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Dreaming of COVID-19

— For many during the pandemic, "nightmare" isn't just a metaphor

MedpageToday
A computer rendering of giant tentacles climbing up the side of an office building while a woman looks on

A physician successfully intubates a critically ill COVID-19 patient, only to find the ventilator has turned into a water cooler. In Italy, an exasperated ER doctor fails to secure a breathing tube, then falls backwards out of the window from several floors up.

These are just two among thousands of dreams researchers have collected in an effort to measure how different stages of the pandemic affected sleep. With the pandemic disrupting mental health, employment, and the social connections of waking life, they are finding that coronavirus-related anxieties are also infecting dreams.

In the earlier stages of the pandemic, dreams tended to be clustered into literal and metaphorical interpretations of the virus, said Deirdre Barrett, PhD, of Harvard Medical School, who published a earlier this year and still runs an . People dreamed of contracting the virus directly, but also reported imagery related to "catching a bug" -- swarms of cockroaches crawling out from under the sheets, or invisible monsters invading the building. (Barrett also makes .)

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A painting by Barrett titled "I Can't Wake Up" (photo courtesy of the artist)

Many people have fantastical dreams that make for amusing anecdotes. Healthcare professionals' dreams reported to Barrett's database, however, tend to include not just the shared terror of the COVID-19 threat, but also a sense of responsibility and failure.

While bad dreams and nightmares both evoke an emotional response, nightmares can cause such strong terror that they disrupt sleep. Recurring nightmares, where a realistic and traumatic plot plays out again and again, are a feature of post-traumatic stress disorder.

Data from China suggests more than and many are experiencing depression, both of which

"Typical people had some nightmares, but it was mostly just that they were really uneasy or intermittently afraid," Barrett told ֱ. "Providers working in the ICUs or ERs or doing general medicine intakes in places where the virus was peaking had almost all nightmares, and they looked like the classic post-traumatic stress nightmares coming from people who have continued to have symptoms well after the trauma is over."

More than 9,000 dreams have been collected in Barrett's survey since it opened on March 23, about half of which were submitted by U.S. dreamers. In a study analyzing about 4,000 responses, dreams recorded during the pandemic were riddled with significantly more negative emotions, anxiety, and death than a normative sample of pre-pandemic dreams, Barrett reported in the journal . The journal, which Barrett edits, also published regarding pandemic dreaming last week.

College-age students in one of them reported dreaming about changing locations, and had perhaps due to more images of face masks and coughing being portrayed in the media, reported Cassidy MacKay and Teresa DeCicco, PhD, of Trent University in Peterborough, Ontario. At the time, physical distancing restrictions had recently been implemented in Canada, but the COVID-19 case count was still low.

"We had a couple of participants specifically talk about food and resource hoarding in their dream journals," MacKay told ֱ. "COVID-19 isn't only affecting their waking life, but their dream life, by making them have more anxious dream imagery."

In the final pair of studies, dreamers who had been more impacted by the virus had more pandemic-related dreams. In one study, had more negative emotions and anxieties pervading their dreams. Among U.S. dreamers, had more pandemic-related dreams.

"I dreamt of being in a very crowded cinema," wrote one Italian dreamer. "I was starting to cover my mouth and nose with a scarf, and I remember well the panic sensation that suddenly assailed me, the terror of being able to become infected pervaded me."

In many of the studies, women more commonly experienced nightmarish dreams than men. Barrett found that women's dreams not only featured more negative emotions than men's, but were also involved more domains, such as anxiety, sadness, and unpleasant body imagery.

"Women, as with any disadvantaged groups, get hit worse by a crisis," Barrett said. She noted that in the U.S., and have shouldered a greater burden of homeschooling their children.

As time wore on, dreams started to reflect aspects of the lockdown, Barrett said. Some dreamers recorded anecdotes of being locked in solitary confinement, or being forced to go to a bar or party where no one was socially distancing or wearing masks.

"There was one where a woman said in her waking life she was going back to work, and they had been told the desks were 6 feet apart and they were installing plastic barriers between them," Barrett said. "So in the dream, that's what she was expecting, but the workman had been confused and put the desks all together, with the plastic barriers closing the desks in one space."

The dreams reported could be explained by the "continuity hypothesis," which suggests what is dreamt is a continuation of the events that occur in waking life, rather than distorted reflections of the subconscious mind, Barrett said.

Dreams where people make social distancing or masking mistakes may also be a part of memory processing, said Anu-Katriina Pesonen, of the University of Helsinki in Finland. In a recent study in she and co-authors used computational linguistics to form clusters of common phrases and words -- such as "coronavirus," "crowd," and "death" -- found in pandemic dreams, creating a network.

"The normal, automatic behaviors of being socially close, handshakes -- suddenly all of this is risky, and you have to change your behavior," Pesonen told ֱ. "Dreaming can help to consolidate some of this new behavior."

In Barrett's study, pandemic dreaming included death at more than triple the rate seen in a control group.

While many death dreams were horrific (e.g., wandering into a cemetery where COVID-19 patients were being embalmed alive), others were positive. One dreamer, for example, attended a family picnic with dead relatives.

Dreams can serve as a means to fulfill wishes made in waking life, and they have a therapeutic potential, Barrett said.

"When people share dreams ... it creates this sense of, 'We're in this together, and everyone is having the feelings that I am," Barrett said. "You would certainly get an empathetic response to the waking life version, but dreams make such a powerful, emotional microcosm drama of the situation that it touches us more deeply."

For healthcare providers or others experiencing traumatic dreams, a process called It involves rescripting the ending of a recurring dream and derailing the traumatic ending to give the dreamer a sense of mastery.

A repetitive dream of failing to secure a breathing tube, for example, could most simply be rewritten by envisioning oneself securing the tube, or by having reinforcements showing up to the ER to assist.

"Sometimes naturally when people have been having trauma nightmares every night, they would have one dream where it was a different ending, and they would wake up feeling the positive dream had changed things and put the trauma behind them," Barrett said. "It carried over into their waking feelings."

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    Elizabeth Hlavinka covers clinical news, features, and investigative pieces for ֱ. She also produces episodes for the Anamnesis podcast.