Jan. 29,1999
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Sleep and Dreams Help to Regulate Negative Moods in Depressed Individuals and Restores Mind, According to Rush Sleep Researchers

A quiet night of quality, restful sleep and dreaming can help both depressed and non-depressed individuals work out their negative feelings and problems, according to sleep researchers at Rush-Presbyterian-St. Luke's Medical Center, Chicago, who conducted two long-term comprehensive studies of how dreams and sleep restore psychological balance after a "bad day."

Results of the studies were published in the September and October issues of Psychiatry Research. One study examines individuals going through a personal crisis (separation/divorce). The second examines individuals dealing with more routine, daily stresses.

In the first study, 61 volunteers who were separated or going through a divorce were tested using the Beck Depression Inventory (BDI) criteria, which measures how much depressed mood is present during a person's waking hours. Thirty-nine of the volunteers met the BDI criteria for depression. Twenty-two tested not depressed.

All of the volunteers spent three nights in the Rush sleep laboratory on two occasions - once close to the time of their marital separation and another, one year later. Researchers monitored each subject's sleep by looking at three characteristics usually associated with mood regulation: eye movement density during the first REM (rapid eye movement) sleep state, strength of the emotions in the first dream and the number of negative dreams recalled during REM awakenings.

Sleeping and dreaming occur in cycles. REM sleep usually occurs 60 to 90 minutes after sleep onset and approximately every 90 minutes throughout the night. There is more REM sleep during the second half of the night than in the first. It is characterized by an active brain, suppression of skeletal muscle tone, bursts of rapid eye movements, and occasional tiny muscular twitches.

Researchers woke each participant during each REM period and asked what was happening in their dream and how they felt about it. Responses were assigned to categories - no report, negative, neutral, positive, un-emotional, mildly emotional, and strongly emotional.

One year later, volunteers again completed another BDI test, spent three nights in the Rush sleep laboratory, and were awakened by researchers during the REM period to share their dreams.

Twenty-two of the original 61 volunteers who scored not depressed a year before again scored not depressed. Of the 39 volunteers who tested depressed initially, 22 no longer tested depressed after one year. These 22 patients had received no medication or psycho-therapy. The changes in mood were related to their pattern of dreams. Those who reported negative dreams at the beginning of the night and not at the night's end were more likely to be in remission one year later than those who reported the opposite pattern.

"The four or five dreams a night reveal whether the person is working things out through the night. Through dreams you work out anxieties, angers, and fears - all feelings experienced that day," said Rosalind Cartwright, PhD, director of the Rush sleep disorder service. "Our dream system serves as an internal therapist, "We work out our anxieties and problems while we are sleeping. As we work out our problems, our dreams get progressively better through the night. By allowing ourselves to get more sleep, we have a chance to handle our problems more productively, waking up in a more restful and peaceful mood. Dreams are an x-ray of our psyche and a mood regulator."

"In this study, we found that negative dreams in the first part of the night may reflect an internal sleep mood regulation process taking place. If these occur later in the night, they indicate a failure in the completion of this process."

"By looking at their dreams both positive and negative and the order they occurred one year ago, we could predict who was going to get better and who wasn't. We are not surprised that the majority of the depressed volunteers got better, Cartwright said."

For depressed individuals or those going through a major crisis, the negative feelings they are experiencing are often too high to diffuse in one night. According to Cartwright, the depressed person may not have enough time to handle or work out their problems effectively overnight. They start REM sleep sooner than those who are not depressed. They have long active dreams with much bad feelings, and often wake up still feeling negative and depressed - not wanting to face another day.

Cartwright says, the warning signs of depression include feeling discouraged, dreading or not looking forward to another day, having nightmares or scary dreams, insomnia, feeling afraid to go back to sleep upon awakening in the middle of the night, having repetitive dreams in which the same scenario repeats itself and feeling anxious about problems or conflicts in one's life.

"For depressed individuals who are not in therapy or taking medications such as anti-depressants, we can predict who is going to get over a depression and who won't by looking at how they handle their emotions in their dreams," said Cartwright.

In the second study, 60 volunteer medical students with no history of depression were tested using the Profile of Mood States (POMS) test before and after two nights of laboratory sleep. This test measures the current mood states of an individual.

During the first night, researchers monitored each subject recording their sleep patterns. During the second night, each subject was awakened during the REM period on a set schedule to tell what they had been dreaming.

The students who experienced some depressed mood before going to sleep reported a dream pattern of decreasing negative feelings to increasing positive feelings. Students who experienced little to no depressed mood before going to sleep reported more positive dreams during the REM periods.

"Normal people handle anxieties, anger and hostilities while they are sleeping and usually wake up feeling better. While sleeping, your mind is processing the day's events and relating it back to older memory experiences," Cartwright said. "REM sleep is actually organizing what is upsetting us today into older memory stores and developing creative solutions to our problems. For example, - 'I've handled this before. Don't be upset. I can deal with this.' REM sleep is actually organizing what's upsetting you. "

"Through becoming aware of the role sleep and dreams play in our lives one can learn to get better quality sleep and help to reshape their feelings. This is especially useful for depressed and mildly depressed individuals," said Cartwright. "Sleeping and dreaming rebuilds the body and the mind. Many in our society are sleep deprived. If we could teach ourselves to sleep longer and better, I'm convinced we could handle our feelings more productively."

### Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about two million people through its outpatient facilities and nine member hospitals.


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