Section 16: Sleep - Separating the Facts from the Fictions

All of the areas that will be presented in this section are designed to provide the clinician with key facts that will support the push for better sleep hygiene and clarify the ways in which better sleep can be promoted and maintained. Again, the rationale for this course is to provide useable and actionable information for clinicians as preparation for real time discussions with clients.

Fact or fiction: The body actually has its own built in “clock” to tell you when it’s time to sleep and time to wake up, and messing with that clock can harm our ability to get a good night’s sleep and lead to a cycle of sleep problems.

Answer: Fact

There is a very complex chemistry occurring every day in our bodies around waking up and falling asleep, involving a number of physiological systems that sometimes work together and sometimes work in opposition to each other. One of the most important systems for sleep is a 24-hour biological “clock” that knows every day when it is time to prepare our bodies to go to sleep to wake up, driven by a complex set of chemical releases that start out in our brains. If our “clock” is working well - and we are following the clock - the chemistry happens at about the same time every night for night sleep. (This clock also operates in similar ways during the day for people working at night and sleeping during the day and at predictable times during the day when nap schedules are implemented. 

Because it has a regular pattern it follows every day, it is called the circadian (From the Latin words for “around” (circa) and “day” (dies)) rhythm. Knowledge of this rhythm and its formal name is helpful for establishing professional authority in discussions with clients. At about the same time every night, the chemistry of getting sleepy starts, and then ‘slow down’ and ‘shut down’ messages are sent to the parts of the brain that would otherwise try to keep us awake and alert. Our circadian rhythm helps to create a window of sleepiness each day during which time it is easiest to get to sleep. 

This predictable pattern of falling asleep at about the same time every night allows us to move successfully through all the stages of sleep in an efficient way and then wake up refreshed at about the same time every morning. If we are willing to listen to our bodies and follow this consistent rhythm, it helps us to get the most out of a good night’s sleep. This rhythm is supported whether a person is getting 7-8 hours of uninterrupted sleep, or working with models that include “first sleep-second sleep” or sleep-plus-nap(s). 

The “clock” has components that work to keep a firm and regular 24-hour schedule, but also components that try to make flexible adjustments if changes are needed. There is a very complex chemistry that involves many different parts of the body and brain in this cycle, including parts of the brain that gather information inputs and use them to regulate the master chemistry of falling asleep and becoming wakeful and alert. One of the key inputs to this information processing system is driven by differences in the level of light between night and day. 

There are specialized retinal cells in the back of our eyes that respond specifically to the presence of light. When light hits these specialized cells, a chemical message is sent to the area of the brain that controls our circadian rhythm, the suprachiasmatic nucleus (SCN).  (Harvard) When this message is received, a variety of effects are generated by the SCN, under the assumption that since light is present, it must be daytime and therefore time to wake up and get alert. Hormones and other chemicals are released through the instructions of the SCN, and our body wants to move to our daytime level of wakefulness. 

At the same time, the SCN also sends out chemical messages to inhibit and restrict the release of chemicals that are designed to help us fall asleep, most importantly a hormone called melatonin.  When light is present, our level of sleepiness is reduced from melatonin restriction while our level of alertness is raised by the release of our “daytime” chemicals.

At the same time, this fine tunes the 24-hour “clock” that our bodies try to maintain to oversee the release of all the right chemicals at the right time of the day. If light happens at a different time from the day before, it starts to make changes to the setting on our “clock” to try to anticipate when day and night chemicals will need to be released.

When sunlight is reduced at night, the specialized cells in the back of our eyes slow down the sending of messages down to the SCN. This signals that it is time to move from daytime chemistry to night chemistry. However artificial light, television, and computer screens bombarding our eyes with light create disruptions to the smooth functioning of these intricate systems. This interferes with our circadian rhythms and contributes to increased difficulties getting to sleep. 

This is one of the reasons that good sleep hygiene typically includes moving towards progressively darker environments as you get ready for sleep and avoiding television and computers late at night. This not only helps you fall asleep on a particular evening, it also helps to establish a routine for your circadian rhythm that supports a regular and smooth functioning day-night cycle of chemical releases. It works with how your body is designed to operate. 

