The nature of delayed dream incorporation ('dream-lag effect'): Personally significant events persist, but not major daily activities or concerns

Clinical correlates of drug-related dreams in opioid use disorder

BACKGROUND AND OBJECTIVES

Drug-related dreams are commonly reported by individuals in treatment for substance use disorders, which may be distressing. Existing evidence suggests that dream recollection may be influenced by clinically relevant phenomena, such as opioid use and withdrawal, general sleep disturbance, affective symptoms, and chronic pain. However, very few studies have explored drug-related dreams among individuals who screened positive for opioid use disorder (OUD).

METHODS

Adults recruited from Amazon Mechanical Turk (MTurk) who screened positive for OUD (N = 154) completed a questionnaire about drug-related dreams, as well as measures assessing sleep, opioid use history, stress, anxiety, and chronic pain. χ² analyses, one-way analysis of variance, and bivariate correlations, correcting for the false discovery rate, were used as appropriate to explore correlates of (1) recollecting a drug-related dream, and (2) experiencing post-dream craving and distress.

RESULTS

Individuals who recollected a past-week drug-related dream were more likely to report other recent sleep disturbances, including poorer sleep quality, greater insomnia symptoms, and a higher risk for sleep apnea. Post-dream craving and distress were both associated with greater insomnia symptoms, poor sleep hygiene behaviors, and greater anxiety symptoms. Individuals who had ever experienced a drug-related dream (recently, or in their lifetime) were more likely to report a history of severe withdrawal, overdose, and intravenous opioid use.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Drug-related dreams were common among individuals in the present sample and were related to other clinically relevant phenomena. Interventions that treat co-occurring OUD, pain, sleep symptoms, and affective symptoms may improve overall well-being in this population.

Stuck in a lockdown: Dreams, bad dreams, nightmares, and their relationship to stress, depression and anxiety during the COVID-19 pandemic

BACKGROUND

An upsurge in dream and nightmare frequency has been noted since the beginning of the COVID-19 pandemic and research shows increases in levels of stress, depression and anxiety during this time. Growing evidence suggests that dream content has a bi-directional relationship with psychopathology, and that dreams react to new, personally significant and emotional experiences. The first lockdown experience was an acute event, characterized by a combination of several unprecedent factors (new pandemic, threat of disease, global uncertainty, the experience of social isolation and exposure to stressful information) that resulted in a large-scale disruption of life routines. This study aimed at investigating changes in dream, bad dream and nightmare recall; most prevalent dream themes; and the relationship between dreams, bad dreams, nightmares and symptoms of stress, depression and anxiety during the first COVID-19 lockdown (April-May 2020) through a national online survey.

METHODS

968 participants completed an online survey. Dream themes were measured using the Typical Dreams Questionnaire; stress levels were measured by the Cohen's Perceived Stress Scale; symptoms of anxiety were assessed by Generalized Anxiety Disorder (GAD-7) scale; and symptoms of depression were assessed using the Quick Inventory of Depressive Symptomatology.

RESULTS

34% (328) of participants reported increased dream recall during the lockdown. The most common dream themes were centered around the topics of 1) inefficacy (e.g., trying again and again, arriving late), 2) human threat (e.g., being chased, attacked); 3) death; and 4) pandemic imagery (e.g., being separated from loved ones, being sick). Dream, bad dream and nightmare frequency was highest in individuals with moderate to severe stress levels. Frequency of bad dreams, nightmares, and dreams about the pandemic, inefficacy, and death were associated with higher levels of stress, as well as with greater symptoms of depression and anxiety.

CONCLUSIONS

Results support theories of dream formation, environmental susceptibility and stress reactivity. Dream content during the lockdown broadly reflected existential concerns and was associated with increased symptoms of mental health indices.

Targeted memory reactivation has a sleep stage-specific delayed effect on dream content

Although new learning is known to reappear in later dream scenarios, the timing of such reappearances remains unclear. Sometimes, references to new learning occur relatively quickly, 1 day post-learning (day-residue effect); at other times there may be a substantive delay, 5-7 days, before such references appear (dream-lag effect). We studied temporal delays in dream reactivation following the learning of a virtual reality (VR) flying task using 10-day home sleep/dream logs, and how these might be influenced by targeted memory reactivation (TMR). Participants were exposed twice to a VR task in the sleep laboratory; once before and once after a 2-hr opportunity to nap (n = 65) or to read (n = 32). Auditory cues associated with the VR task were replayed in either wake, rapid eye movement (REM) sleep, slow-wave sleep (SWS) or were not replayed. Although we previously showed that TMR cueing did not have an immediate effect on dream content, in the present study we extend these results by showing that TMR in sleep has instead a delayed effect on task-dream reactivations: participants dreamed more about the task 1-2 days later when TMR was applied in REM sleep and 5-6 days later when it was applied in SWS sleep, compared to participants with no cueing. Findings may help explain the temporal relationships between dream and memory reactivations and clarify the occurrence of day-residue and dream-lag phenomena.

