Editor’s intro: If a person’s airway is obstructed, dreams can symbolically reflect the discomfort and even panic that result from not breathing properly. In this article, see how dreams can offer clues to sleep clinicians about their patients’ sleep quality.
by J.M. DeBord
The dreaming mind is a translator. It takes input received while dreaming and translates it into symbolic imagery. The type of input runs the gamut from memories, thoughts, and emotions to physical sensations and bodily messages.
Include breathing on that list. Your body has a monitoring system that reports to your mind and makes your dreams part of the process. If your airway is obstructed from a condition such as sleep apnea, your dreaming mind will translate it into symbolic imagery. Here’s what to look for, beginning with my all-time favorite example.
A woman who attended a lecture I gave at Canyon Ranch Spa in Tucson asked me why her husband has recurring dreams about being stuck upside down in a chimney. She said the dream is so common, they refer to it in shorthand as “the chimney dream.”
“Does he have sleep apnea?” I asked in return. Her face lit up. Yes, he has sleep apnea.
“Imagine you are the dreaming mind and you want to create imagery that symbolically represents an airway. A chimney is an airway. Now, how do you tell the story about an obstructed airway? One way is to stick your husband upside down in the chimney.”
A house in a dream can symbolize the body — it’s the place where your mind lives. The body’s “chimney” is the airway.
Sleep apnea can manifest in dreams as anything that blocks the airway such as strangulation or choking while trying to swallow something large or sharp, or indirectly in scenes such as trying to breathe while in outer space or underwater, and even more indirectly in heavy symbolism such as a clogged pipe or broken elevator. It’s often accompanied by panic. Think about it: every cell in your body is hollering for more oxygen, or CO2 is building up in the bloodstream and the clock is ticking before serious harm happens.
The dreaming mind is a clever storyteller. It has many ways of telling a story about sleep apnea and other issues related to breathing. Next, another example that I think is sleep apnea, but the dreamer only knows for sure that he’s never been diagnosed with it so there’s no saying for sure.
I’m going to recount the dream in ﬁrst-person and in the words of the dreamer so you get the full impact. Imagine it’s your dream:
Had a dream last night that I’m standing alone in a small room. Out of nowhere I pull a straw out from my pocket. I close one side of it with my hand, while the other I put in my mouth. Then I start to suck in all the air to try and suffocate myself. I did that a total of four times and felt my heart pounding and hurting because of a lack of oxygen. I woke up after the fourth time in a panic and my heart was pounding as though I was suffocating in my sleep, too.
That sure looks to me like a dream about an obstructed airway. A straw can symbolize an airway, and in the dream the straw is closed. You, as the dreamer, are a participant in the story and act out the symbolism. The dream-story has a script you follow subconsciously. When the dreamer closes off one end of the straw and tries to breathe through it, he’s acting out symbolism, and the most likely candidate for the meaning of the symbolism relates to breathing. With that in mind, look back at the main details of the dream:
- I close one side of [the straw], while the other I put in my mouth. Then I start to suck in all the air to try and suffocate myself.
- …I felt my heart pounding and hurting because of lack of oxygen.
- …I was suffocating in my sleep.
- Plus, he tries four times to breathe through the straw. That’s about as many unsuccessful breathing attempts in a row you can tolerate before panic sets in.
He says as far as he knows he doesn’t have sleep apnea or sleep-related breathing issues, but his dream sure says otherwise. It’s possible the dream is symbolic of something else – he could be suffocating in the personal sense of being under too much pressure and stress. He could feel severely constrained, panicky, or weighed down by heavy expectations. The cause-and-effect relationship between the body and dream content is a two-way street. Dream content responds to what’s experienced by the body, and the body responds to dream content, such as when you dream about running and mimic the action while asleep.
However, look at how his body reacts with symptoms such as elevated heart and breathing rate. There are other possibilities for why it responded this way. Your body can respond to dream imagery as if it’s actually happening. Heavy stress, embarrassment and powerfully-felt emotions such as fear or anger can cause a person to constrict their breathing while awake or asleep. After 25 years of interpreting dreams, though, I’ve developed my gut instinct and it says “this dream is about a constricted airway.” Whether it’s a one-time thing – for example, his tongue rolled back in his mouth, possibly creating a straw shape – or it’s an ongoing sleep-related breathing issue can’t be known after the fact, but it gives the person something to think about and watch out for.
Which raises a question: how do you know that your airway is constricted while you’re asleep, other than by recognizing the signs your dreams give you? Well, you could spend time in a sleep lab, but ﬁrst I suggest that you use a voice-activated recorder on your nightstand to monitor your sleep. The sounds of snoring or labored breathing should be loud enough to activate the recording device. I found several voice-activated recording apps for phones.1,2
A close member of my family is a heavy snorer and to hear it at its worst is worrisome. I remember well the ﬁrst time I heard him experiencing serious breathing difficulties while sleeping, not just snoring but like a jackhammer pounding concrete. I went to his bedroom and listened to his breathing. Ten seconds elapsed and he didn’t breathe. Twenty seconds.