This means that there may be special challenges for clients whose normal work or life schedule operates at variance from the normal day-night/light dark routine, e.g., night shift workers. A small percentage of people will be able to work night shifts with virtually no negative effects, moving quickly and easily into a rhythm of day sleep and night wakefulness. Another percentage of people will adapt reasonably well to inverted schedules. Their diurnal rhythm will eventually shift the time schedules for the release of the chemistry of sleep and wakefulness to align with what they are doing. 

However, a large percentage of people will not fare as well. Many people simply do not sleep as well or live as healthily when their body is asked to work against the normal diurnal rhythm. There are known risks and dangers for night shift personnel, as evidenced by the research results for impacts on health and well being. (CDC) There are increases in the risk for certain medical problems for night shift workers, typically the same sort of medical problems that are likely to increase in sleep deprived individuals.  We will look at these risks and dangers in a later section. 

Research also shows a significantly higher risk for accidents and injuries among night shift workers, mostly due to a reduction in alertness. (CDC) There is also clear research indicating increased mistakes and decreased productivity for people who work night shifts. Aside from the small numbers of people who appear to have enormous flexibility in adjusting their diurnal rhythms, we are not generally well designed for night shift work. 

For clinicians who see night shift personnel in treatment, it is important to understand these considerations as mental health issues are assessed. What may appear at first glance to be depression or anxiety in a night shift worker may simply represent the cumulative effects of reduced sleep or diminished sleep effectiveness. We noted in an earlier section that there appears to be a fair amount of flexibility in how people get their 7-8 hours of sleep, but in fact it appears that most people do better when the major part of their sleep occurs at nighttime.

It is also important to consider how to support and structure approaches to sleep that reduce the negative impacts of an inverted day- night sleep schedule. In particular, it is vital to convey the importance of controlling and minimizing exposure to bright light as night shift personnel transition towards their main period of sleep after work.  Night shift workers who drive home as the sun is coming up may need to schedule in a period of time to move to increasingly dark environments at home before attempting to fall asleep, making sure that they set up their sleep rooms for maximum darkness.  

There is a second system that interacts with the circadian rhythm. It is called the ultradian rhythm, from the Latin words for “beyond” (ultra) and “day” (dies). (Kripke) This second system doesn’t just happen at night, but rather occurs all day for people, creating back and forth swings between periods of high energy (peaks) and low energy (troughs), most commonly on a cycle of about 2½ hours. Most people feel this as alternating highs, like the burst of energy first thing in the morning, and lows, like the period right after lunch when you feel really sluggish and sleepy (which is often siesta time in cultures that use naps as part of their sleep routine).

It is usually easiest to get to sleep when the ultradian rhythm slides your energy level down to a trough at the same time that your circadian rhythm starts releasing the right chemicals for falling asleep. If both systems are aligned, you get a double dose of sleep inducing chemicals. If you miss that cycle and the ultradian rhythm starts to move your body back to a period of higher energy, it can make it harder to fall asleep. Some people who miss the trough at their regular sleep time can then have a hard time falling asleep until the ultradian rhythm moves back around to the next cycle of low energy about 2 ½ hours later. 

If we have a regular schedule and we wake up to morning light – and go to sleep when light is waning – the 24-hour chemistry of both the circadian and ultradian systems is reinforced and re-set properly every day in concert with how we get in our main period of nighttime sleep. For the circadian rhythm, this fine tunes the chemistry for falling asleep to coincide with our window for sleep time. This also moves our bodies and brains through the necessary changes for moving smoothly through the many stages of sleep, altering which areas of our brains are in motion at various stages of the sleep cycle. 

For most of our time on this planet, this system worked well to allow us to get a good night’s sleep. However, if we miss our sleep time, the chemistry of both systems will move on without us – and then our sleep systems start to get confused. This can make it harder to fall asleep and cause us to either miss or reduce the effectiveness of the many things that our sleep stages are trying to do to take care of us. 

As we have noted, artificial lighting, television, and computers can interfere with the healthy functioning of our biological clock due to light hitting those specialized retinal cells. Additionally, watching television or videos on the computer can actually alter our brain waves in ways that disrupt the movement towards a state of relaxation and sleepiness. (Krugman) Very specific kinds of brain waves are induced by watching television, and they are not particularly good for the movement towards sleep for many people. For this reason, some people can vastly improve their ability to get to sleep simply by turning off the TV and computer earlier in the evening.