The Effects of Sleep Quality on Dream and Waking Emotions

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into waking and dream emotional experience remains unclear. We have previously described a discontinuity between wakefulness and dreaming, with a prevalence of positive emotions in wakefulness and negative emotions during sleep. Here we aim to investigate whether this profile may be affected by poor sleep quality. Twenty-three ‘Good Sleepers’ (GS) and 27 ‘Poor Sleepers’ (PS), identified through the Pittsburgh Sleep Quality Index (PSQI) cut-off score, completed three forms of the modified Differential Emotions Scale, assessing, respectively, the frequency of 22 emotions over the past 2 weeks, their intensity during dreaming and during the previous day. The ANOVA revealed a different pattern of emotionality between groups: GS showed high positive emotionality in wakefulness (both past 2 weeks and 24 h) with a significant shift to negative emotionality in dreams, while PS showed evenly distributed emotional valence across all three conditions. No significant regression model emerged between waking and dream affect. In the frame of recent hypotheses on the role of dreaming in emotion regulation, our findings suggest that the different day/night expression of emotions between groups depends on a relative impairment of sleep-related processes of affect regulation in poor sleepers. Moreover, these results highlight the importance of including sleep quality assessments in future dream studies.

Relationships between Dream and Previous Wake Emotions Assessed through the Italian Modified Differential Emotions Scale

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into wake and dream emotional experience remains unclear. Here, we aimed to assess dream emotions and their relationships with wake emotions through the modified Differential Emotions Scale (Fredrickson, 2003), which includes a broad array of both positive and negative emotions. The scale has been first validated on 212 healthy Italian participants, in two versions: a WAKE-2wks form, assessing the frequency of 22 emotions over the past 2 weeks, and a WAKE-24hr form, assessing their intensity over the past 24 h. Fifty volunteers from the wider sample completed the WAKE-24hr mDES for several days until a dream was recalled, and dream emotions were self-reported using the same scale. A bifactorial structure was confirmed for both mDES forms, which also showed good validity and reliability. Though Positive and Negative Affect (average intensity of positive and negative items, PA, and NA, respectively) were balanced in dreams, specific negative emotions prevailed; rmANOVA showed a different pattern (prevalence of PA and positive emotions) in wake (both WAKE-2wks and WAKE-24hr), with a decrease of PA and an increase of NA in the dream compared to previous wake. No significant regression model emerged between waking and dream affect, and exploratory analyses revealed a stable proportion of PA and NA (with prevailing PA) over the 3 days preceding the dream. Our findings highlight a discontinuity between wake and dream affect and suggest that positive and negative emotions experienced during wake may undertake distinct sleep-related regulation pathways.

Integration of waking experience through dreams considered in light of individual differences in implicit learning ability

The present study explored whether individual differences in implicit learning were related to the incorporation of waking events into dreams. Participants (N = 60) took part in a sequence learning task, a measure of implicit learning ability. They were then asked to keep a record of their waking experiences (personally significant events [PSEs]/major concerns), as well as their nightly dreams for a week. Of these, the responses of 51 participants were suitable for further analysis in which participants themselves and three independent judges rated the correlation between waking events and dreams of the same day. Implicit learning ability was found to significantly correlate with the incorporation of PSEs into dreams. The present results may lend support to the Horton and Malinowski autobiographical memory (AM) model, which accounts for the activation of memories in dreams as a reflection of sleep-dependent memory consolidation processes that focusses in particular on the hyperassociative nature of AM during sleep.

A Paradigm for Matching Waking Events Into Dream Reports

In this study, participants recorded their waking events (Personal significant events, PSEs/Major concerns, MCs) and dream reports for 7 days. These events and dreams were paired by the same day (216 PSEs-dreams pairs and 215 MCs-dreams pairs). Then participants were instructed to both find similar features (characters, objects, locations, actions, emotions, and themes) of their events-dreams pairs and give a match score of their events-dreams pairs. Besides, we proposed a method for independent judges to match waking events into dreams (the external ratings). The rating standard of the external-ratings was to look for similar behaviors between events and dreams. Based on this rating standard, three independent judges were instructed to rate participants’ events- dreams pairs. Firstly, we compared the two kinds of methods of self-ratings. Spearman correlations showed that the two methods were significantly correlated with each other. These results suggested that the sum of different kinds of similar features could be used to represent self-ratings reported of the degree of the correlation between a waking event and a dream. Regression correlations showed that for PSEs-dreams pairs, actions, emotions, and themes were similar features that affected the degree of the correlation between an event and a dream of the same day, and for MCs-dreams pairs, emotions, and themes were similar features that affected the degree of the correlation between an event and a dream of the same day. These results suggested that different kinds of similar features had different influence on the self-ratings’ evaluation for the degree of matching between waking event and dream. Secondly, we compared the rating results of the self-ratings and the rating results of the external-ratings. Spearman correlations showed that the results of the self-ratings were significantly correlated with the results of the external-ratings. So this study’s method for the external ratings may be suitable for future studies. Besides, as the external ratings of this study can rate dream metaphors, we also made a short discussion on dream metaphors. Future studies can use the method to explore dream metaphors.

