Nightmares &/or PTSD
Partial Arousal Disorders (sleep walking/sleep eating/night terrors/confusional arousals, Enuresis)
Narcolepsy
OSA/PLMD

52. Conclusion
“Dreaming is, above all, a time when the unheard parts of ourselves are allowed to speak.”
-Diedra Barrett