There are specific names for the several kinds of sleep disturbances that fall into these categories. As noted in a previous section, these are called Circadian Rhythm Disorders, where internal or external factors cause the body’s circadian rhythm to be out of synchronization with the day-night schedule in which the person is operating.

Advanced Sleep Phase Disorder is most typically seen in elderly individuals. Typically this occurs when the bedtime is moved up to a very early time in the evening – between 6 and 9 PM, with a correspondingly early rising time of between 2 and 5 AM. 

Delayed Sleep Phase Disorder is more commonly seen among adolescents, who move their bedtime back progressively later into the night, sometimes to 2 Am or later, with a correspondingly delayed rising time. While left to their own devices, there would be a passage through a full sleep cycle, but this schedule does not align well with demands of a school or work environment. 

Advanced and Delayed Sleep Phase Disorders seem to be extensions and exaggerations of people’s normally variable preferences to be morning people – “larks” – or night people – “night owls”. These disorders only become problems when they lead to sleep insufficiency. 

As we have noted, Shift Work Sleep Disorder is generally seen in clients whose work requires them to have sleep schedules that do not align with a normal day night schedule. The capacity to adjust and adapt to reversed day-night schedules varies from person to person. While many night shift people are able to tolerate the disruption and still get adequate amounts of sleep, there are a sizeable number of people whose bodies do not allow that degree of flexibility. They cannot reset their circadian rhythms to allow them a good night’s sleep if they are working the night shift and have to sleep during the day.

Finally, Jet Lag is a real and serious problem for certain clients whose work causes them to travel to very different times zones with little or no time for their circadian rhythms to adjust to the changes in the day-night schedule. It can take some people two to three weeks for the body to fully reset its circadian rhythm once a regular day-night pattern of light-darkness is established. When these clients are constantly traveling, their body simply cannot keep up with the changes, leading to the development of insomnia and related sleep insufficiency.


Practical Applications

Please note that the chemistry of our sleep-wake cycle is complicated, with individual differences between people among the many different chemical systems that influence sleep. For this reason, artificial light and TV or computers won’t have the same degree of effect on everyone’s ability to get to sleep and move through the sleep cycle.

However, from a very practical perspective, people who are dealing with simple insomnia can usually benefit from understanding some of the basic knowledge about what is happening in our bodies in preparing for sleep. This knowledge will support recommendations about how to work in cooperation with our own body clocks and establish better conditions for getting to sleep. 


Fact or fiction: A good night’s sleep necessarily means 7-8 uninterrupted hours.

Answer: Fiction 

One of the most common misconceptions about a good night’s sleep is that there is only one good way to get it. It is not uncommon for clients to experience a fair amount of distress over the fact that their sleep patterns do not adhere to the “norm” of a night of 7-8 hours of solid, uninterrupted sleep. This distress has been described as sleep anxiety. (Anxiety Care UK) One of the main purposes of using cognitive/psychoeducation approaches to sleep disorders is to reduce this sleep anxiety. 

First, as we have already noted, there are people whose sleep needs fall outside the norm. Some people seem to require less than 7-8 hours of sleep to function normally. These people do not need to fret if they are not getting the “right” amount of sleep. 

Next, while it is preferable to have a regular routine for sleep – in order to align with the complex chemistry of sleep – there is flexibility as to what that routine can be. In fact, virtually everyone has one or more instances of waking up during the course of a night’s sleep. It is part of the normal process of moving through the various stages of sleep.  Most of the time, people fall back to sleep so quickly that they don’t even remember the wakeful period and they think they are sleeping through the night in one uninterrupted stretch. 

However, the idea of sleeping in one uninterrupted chunk of sleep time is not necessarily the norm around the world, nor is it the historical norm. A history professor at Virginia Tech in the early 1990s came across curious references to a “first sleep” and a “second sleep”, both in literature and in medical references from England and France in pre-industrial times. (Hegarty) 

Apparently, it was completely normal for people of that era to have an initial period of sleep of approximately four hours, followed by a 1-2 hour period of wakefulness and activity – including eating, reading, conversation and sexual activity – followed by a return to bed for another approximately four hours of sleep. 