Predicting the affective tone of everyday dreams: A prospective study of state and trait variables

Although emotions are reported in a large majority of dreams, little is known about the factors that account for night-to-night and person-to-person variations in people’s experience of dream affect. We investigated the relationship between waking trait and state variables and dream affect by testing multilevel models intended to predict the affective valence of people’s everyday dreams. Participants from the general population completed measures of personality and trauma history followed by a three-week daily journal in which they noted dream recall, valence of dreamed emotions and level of perceived stress for the day as well as prior to sleep onset. Within-subject effects accounted for most of the explained variance in the reported valence of dream affect. Trait anxiety was the only variable that significantly predicted dream emotional valence at the between-subjects level. In addition to highlighting the need for more fine-grained measures in this area of research, our results point to methodological limitations and biases associated with retrospective estimates of general dream affect and bring into focus state variables that may best explain observed within-subject variance in emotions experienced in everyday dreams.

The Functional Role of Dreaming in Emotional Processes

Dream experience (DE) represents a fascinating condition linked to emotional processes and the human inner world. Although the overlap between REM sleep and dreaming has been overcome, several studies point out that emotional and perceptually vivid contents are more frequent when reported upon awakenings from this sleep stage. Actually, it is well-known that REM sleep plays a pivotal role in the processing of salient and emotional waking-life experiences, strongly contributing to the emotional memory consolidation. In this vein, we highlighted that, to some extent, neuroimaging studies showed that the processes that regulate dreaming and emotional salience in sleep mentation share similar neural substrates of those controlling emotions during wakefulness. Furthermore, the research on EEG correlates of the presence/absence of DE and the results on EEG pattern related to the incorporated memories converged to assign a crucial role of REM theta oscillations in emotional re-processing. In particular, the theta activity is involved in memory processes during REM sleep as well as during the waking state, in line with the continuity hypothesis. Also, the gamma activity seems to be related to emotional processes and dream recall as well as to lucid dreams. Interestingly, similar EEG correlates of DE have been found in clinical samples when nightmares or dreams occur. Research on clinical samples revealed that promoting the rehearsal of frightening contents aimed to change them is a promising method to treat nightmares, and that lucid dreams are associated with an attenuation of nightmares. In this view, DE can defuse emotional traumatic memories when the emotional regulation and the fear extinction mechanisms are compromised by traumatic and frightening events. Finally, dreams could represent a sort of simulation of reality, providing the possibility to create a new scenario with emotional mastery elements to cope with dysphoric items included in nightmares. In addition, it could be hypothesized that the insertion of bizarre items besides traumatic memories might be functional to "impoverish" the negative charge of the experiences.

The nature of delayed dream incorporation ('dream-lag effect'): Personally significant events persist, but not major daily activities or concerns

Incorporation of details from waking life events into rapid eye movement (REM) sleep dreams has been found to be highest on the 2 nights after, and then 5–7 nights after, the event. These are termed, respectively, the day‐residue and dream‐lag effects. This study is the first to categorize types of waking life experiences and compare their incorporation into dreams across multiple successive nights. Thirty‐eight participants completed a daily diary each evening and a dream diary each morning for 14 days. In the daily diary, three categories of experiences were reported: major daily activities (MDAs), personally significant events (PSEs) and major concerns (MCs). After the 14‐day period each participant identified the correspondence between items in their daily diaries and subsequent dream reports. The day‐residue and dream‐lag effects were found for the incorporation of PSEs into dreams (effect sizes of .33 and .27, respectively), but only for participants (n = 19) who had a below‐median total number of correspondences between daily diary items and dream reports (termed “low‐incorporators” as opposed to “high‐incorporators”). Neither the day‐residue or dream‐lag effects were found for MDAs or MCs. This U‐shaped timescale of incorporation of events from daily life into dreams has been proposed to reflect REM sleep‐dependent memory consolidation, possibly related to emotional memory processing. This study had a larger sample size of dreams than any dream‐lag study hitherto with trained participants. Coupled with previous successful replications, there is thus substantial evidence supporting the dream‐lag effect and further explorations of its mechanism, including its neural underpinnings, are warranted.