Relationship Between Epilepsy and Dreaming: Current Knowledge, Hypotheses, and Perspectives

The interactions between epilepsy and sleep are numerous and the impact of epilepsy on cognition is well documented. Epilepsy is therefore likely to influence dreaming as one sleep-related cognitive activity. The frequency of dream recall is indeed decreased in patients with epilepsy, especially in those with primary generalized seizures. The content of dreams is also disturbed in epilepsy patients, being more negative and with more familiar settings. While several confounding factors (anti-seizure medications, depression and anxiety disorders, cognitive impairment) may partly account for these changes, some observations suggest an effect of seizures themselves on dreams. Indeed, the incorporation of seizure symptoms in dream content has been described, concomitant or not with a focal epileptic discharge during sleep, suggesting that epilepsy might directly or indirectly interfere with dreaming. These observations, together with current knowledge on dream neurophysiology and the links between epilepsy and sleep, suggest that epilepsy may impact not only wake- but also sleep-related cognition.

Dream Recall/Affect and the Hypothalamic–Pituitary–Adrenal Axis

In this concise review, we present an overview of research on dream recall/affect and of the hypothalamic–pituitary–adrenal (HPA) axis, discussing caveats regarding the action of hormones of the HPA axis (mainly cortisol and its free form, cortisol-binding globulin and glucocorticoid receptors). We present results of studies regarding dream recall/affect and the HPA axis under physiological (such as waking) or pathological conditions (such as in Cushing’s syndrome or stressful situations). Finally, we try to integrate the effect of the current COVID-19 situation with dream recall/affect vis-à-vis the HPA axis.

Increase of both bottom-up and top-down attentional processes in high dream recallers

Event-related potentials (ERPs) associated with the involuntary orientation of (bottom-up) attention towards an unexpected sound are of larger amplitude in high dream recallers (HR) than in low dream recallers (LR) during passive listening, suggesting different attentional functioning. We measured bottom-up and top-down attentional performance and their cerebral correlates in 18 HR (11 women, age = 22.7 +/- 4.1 years, dream recall frequency = 5.3 +/- 1.3 days with a dream recall per week) and 19 LR (10 women, age = 22.3, DRF = 0.2 +/- 0.2) using EEG and the Competitive Attention Task. Between-group differences were found in ERPs but not in behavior. The results confirm that HR present larger ERPs to distracting sounds than LR during active listening, suggesting enhanced bottom-up processing of irrelevant sounds. HR also presented a larger contingent negative variation during target expectancy and a larger P3b response to target sounds than LR, speaking for an enhanced recruitment of top-down attention. Enhancement of both top-down and bottom-up processes in HR leads to an apparently preserved attentional balance since similar performance were observed in the two groups. Therefore, different neurophysiological profiles can result in similar cognitive performance, with some profiles possibly costlier in term of resource/energy consumption.

Dream Activity in Narcoleptic Patients During the COVID-19 Lockdown in Italy

Some studies highlighted that patients with narcolepsy type-1 (NT1) experience high lucid dream frequency, and this phenomenon has been associated with a creative personality. Starting from the well-known “pandemic effect” on sleep and dreaming, we presented a picture of dream activity in pharmacologically treated NT1 patients during the Italian lockdown. Forty-three NT1 patients completed a web-survey during Spring 2021 and were compared with 86 matched-controls. Statistical comparisons revealed that: (a) NT1 patients showed greater sleepiness than controls; (b) controls showed higher sleep disturbances than NT1 patients, and this result disappeared when the medication effect in NT1 was controlled; (c) NT1 patients reported higher lucid dream frequency than controls. Focusing on dreaming in NT1 patients, we found that (a) nightmare frequency was correlated with female gender, longer sleep duration, higher intrasleep wakefulness; (b) dream recall, nightmare and lucid dream frequency were positively correlated with sleepiness. Comparisons between low and high NT1 lucid dreamers showed that patients more frequently experiencing lucid dreams reported a greater influence of dreaming during wakefulness, especially concerning problem-solving and creativity. Overall, our results are consistent with previous studies on pandemic dreaming carried out on healthy subjects. Moreover, we confirmed a link between lucidity and creativity in NT1 patients. Considering the small sample size and the cross-sectional design, our findings cannot provide a causal relationship between lucid dreams and the COVID-19 lockdown. Nevertheless, they represent a first contribution to address future studies on this issue, suggesting that some stable characteristics could interact with changes provoked by the pandemic.