This sleep pattern aligns very closely with experiments that have been conducted to determine what sleep cycles would occur if the influence of artificial lighting were removed from people’s lives. Experiments conducted at the National Institute of Mental Health revealed that this split sleep pattern would become the norm for subjects once all sources of artificial light were removed from their lives during the experimental period. (Wehr) We seem to be built for first sleep and second sleep. 

As another variation, many cultures include daytime napping as a normal and traditional part of the routine of sleeping and waking. Workers in many Asian cultures have a post-lunch nap built into their daily work schedules, and the afternoon siesta is a well-established tradition in Spain and some other Spanish speaking countries. Research indicates that napping is a wonderful way to gain the benefits of sleep outside of the “normal” nighttime schedule. 

As most clinicians understand, there are distinct phases that people go through in the course of a complete night’s sleep. As they first fall asleep they move fairly quickly through Stage I, the transition stage at which people sleep quite lightly, spend a little more time moving through the somewhat deeper Stage II – when most incidences of sleep walking and sleep talking occur - then move towards the deep stages of sleep in Stages III and IV, also called Slow Wave Sleep.  

It is typically during these deep sleep stages, particularly in Stage IV sleep, that the body engages in the important cellular repair work and muscular regeneration needed for physical restoration. For children and teenagers, it is important to note that the key hormones of growth only get released during this deep Stage IV rest. If Stage IV sleep is interrupted over time, then it will have an impact on a child reaching his/her full height. 

Once Stage IV has been completed, the body moves backwards through the same series of stages, from III to II to I and into the first REM stage. The REM stage is typically when our most vivid and emotional kinds of dreaming occur, although other kinds of dreaming also occur during other stages of sleep, including the deep stages of sleep in Stage III and IV, and dreams don’t always happen during REM sleep. (Kripner and Combs) 

For most people, extended periods of Stage III and IV sleep only occur during the first two full sleep cycles of the night, which require about four hours of sleep to complete. This means that First Sleep is essential for the deep restoration periods our body needs. In the sleep cycles after the first four hours, whether as part of an uninterrupted full night’s sleep or as part of Second Sleep, the body spends a greater proportion of time in Stage II sleep and REM sleep, with the body moving towards almost exclusively REM sleep after another two full sleep cycles have been recorded. 

Over and above this set of understandings, it must also be clarified that not every adult requires an “average” amount of sleep. Many healthy adults are able to function perfectly well on as little as five hours of sleep, while other people seem to require much more sleep. There is a great deal of variability in this area as there is in many other aspects of our make-up as human beings. 

What is clear from decades of research is that the purposes and mechanisms of sleep are very complex. A great deal of progress has been made over the past couple of decades in understanding the biochemistry of  sleep, so we have a clearer picture of what it is about that biochemistry during each of the stages of sleep that contributes to emotional and physical health. Some of this knowledge will be presented in a later section. With this increase in understanding though, some myths have been challenged, particularly concerning the REM or dream stage of sleep. This particular issue will be examined as our next section.


Practical Implications 

The research seems to indicate that while getting 7-8 hours of sleep each day is essential for overall good health and optimal cognitive and emotional functioning, there may be much more room for flexibility concerning the use of different patterns and schedules for getting a good “night’s” rest.

This can be very encouraging information for clients whose lives contain impediments and obstacles to getting a full 7-8 hours of uninterrupted sleep each night and for clients who have gotten so worried about not getting enough sleep that it is interfering with their ability to fall asleep due to sleep anxiety.

In our role as educator, we can pass forward research based information that supports the idea of more flexibility in this area. This allows you to normalize different approaches and lets you safely advise your clients to relax a little bit if their sleep schedules do not align perfectly with the “norm”. This may help them avoid sleep anxiety when they are trying to get to sleep, consistent with the principles of CBT.


Fact or fiction: Your dream stage of sleep is so important for your mental health, creativity, and learning that the absence of dream stages of sleep can lead to insanity. 

Answer: Fiction 

Research has clearly demonstrated that the absence of REM sleep and dreaming does not inevitably lead to insanity or mental breakdowns, as there are individuals who have particular kinds of sleep disturbances where they never experience REM sleep (Kripner and Combs), as well as people with head injuries who apparently do not experience dreaming.  (Domhoff)  This misconception about the critical need for REM sleep is one of the first casualties of better research on sleep stages. 

