COVID-19 dreams? Here's what they mean

Whether the cause is stress related to working from home, wearing masks, lack of day care, or limited access to health care, COVID-19-related anxiety has spilled into nearly every aspect of our lives. Apparently, it has even invaded our dreams.

People are reporting strange, intense, colorful, and vivid dreams—and many are having disturbing nightmares related to COVID-19.

But Christine Won, MD, a Yale Medicine sleep specialist, who has noticed an uptick in patients reporting recurrent or stressful dreams, provides reassurance that this is no cause for concern. "Nightmares and bad dreams, in general, have not been shown to be unhealthy," she says. "Some think it's a way for us to work out our daily stresses or preoccupations during the day."

Susan Rubman, Ph.D., a Yale Medicine psychologist and sleep specialist, agrees, noting that these dreams and nightmares are surprisingly common. "People say they feel alone in having so many strange dreams, but it is a significant phenomenon, and it's happening with some frequency during the pandemic," she says. "It's important to realize that this is part of human nature and to know you are not alone."

What's more, doctors aren't surprised to hear reports of anxiety-related dreams about COVID-19. At least one small study after 9/11 showed a significant increase in something called "central image intensity" (the central image is considered the emotional focus of a dream). The researchers concluded this arose from increased emotional arousal after the trauma. As the number of COVID-19 cases has increased, a Harvard researcher reports receiving thousands of responses to an online dream survey she created. These showed clusters of COVID-related dream content around specific topics, including fear of getting the virus, frustration over social distancing and sheltering at home, and forgetting to take steps to avoid the virus.

What is a nightmare, anyway?

Bad dreams can be disturbing, but the definition of nightmares is more intense "dreams with vivid and disturbing content," according to the National Sleep Foundation. People who have nightmares typically are immediately awakened by them and have strong recall of the dream, often with anxiety that can linger, Rubman says. "Nightmares are often reflective of our own effort to avoid threats to our security, our survival, or our physical integrity," she says. An estimated 50 to 85% of adults report having an occasional nightmare, and up to 50% of young children report having nightmares so severe they wake up their parents.

Craig Canapari, MD, a pediatric sleep specialist for Yale Medicine, says that among children, COVID nightmares may be most common in those whose families are experiencing a lot of stress during the pandemic, as well as in teenagers who are going to bed late and sleeping late because of cancelled school. "Some teenagers have become totally nocturnal," Dr. Canapari says. "If they are staying up late and not making up the extra sleep, they will get 'REM rebound' when they do eventually sleep more." This means they experience an increase in REM sleep (described below), which is associated with disturbing dreams.

How dreaming works

Sleep is not one continuous experience; rather, each evening contains several stages of non-dreaming sleep, including a state between being awake and falling asleep (light sleep); onset of sleep; and deep restorative sleep. "I like to compare sleep stages to carousel horses where we move up and down through the different stages across the night," Rubman says. Another one of these stages, when most dreams occur, is called rapid eye movement (REM), because the eyes dart back and forth very quickly, heart rate and blood pressure rise, and brain activity becomes more intense.

People spend about a quarter of a night's slumber in REM sleep, with dream cycles occurring about every 90 minutes, becoming longer and more intense in the latter half of the night. "It's hard to judge time when you are inside a dream," Rubman says, but the actual duration of a dream can range from a couple of minutes to as long as 30 to 45 minutes. You are more likely to remember dreams if you wake up during them, she adds, but not remembering your dreams does not mean you are not having them.

What do your dreams and nightmares mean?

Doctors aren't certain whether such dreams carry much meaning beyond possibly being a sign a person is under more stress than usual. "I wish it were the case that we could draw a point-to-point correlation between what happens in our dreams and some meaningful information during the day, but we can't always do that," Rubman says. "We can't say I dreamt about 'X' so it must be that 'Y' is bothering me. However, if we are anxious or distressed or feeling a lack of control during the day, it can certainly show up in some way in our dreams. Often the format is not obvious."

For instance, the Harvard survey turned up dreams about different types of bugs—bed bugs, cockroaches, stink bugs, and various types of flying insects. People often use the word "bug" to refer to a virus-like illness, Rubman says.

There is data to show that REM sleep helps people sort through the information and stimuli they are bombarded with every day, says Rubman, who compares this with separating mail—throwing out the junk mail, and keeping the bills and important letters. Dream content about standing in line without a mask may be sorted into the "important pile" because it indicates that the dreamer is concerned about their own safety or the safety of those around them.

The important thing is to get a good night's sleep

The real problem with these COVID dreams is that they may impact sleep quantity and quality. "From my perspective, I'm most concerned about the sleep disruption," Dr. Won says, adding that a good night's sleep is essential to helping the body function optimally. "All of these dreams may be a sign of stress, which can lead to sleep fragmentation and unrefreshing sleep, affect the immune system, and cause psychological distress."

What's more, over the long haul, chronic sleep disruption is associated with such serious long-term issues as dementia and heart disease, she says.

Yale Medicine providers suggest trying these strategies to help with bad dreams and nightmares:

• Create a healthful daytime routine. It should include exercise, healthy meals, and techniques for stress relief.
• Do dream imagery rehearsals. This essentially means rewrite the script of a recurring disturbing dream before you go to sleep—try adding a happy ending. For instance, says Dr. Canapari, a child who likes the Harry Potter series could imitate a spell from it that made the thing they were most scared of look ridiculous.
• Establish a calming bedtime routine. Dr. Won advises spending time relaxing—flipping through a magazine or doing some light reading. "Don't watch a documentary on the Ebola virus or something like that," Dr. Won says. "Do things that will help you feel more relaxed."
• Avoid alcohol before bed. Alcoholic drinks not only disrupt sleep, they can also cause more intense dreams.

While dreams aren't necessarily a reason to seek professional help, Yale Medicine providers urge anyone who is concerned that disturbing dreams and nightmares are related to a greater problem with anxiety to talk to a mental health professional or sleep specialist who can make a comprehensive assessment. Dr. Canapari tells parents concerned about children who are having nightmares to talk to their pediatrician or a mental health specialist.

"The pandemic is a shared experience and lots of people are experiencing anxiety and fear," Rubman says. "If you are uncomfortable, there is help available."