Good Night, Sleep Tight, Don’t Let the COVID Dreams Bite!

Catherine started her day like any other. She grabbed her purse, put on a face mask, and began walking through the city. Suddenly people were walking toward her. Lots of people. People without masks. They got closer and closer—so close she could hear their breathing. She told them to get back, get away. But they encircled her, penning her in, breathing heavier and heavier, until she panicked and screamed. Then she woke up.

Catherine (not her real name) reports that ever since the COVID-19 pandemic began, she has been having increasingly disturbing dreams. She’s not alone. According to Dimitri Markov, MD, a sleep disorders specialist at Jefferson Sleep Disorders Center and assistant professor of psychiatry and human behavior, the coronavirus crisis has triggered more frequent, more intense, and more troubling dreams.

“People are reporting more vivid dreams, more anxiety-laden dreams. That is a reflection of a much higher-level of stress that millions of us are feeling right now,” Markov says. Some of the dreams patients are reporting focus on getting COVID themselves or infecting their loved ones; being in a crowded restaurant where no one is wearing a mask; and being isolated and alone in an asylum.

Nightmares, dreams, and sleep disturbances are common in times of trauma and disaster. For example, research showed a significant increase in the number and intensity of dreams after the 9/11 terrorist attacks.

Markov says the difference in that case was the adversary was tangible—we saw a plane fly into a building.

“With this virus we cannot see it, we don’t know how to protect ourselves, or even if we can protect ourselves,” he says. “It has been with us since March, and it is continuously out there, and we don’t know what the outcome will be—and anxiety is building.”

Add to that the amount of extra sleep time Americans have been getting since the onset of the pandemic, and you have a recipe for nightmares.

Since COVID-19 pushed the pause button on everyday life, Americans have been getting an average of 20 percent more sleep per night, according to the Centers for Disease Control. Unfortunately, that doesn’t mean they are waking up more rested and refreshed. A survey conducted by Sleep Standards found that more than 87 percent of people in the U.S. have reported unusual dreams since the pandemic began. And Markov says people are remembering those dreams more often.

With more sleep comes more rapid eye movement (REM) sleep, the stage during which the most vivid dreams occur. The REM stage usually occurs about 90 minutes after falling asleep, and occurs several times a night; if you wake up naturally from REM sleep, you’re more likely to remember those dreams.

“In order to remember a dream, there needs to be a period of wakefulness,” Markov explains, adding that if a person has a frightening dream, wakes up as a result, and remains awake for five to 10 minutes, then they will be able to encode the memories of that dream. “With the high level of anxiety caused by COVID, there is more of this wakefulness, which allows us to remember dreams more.”

Markov says that common fears are expressed in dreams.

“Dreams are a mirror of our everyday reality filled with fear over an invisible enemy. We’re faced with this frightening virus, which we don’t have any control over; we don’t know who has it, don’t know who doesn’t, so we are naturally more anxious about it.”

He notes, however, that bad dreams don’t present a danger to wellbeing—with one exception: healthcare workers.  

“Frontline healthcare workers—emergency room physicians and nurses, emergency room personnel, pulmonary physicians, pulmonary nurses—their dreams are more traumatic because they are a reflection of their everyday life,” he says. “Some include: ‘I was trying to get a ventilator for the patient, and the ventilator didn’t work’; ‘I was trying to save the patient and I couldn’t.’ There is a lot of guilt about not being able to save the patient—a feeling of helplessness. These nightmares can signal PTSD.”

Those frontlines workers, he says, might need additional support. Talking to friends and peers can help, but sometimes the more severe symptoms are best helped by therapists.

For the general public, though, the dreams are mostly just unsettling. While it’s impossible to control dreams, Markov says improving the quality of sleep can help mitigate the nightmare scenarios that invade your slumber. He recommends:

• Getting into a routine by creating a consistent schedule of sleep time/wake time
• Avoid consuming caffeine and alcohol close to bedtime
• Turn off electronics before bedtime; don’t use them in bed
• Don’t spend excessive time in bed when not sleeping
• Avoid exercising close to bedtime

Another technique for fending off nightmares is to talk them out with friends or family members.

“Human contact is important during these times of isolation,” Markov says. “Connecting with someone else evokes empathy, which helps deal with the stress.”