There does appear to be a real need for people to get adequate amounts of REM sleep, because when people in research studies are prevented from entering into the REM stage of sleep, the body tries to make up for this disturbance by moving more quickly into the REM sleep and increasing the percentage of time spent there. (NINDS) We can deduce from this that there may be an important purpose for this stage of sleep, but the most current research is not fully prepared to explain what that purpose is.

This is not the only – nor perhaps the most important - misconception that exists around REM sleep and dreaming. Mental health clinicians work in a profession that has a long and interesting history of theories about the role of dreaming in the life of clients. However, recent neuroscience has re-arranged the landscape around the old Freudian view of the purpose and meaning of dreams. 

This has occurred in ways that both support some aspects of that view and challenge others. Because there is new imaging equipment that can increasingly clarify what is happening in the brain at a physical level, as well as a more complete picture of what is occurring chemically, new explanations – better grounded in science – are reshaping what we claim we know for sure. 

These are important considerations because some mental health clinicians seek to explore the inner life of their clients through discussion of their clients’ dreams.  If we are to do this, it is better for creating professional authority to operate with the most up to date knowledge - and not artifacts from earlier and less fully researched theories. If we are going to have dream discussions with our clients, we should have a much clearer picture of what is actually going on when we are dreaming. This is where the latest research is useful. 

To begin with, as we have noted, dreaming can occur in other stages of sleep besides the REM stage. Research seems to indicate that the nature of the dreaming is slightly different: less vivid and less emotional in nature, perhaps viewed as halfway between REM stage dreaming and waking consciousness. Some research indicates that this Non-REM dreaming serves functions that support different kinds of learning and information processing functions while the body is sleeping.  (Kripner and Combs) 

What happens neurologically during REM stage dreaming is very interesting, but not precisely what Freud had theorized when he was trying to make sense of the very powerful reports from his patients about their dream life. During REM sleep, there is a general shutting down of many parts of our brain in the frontal cortex that are used during waking hours to control and direct the flows of information about our thoughts and emotions. 

For starters, our working memory is mostly deactivated. Working memory is that conscious capacity to hold selected information in your thoughts so it can be integrated, processed and combined with other pieces of information – including our judgment about whether what is occurring in our thoughts is real or not. When you are dreaming, the de-activation of working memory makes it easier for the brain to jump from one thing to another in your dreams and experience our mental activities without judgment. 

We also have changes to our ability to focus attention on a single thing, plan for the future, engage in self-reflection, or hold onto a sense of our self-identity. This combination of things allows us to live fully in the moment of our dreams, with the areas of our brain that control conscience, censorship, and self-judgment on a temporary vacation. 

However, the de-activation of working memory tends to make it harder to remember dreams unless you think about them immediately upon waking up, when working memory comes back on line. In order for information to make it into long-term memory, it has to first make it into working memory and/or short-term memory, from which it makes the transfer into medium then long-term storage. 

While this selective deactivation within our frontal cortex is occurring, the seat of our emotions – the limbic system – is made to be more active. This means we attach and associate a greater amount of emotion to whatever images populate our dreams.  

At the same time these changes are occurring, some large and random spikes in neuronal activity are sent out from deep in the most primitive areas of the brain, releasing an important neurotransmitter – acetylcholine - through the neo-cortex of the brain, causing widespread activation of the memories and other information that is stored there. (Kripner and Combs) This is the raw material for our dreams, and this material works its way up to the visual cortex where it becomes the random images that form our dreams.

Because the brain is in a state of being where the conscious control systems have been de-activated, the usual rules for what makes its way into the central stream of our consciousness are different. The brain is in a much more fluid state, with many of our conscious control systems shut down. Material that would usually not be allowed to come into consciousness, strange relationships between different thoughts and ideas that would otherwise be considered ridiculous,  and random unconnected thoughts that would normally not be worth considering, all of these have a much more wide open field to be mashed together and turned into images, ideas and feelings in our dreams. 

However, our brains are not pre-disposed to tolerating the high degree of randomness that occurs during the dream state. There is a central organizing feature of the brain that continuously works to create cohesive narratives from the complex flow of ongoing material we are processing throughout the day.