199 COVID-19 Pandemic Sleep and Dreams at the US-Mexico Border

Introduction The impact of the COVID-19 pandemic in the border region is not well-described, including the impact of pandemic-related sleep disturbances on dream experiences, despite frequent reports of meaningful changes to dreams in the population. Methods Participants were 155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) Study and a COVID sub-study (95% Hispanic/Latino). Participants were asked whether, as a result of the pandemic, they have experienced more schedule regularity, improved/worsened sleep, more initial or middle-of-the-night insomnia, more sleepiness, and more napping. They were also asked whether they experienced more, fewer, or the same amount of dreams in general, positive dreams, and negative dreams. Multinomial logistic regressions were used to examine overall, positive, and negative dream recall (more or less vs same) as outcome and perceived change in sleep as independent variable, adjusted for age, sex, socioeconomics, and mental health symptoms (assessed with PHQ4). Results Those who reported more schedule regularity were less likely to report more negative dreams (Relative Risk Ratio [RRR]=0.40, p=0.010). Those who reported improved sleep were also more likely to report more positive dreams (RRR=3.97, p=0.004). Those with worsened sleep were more likely to report fewer dreams overall (RRR=2.23, p=0.037), fewer positive dreams (RRR=2.24, p=0.003) and more negative dreams (RRR=3.69, p<0.0005). Those with more initial insomnia were more likely to report fewer positive dreams (RRR=2.43, p=0.002) and more negative dreams (RRR=4.12, p<0.0005). Those with more middle-of-the-night insomnia reported fewer dreams overall (RRR=2.35, p=0.018), fewer positive dreams (RRR=2.55, p=0.001), and more negative dreams (RRR=5.01, p<0.0005). Those with more daytime sleepiness were more likely to report fewer dreams overall (RRR=4.75, p<0.0005), fewer positive dreams (RRR=1.92, p=0.019), and more negative dreams (RRR=3.91, p<0.0005), and were less likely to report more positive dreams (RRR=0.26, p=0.018). Those who reported napping more were more likely to report fewer dreams overall (RRR=2.78, p=0.008), fewer positive dreams (RRR=2.10, P=0.008), and more negative dreams (RRR=2.83, p=0.003), and were less likely to report more positive dreams (RRR=0.16, p=0.004). Conclusion Those whose sleep worsened due to the pandemic reported less dream recall, and dream content that was more negative and less positive overall. Support (if any) R01MD011600, R01DA051321

