Most of us have intense dreams from time to time, but especially vivid ones can sometimes be a sign of a sleep disorder, like sleep apnea, a condition where your throat muscles relax during sleep. “Some people with sleep apnea may wake up from a dream—sometimes they are aware of choking, snoring, or gasping during sleep,” says Indira Gurubhagavatula, MD, MPH, associate professor and director of the sleep medicine fellowship at University of Pennsylvania, and director of the SleepDisorders Center at Crescenz VA Medical Center. If it happens often enough, they might end up exhausted during the day.
To be sure, your nighttime imagination doesn’t necessarily point to a sleep disorder: Stress, trauma, and anxiety are commonly known to lead to wild dreams. And they can also be side effects of certain medications, recreational drug use, or alcohol, Dr. Gurubhagavatula says. But if your dreams come with a feeling like you can’t breathe, they could point to sleep apnea.
What do dreams have to do with sleep apnea?
“Sleep apnea is a medical disorder in which the airway collapses in on itself, and it may close partially or completely during sleep,” Dr. Gurubhagavatula says. And this can happen repeatedly. “Each time the airway collapses, the amount of oxygen that can get through decreases. When the oxygen in the blood drops low enough, the brain signals the body to release the stress hormone adrenaline that causes a brief arousal from sleep.”
The reason this is more likely to happen during a dream is that dreams tend to occur during a stage of sleep called REM (for rapid eye movement). “This stage of sleep is characterized by a paralysis of muscle groups throughout the body, including the tongue and other muscles that help keep the airway open,” says Dr. Gurubhagavatula. It’s this paralysis that prevents you from acting out your dreams. “A person who is prone to having sleep apnea may experience it more often during REM sleep, when they are dreaming, since the upper airway muscles are paralyzed and may collapse more easily and more frequently.”
When a blocked airway tells your body to release enough adrenaline to wake you up in the middle of a dream, you’re more likely to realize you were dreaming—and to remember it—rather than sleeping through the dream, she says.
How can I tell if my vivid dreams are a sign of sleep apnea?
Of course, not every wild dream means you have signals sleep apnea. But look out for additional symptoms that you experience (or that someone else has seen you struggle with) at night while you sleep:
- loud, habitual snoring
- waking up with a sensation of choking or not being able to breathe
- gasping or snorting
- panicked sensation during sleep
- feeling tired after a full night’s rest
- needing to urinate frequently at night
- waking up with a headache
- little energy or motivation
- depressed mood
- low libido
Sleep apnea is more likely if you have some of the risk factors, like obesity, advancing age, a first-degree relative with sleep apnea, low thyroid function, are male, or a postmenopausal female. Alcohol and some medications, like opiates, can also increase the risk for sleep apnea, Dr. Gurubhagavatula says.
Also, keep in mind that the opposite issue can also point to sleep apnea: If you never remember your dreams, it could signal that you're not falling into deep enough REM sleep because you're having trouble breathing.
When should I see a doctor?
Sleep apnea is extremely common, easy to diagnose, and effective treatments are available, according to Dr. Gurubhagavatula. It’s worth considering an evaluation if you’re experiencing any symptoms—especially if you find you’re getting sleepy while driving (or are worried that you might).
If you do have sleep apnea, it isn’t merely disrupted sleep or loud snoring that you’re dealing with. “Untreated sleep disorders can cause health and safety problems over time and can impact productivity,” says Dr. Gurubhagavatula. “Not only does sleepiness increase the risk for accidents, but sleep apnea has been associated with heart disease, stroke, hypertension, impairment of brain functions including memory, focus, attention, reaction time, and mood.”
Fortunately, since the pandemic, many sleep centers continue to offer telehealth appointments, so you can see a specialist at your convenience. “Doctor evaluations and even sleep studies can be done at home. Treatment can help improve your symptoms and reduce long-term risks,” Dr. Gurubhagavatula says. “And with healthy sleep, you can feel better and perform more effectively at work or at home.”
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