This narrative creation function is designed to help us make sense of the world - so we can respond to opportunities, dangers and challenges in the most effective way possible, and it does not shut down when we dream. Michael Gazzaniga, one of the team of neuroscientists who first uncovered and described the right brain-left brain split, has spent a great deal of time named studying and writing about this narrative creation system. He calls it the Interpreter. (Gazziniga)

This part of the brain, always working to help us make sense the world, tries to form the most cohesive story possible out of the images, ideas and feelings that occur during dreaming. (Gazziniga) The de-activation of the conscious control systems and the increased fluidity of the brain when dreaming simply gives this “narrative creation function” much more difficult material to work with in terms of creating a cohesive and reasonable story. As good as the Interpreter is in creating order out of fairly random information, it is overmatched when we are dreaming and the stories can’t help but be pretty wild.

There is another set of rules that do not change when we are dreaming. Our brains sort and store information based upon associations. Things that have something in common tend to get connected together in our memories, meaning there are literally neuronal “wires” that allow messages to be passed back and forth. 

This is true whether the associations are based upon common features – like tables having legs and elephants having legs – or whether the associations are based upon two memories being stored at the same time – like Pavlov’s dog associating a bell with food being delivered.

These connections mean that whenever a stored memory is activated or evoked, neuro-electrical messages are passed back and forth - to some degree or another - with all of the other memories that have connections through those associations. Each memory is connected to a lot of other things through a complex chain of associations that go both ways and allow electrochemical messages to be sent in both directions.

If one part of the chain gets activated, it can wake up the whole chain to which it is connected. In clinical work with addictions, this is why we worry about finding all of the potential triggers that might set off a relapse.  Something that might on the surface seem far afield from the substance use can possess hidden associative connections - connections that spark the activation of a whole chain of other associations that, once activated, can lead back to the use of the addictive substance.

As we have noted earlier, when we are dreaming there exists widespread de-activation any of the conscious control systems that might interfere with accessing and connecting up all of our chains of association. This allows for a wide open field for finding and matching up connections between things. Much looser associations between very different things – associations we wouldn’t consider when conscious – are permitted to be tried out as if they were just as logical as anything else we might consider. This lends itself to some really creative combinations being brought together.

It is important to note that the choices of where to start in this process are not entirely free and random. Even in this wide open process, there are some rules that are driven by adaptive purposes. First, newer memories, still fresh in our thoughts, have a slight advantage in terms of being activated by the release of acetylcholine in the REM stage of sleep. (Kripner and Combs) 

Likewise, things that are somewhat unresolved emotionally may have more activation potential. Our most recent memories – particularly our more emotionally important recent memories – are ever so slightly more likely to be brought into the dream process. Once activated, they form the first link in the chain of associations when the dream formation is set in motion.

This is useful in terms of learning, because it means that the new memories will “reach out” to other stored information with which they have some kind of associative connection. If a connection is successfully formed through this process, it links up the new memory with a larger memory chain, causing it to be reinforced and strengthened through association with a wide range of other things that have already been established in the cognitive structures of the person.

Memories of newer experiences that resonate with what is already established and considered important will be more likely to be assimilated and connected up to longer-term memory storage. Even if a person does not awaken in a manner that allow them to remember the dreams from the previous night, this process will occur and important new information will be process and stored below the surface of consciousness where information hibernates prior to being used.

If new experiences do not resonate in any important way with what is already in storage, those experiences are more likely to be allowed to drop out of memory. This is one of the ways that a person’s memory systems keep the amount of new information absorbed at a manageable level. Every night, unimportant information apparently gets pruned from the neurons that store short-terms memories via synaptic connections. This frees up resources for storing the important stuff into a person’s memory structures.

This process of memory transfer and storage is supported somewhat more effectively during the dream state because the limbic system is highly activated. During the REM dream state, the memory storage process occurs in combination with increased emotional content. Because emotional experiences are more powerfully stored in our memory, this may help to solidify these newly consolidating memories. The dream process during the REM stage does seem to be particularly important for certain kinds of learning processes, particularly social learning with emotional components. (Kripner and Combs)

There is another creative side to the dreaming process. The freedom that permits random thoughts from widely separate areas of the brain to be activated together also permits an increase in the construction of creative new possible relationships between: 1)new material and new material, 2) new material and old material, and 2) old material and old material.