210 Changes in Dream Recall During the COVID-19 Pandemic: Associations with Sleep, Stress and Dream Content

Introduction During the COVID-19 pandemic, individuals have faced unprecedented events, which are often stressful. Stress has an important impact on dreams, and stress-induced sleep difficulties may also impact dream recall. The present study evaluated associations between sleep, stress and dream content on dream recall during the pandemic. Methods A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked if they remember more, fewer or about the same amount of dreams as before the pandemic. They were also asked whether the pandemic was associated with more stress, a more regular schedule, improved sleep, worse sleep, more early insomnia, more middle-of-the-night insomnia, more sleepiness, and more naps. They also completed the Insomnia Severity Index, Fatigue Severity Scale, Epworth Sleepiness Scale, Brief Index of Sleep Control, Assessment of Sleep Environment, GAD-7 anxiety scale, and PHQ9 depression scale. Multinomial logistic regressions examined correlates of increased or decreased recall (versus same), adjusted for age, sex, and race/ethnicity. Results Those who experienced greater schedule regularity were less likely to report decreased recall (RRR=0.50,p<0.0005), as were those who reported sleep improvement (RRR=0.48,p=0.006). Those whose sleep worsened were more likely to report both increased (RRR=1.64,p=0.003) and decreased (RRR=2.16,p<0.0005) recall. Those suffering maintenance insomnia were more likely to report both increased (RRR=1.70,p=0.001) and decreased (RRR=2.68,p<0.0005) recall, as did those who reported more daytime sleepiness (Increased RRR=1.57,p=0.006; Decreased RRR=1.94,p=0.001). Those whose dream content was more negative were more likely to report both increased (RRR=4.05,p<0.005) and decreased (RRR=3.35,p<0.0005) recall, as did those who reported less negative content (Increased RRR=4.20,p<0.0005; Decreased RRR=5.05,p<0.0005). Similarly, those who reported more positive dream content reported both increased (RRR=17.37,p<0.0005) and decreased (RRR=7.14,p=0.02) recall, as did those who reported less positive content (Increased RRR=4.49,p<0.0005; Decreased RRR=5.59,p<0.0005). Less recall was associated with greater insomnia severity (RRR=1.08,p=0.001), fatigue (RRR=1.04,p=0.001), sleepiness (RRR=1.09,p=0.01), COVID stress (RRR=1.67,p=0.03), anxiety (RRR=1.08,p=0.01), and depression (RRR=1.06,p=0.007), worse sleep environment (RRR=1.06,p=0.005), and less sleep control (RRR=0.56,p=0.001). Conclusion The results of this survey suggest that a sudden decrease in dream recall in reaction to a new stress could be considered as a pejorative indicator regarding sleep quality and mental health. Support (if any) R01MD011600, R01DA051321

Dreaming in Adolescents During the COVID-19 Health Crisis: Survey Among a Sample of European School Students

According to the continuity hypothesis of dreaming and contemporary psychodynamic approaches, dreams reflect waking life. The aim of the present study was to explore the relationship between the COVID-19 pandemic and dreaming in adolescents. A cross-sectional survey was conducted in Italy, Romania and Croatia involving 2,105 secondary school students (69% girls, mean age 15.6 ± 2.1 years; 31% boys, mean age 15.1 ± 2.2 years; mean age of whole sample 15.4 ± 2.1 years). No substantial differences between countries were found. Thirty-one percent of the participants reported heightened dream recall, 18% noticed an increase in nightmares during the lockdown, and 15% of the provided dreams (n = 498) included pandemic-related content. The results indicate that subjective emotional reactions to lockdown had a significantly higher correlation to dreaming than objective distress (i.e., illness or death of a close one because of COVID-19). These findings suggest that attention to dreams should be included in preventive programs for adolescents with pandemic-related stress.

The route to recall a dream: Theoretical considerations and methodological implications

The goal of this paper is to shed new light on the relation between dream recall and dream experiences by providing a thorough analysis of the process that leads to dream reports. Three crucial steps of this process will be distinguished: dream production (the generation of a conscious experience during sleep), dream encoding (storing a trace of this experience in memory), and dream retrieval (accessing the memory trace upon awakening). The first part of the paper will assess how major theories think about the relationship between dream reports and these distinct steps. The second part will systematise how trait and state factors affecting dream recall — given different theoretical assumptions — might interact with dream production, encoding and retrieval. Understanding how the distinct steps of dream recall can be modulated by different factors is crucial for getting a better grip on how to acquire information about these steps empirically, and for drawing methodological conclusions with regard to the tools dream research relies on to collect subjective data about dream experiences. The third part of the paper will analyse how laboratory reports, logs and retrospective scales interact with the different factors that affect the distinct steps leading to dream reports, and will argue that prospective methods provide more direct access to data regarding dream production and encoding than retrospective methods, which — due to their inability to provide systematic control over the factors affecting the retrieval stage screen-off the variability in the production and the encoding of dreams.