Twenty-ﬁve seconds. Then “WHOA-ACK-ACK-ACK-ACK!” as he pulled in a powerful breath and forced air through his obstructed airway. Next, a few normal breaths, then a few labored ones along with snoring, then silence again. No breathing. Then the jackhammer. I woke him up (gently) and urged him to sleep on his side.
Another way to tell if your airway is constricted while you’re asleep is by how you feel when you wake up. I snore if I sleep on my back, and when I do, I wake up with a headache. Hello, oxygen deprived brain (or more accurately, hello carbon dioxide saturated brain).3 When I wake up tired after a full night of sleep, it means I’m not getting the deep sleep I need to feel rested.
Why? Airway obstruction, usually. When I sleep badly, I have less dream recall.
My personal observations are born out by research into the dream lives of people with sleep apnea compared with people without it. People with obstructive sleep apnea (OSA) have less dream recall than people without OSA4 and report more unpleasant dreams and less emotional variation.5
Interesting ﬁndings, wouldn’t you say? Even more interesting to me are the causes. I get asked frequently about sleep issues, or ﬁnd sleep issues at the heart of dreaming issues such as nightmares. Sleep apnea disrupts the normal rhythm of sleep. The person with OSA does not reach the deepest stages of sleep that provide the greatest beneﬁts in terms of rest and recuperation. Also, the most vivid and intense dreaming occurs during REM-stage sleep (rapid eye movement). REM is the pinnacle of sleep. Unless a person is sleep-deprived (in which case they can fall into REM sleep quickly after going to sleep), they won’t experience REM until the end of the ﬁrst sleep cycle. They won’t cycle through sleep stages normally unless the body sheds core heat and breathes in a long, shallow rhythm.
Now imagine the dreaming mind, the translator of all input received including messages from the body, responding after a person hasn’t breathed for, oh, let’s say 30 seconds. And let’s say that airﬂow has been declining for, oh, ten minutes. Now you’re seriously oxygen-starved and CO2 is building up rapidly in your bloodstream. Soon it will be at poisoning level. You might even be turning blue. Can you imagine how that extreme panic would translate into dream imagery? It’s the most horrifying nightmare imaginable, which is how it’s been described to me by the few apnea patients I’ve worked with who remember what they were dreaming just before jolting awake. For many reasons, people want to forget those memories. Plus, they might experience apnea-induced nightmares and not know the cause. They jolt awake to breathe and don’t know they haven’t been breathing unless someone tells them or they recognize the symptoms such as elevated heart and breathing rate, headache, and gasping and choking. So then they don’t know that the nightmare is caused by sleep apnea and the condition ﬂies under the radar.
[Specialists who diagnose sleep-related breathing issues would be wise to ask about a patient’s dreams. To my knowledge, it’s not a common practice in sleep medicine.]
Obviously, sleep apnea disrupts the sleep cycle, which means that people who have it experience fewer and shorter REM stages. Which means less dreaming and less vividness. Which means fewer dreams to recall and less emotional variation to them. Keep in mind, snoring is a sign of a restricted airway and can produce similar symptoms and effects as mild apnea.
How do you use this information to tell whether you have sleep apnea or other sleep-related breathing issues? One way is to ask yourself if you think you dream less, have less recall, or less emotional variation than you used to. Another way is to recognize and respond when you aren’t sleeping well. Your attention span is shorter. You’re more irritable and your temper is shorter.
You have difficulty processing new information and recalling old information. Sometimes, though, I think that people avoid reaching that conclusion because there’s this idea in society that sleep issues are somehow less important than other medical issues. They aren’t even recognized as legit in some circles, and you’re perceived as weak if you express a need for something related to sleep such as more of it, or better quality.
Disrupted sleep, a growing trend that now affecting hundreds of millions of people around the globe, has other causes such as excessive light and noise, stimulants, and the use of electronics immediately prior to sleep. A growing body of evidence suggests that we aren’t dreaming as well because we aren’t sleeping as well, and we aren’t sleeping as well because of a variety of factors that include not breathing as well.
This trend needs to change.
Dr. Ronald Perkins notes that dreams are among the many symptoms of sleep-breathing issues. See his article “Treating sleep disorders with oral appliances,” here.
- Dictaphone Voice Recorder iPhone app by Dorada App Software Ltd. https://itunes.apple.com/us/app/dictaphone-voice-activated-recorder/id834938465?mt=8/
- Smart Recorder – High-quality voice recorder Android app by SmartMob. https://play.google.com/store/apps/details?id=com.andrwq.recorder&hl=en/
- Peters B. Morning Headaches May Be a Sign of Obstructive Sleep Apnea. Verywell Health. January 9, 2018. https://www.verywell.com/obstructive-sleep-apnea-am-headaches-3014738/
- Fisher S, Lewis KE, Bartle I, Ghosal R, Davies L, and Blagrove M. Emotional Content of Dreams in Obstructive Sleep Apnea Hypopnea Syndrome Patients and Sleepy Snorers attending a Sleep-Disordered Breathing Clinic. J Clin Sleep Med. 2011;7(1):69–74. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041622/
- Ochman P. Do People with Sleep Apnea Dream? Sleep Apnea Treatment Centers of America. October 25, 2013. http://curemysleepapnea.com/sleepsource/2013/10/25/ people-sleep-apnea-dream/