Sometimes a new memory unit will have associative connections with two very different memory chains that have been stored previously but always kept separate in the person’s mind. The new memory unit, by simultaneously activating the two separate memory chains, can serve as a bridge or catalyst to create integration of the previously separate ideas or constructs. This allows new insights to what is already known:  the formation of a whole new set of understandings organized at a more complex level.

In schools of psychotherapy that utilize systems theories and principles, there is a concept called the bifurcation point. This is the point at which an individual or system of individuals will reach a state of crisis and pressure where a decision must be made to either 1) give in to the resistance to change and apply renewed effort to holding onto a pre-existing pattern of Affect, Behavior and Cognition (to be referred to as an ‘ABC’ construct for our purposes here), or 2) undergo some kind of transformational change process where a new paradigm or mode of affect, behavior and cognition is adopted.

In many cases, reaching and positively moving through this bifurcation point is the whole point of psychotherapy. In therapy, we try to envision and move our clients towards new and healthier ABC constructs. We position these new constructs in opposition to our clients’ old and dysfunctional ABC constructs - and try to build bridges between them no matter how incompatible they might be experienced by the client. We try to integrate new information and emotional material in ways that create transformational changes to the ways in which our clients understand the history of their own experience, inviting them through and past the bifurcation point towards real change.

There are aspects of this attempt to push through the bifurcation point that may actually be aided by the person’s dream processes. During waking states of being, a person’s conscious control systems – including his/her defenses – operate at full alert. This can prevent connections being created between incompatible ABC constructs, no matter how skillfully a therapist brings the healthier constructs to the table.

However, the defenses that hold a person’s resistance in place are altered during the dream stage, as the person moves into a much more fluid state for creating new connections and associations. The client’s dreams may do some of our therapy work for us, integrating information during sleep that might be too distressing to bring together in waking life. 

The person may or may not remember the dreams in which this integration process is occurring, but the ongoing information processing occurs each night whether the client remembers it consciously or not. Most experienced psychotherapists have had at least a few instances where clients seem to break through the bifurcation point for reasons that cannot be easily explained by what is occurring in the actual therapy sessions. It is not unreasonable to think that some of the transformational work of therapy is at least being supported by the information processing functions of a person’s dreams.

However, it is important to issue a note of caution for clinicians who may wish to construct whole sessions around the examination of a client’s dreams. The openness and fluidity of the dream state means that there will be a lot of randomness to the process. Not all dream content appears to reveal deep and valuable material for therapy.

The dream formation process is perfectly capable of randomly assembling bizarre combinations of things that turn out not to have any deeper meaning beyond the wild associative pairings of a dream. Along with the useful “signals” that dreams create, there is a whole lot of meaningless “noise”. To paraphrase Freud, even when it comes to dreams, sometimes a cigar is just a cigar.

However, clients are inclined to have a deep emotional response to their dreams because the limbic system is highly activated during the REM stage of sleep. This means we are inclined to give a lot of emotional weight to our dreams – not because they are actually that important, but because our limbic system activation makes it feel like they are that important. This can lead to an over-valuation of the importance of what we dream.

Current research is pointing to the idea that dreams may just be an “accidental by-product of two great evolutionary adaptations – sleep and consciousness.”(Domhoff) As human beings, we are neurologically inclined to seek out meaning and create meaning from whatever random information is presented to us – even when there isn’t much meaning, just randomness.  So even if the combinations of things produced by our dreams are just random items randomly activated at the same time in our dreams, the Interpreter tries to create cohesiveness and meaning from the randomness. This can incline us to create meaning that isn’t actually there.

For mental health clinicians who respect the need for evidence-based practice, this means we should proceed with great caution and humility for how much we don’t know and don’t understand in all of these processes.


Practical Implications

The most up to date research with regard to dreams and dreaming seems to suggest that a somewhat cautious and humble position should be taken with regards to the use of dream interpretation as a vehicle for driving therapeutic change. While there may be a useful purpose for dreaming in terms of information processing and the integration of new experiences with previously stored memory structures, recent advances in understanding through cognitive neuroscience suggests that we proceed cautiously in applying a more Freudian view of the nature and purposes of dreams.