Sleep and the Therapeutic Possibilities of Dreaming. Yes, Really.

Let’s turn back the clock to somewhere around 1350 BC, specifically to ancient Egypt. To consult with the god of fertility, Bes, Egyptians would engage in an unorthodox practice which involved drawing the deity on their hand, wrapping both their hand and their neck in cloth, then going to sleep. Strange, I know, and, needless to say, it probably didn’t do much to help them conceive.

Fast forward around three thousand years, and we have neuroscientists trying to do the same thing, but perhaps with a bit more flair than the Egyptians. The Egyptians were probably the first to control their sleep - or, more specifically, their dreams. Their intentions are like our own: they wanted to benefit themselves. While the Egyptians wanted to help with conception and childbirth, we can use sleep to our advantage as a way of therapy, for illnesses such as PTSD. But first, we ought to look into what sleep is. For the sake of this article, we’ll separate these fractions into two main subtopics: non-REM and REM sleep. Let’s start breaking that down.

The first stage, non-REM sleep, begins with a type of sleep called “deep” sleep, which plays a key part in brain wellbeing and recovery from injuries. In the first “slow wave” section of deep sleep, our brains begin a sort of washout process, which clears out debris such as misfolded proteins that our bodies accumulated during our wakefulness period (i.e. the periods of time where we are not asleep). Sleep expert Dr. Gina Poe calls this “a bilge pump of the brain”. While some neurones stay silent, another portion of them are firing at the same time - essentially, they are “contracting” and “expanding” at the same time, in terms of clearing out debris and leaving the brain in a more pristine term, for the lack of a better word. Think of it as clearing out your desk daily instead of weekly.

As more and more random pieces of paper, pens and cables build up, it becomes increasingly difficult to navigate your workspace and get your assignments done properly. Moreover, it has been shown that if one misses the first slow wave sleep section, one risks losing a big bolus of growth hormone release. This also includes protein synthesis not only for growth and repair, but also for memory. Therefore, it is crucial not to miss this section of sleep, if you want to consolidate your learning for exams, and to grow an extra few centimetres (which is nice).

The second stage is the one we all know and love: REM sleep, or “Rapid Eye-movement” sleep. No, it is not called rapid eye-movement sleep because scientists are bad at naming things (this was my initial thought as well), but because we literally have fast, rapid eye movements. In addition to that, our muscles become paralysed, preventing us from acting out our dreams. Moreover, we can find intense and high levels of brain activity, metabolic activity, and dreaming.

It is this stage of sleep in which the brain starts to process emotions, and learns or unlearns information. Interestingly, it can also act like a self-sustained therapy. The neurotransmitters normally omnipresent in the brain, such as serotonin and norepinephrine, are absent during REM sleep, with the stress hormone epinephrine only present at low levels. This allows our brains to replay and process emotionally-stimulating content without the somatic experience of fear or anxiety. In a sense, we produce our own “soma”.

Poorly crafted references to Brave New World aside, the role of sleep in trauma could play a crucial role in healing troubled persons without forcing them to relive traumatic events without emotional distress. Even if the emotional system is highly active, without norepinephrine, one is able to separate these emotions from the cognitive parts of the memory. When it is replayed in the hippocampus during dreams, we are able to take away the important parts: that we were scared and that we were hurt. It does not bring back the elevated heart rate and the trauma. When this goes wrong however - that is, when we cannot divorce norepinephrine from the emotional system - we encounter something that nobody wants to face: PTSD.

For those suffering from PTSD, the norepinephrine system is not downscaled during REM sleep. As such, the REM sleep serves not to heal and prevent emotional suffering, but instead amplifies those emotions, forcing patients to relive the same memories over and over. A technique called target memory reactivation (TMR) has been promising in preventing this issue. It tricks the hippocampus by evoking what looks like memory recall, and influences what the hippocampus replays during sleep. Schwartz et al. at the University of Geneva have used this type of therapy to prevent nightmares. A study was conducted in a group of thirty-six people who regularly experience nightmares. They spent time looking at images that promised an end to their bad dreams. They also listened to the sound of a piano chord - what they interpreted as a “pleasant sound” - during sleep; a piano chord was played at a ten-second interval throughout the REM sleep stage. After two weeks, they reported to have significantly less nightmares, which continued even after three months.

So where do we go from here? We’re approaching the end of this article now, so I’ll do my best to finish my point before I start boring you. As with all new practices and technologies, caution is utmost. In introducing stimuli to structure our dreams, we could lose the affects of deep sleep. The potential for dream therapy via dream engineering is real, and it’s a great thing. However, the potential for misuse is also quite real. Perhaps, then, the best, and most logical thing we should do is to tread lightly.