REM Rebound Demystified
Managing intense dreaming when sleep deprivation or substance use stops
Kelly thought she had finally won some hard-earned peace. With the support of therapy, good friends and deep determination, she had weaned herself off the cocktail of substances that had barely kept her insistent anxiety in check. She was exercising, was in a new relationship, was working through her childhood trauma… and then she found herself in the basement of a large house, sitting at the bar downing shots of vodka, letting it burn her throat, enjoying the intoxication… yet feeling something was off. The man behind the bar gave her a look, as if he saw right through her. Then his eyes blazed a shocking red, and she woke up in terror.
When you end a period of sleep deprivation or substance use, your dreams return, sometimes with a vengeance. To manage this period of nocturnal intensity, it helps understand the causes of increased rapid-eye movement sleep (REM rebound) and learn to befriend your dream life. In Kelly’s case this took time, resolve, and support to stay with the difficult feelings unearthed by her dreams. (More on this later.)
Sleep deprivation has many causes, from disordered breathing (sleep apnea) or excess worry to substance use or abuse. Whatever the cause, if you have experienced a period of sleep deprivation, have diligently pursued the correct remedy, and finally lay your head down in expectation of a long, deep, refreshingly sleep, it is dismaying to experience quite the opposite. Instead of the quietude of sleep, you may be immediately plunged into a period of intense dreaming and wake up feeling as though you have been running marathons through mazes or wrestling with your demons for the entire night.
While some may welcome the return of dreaming after a period of sleep problems, most are dismayed by the intensity of it, especially if they have been suffering from inadequate sleep for a long time. This phenomenon is called REM Rebound. Despite the temporary intensity it brings, it can be seen as a good sign that your sleep is on its way to returning to its normal, healthy, restorative rhythm.
Understanding REM
REM sleep is associated with our most intense and interesting dreams, and plays an important role in emotion regulation. This sleep stage is so important that following a period of REM deprivation, our body will automatically make up for what it has missed. REM rebound is characterised by intense dreaming and a structural shift in the normal sleep cycle. Typically, we start the night with a period of deep, slow-wave sleep interspersed with cycles of mainly non-REM sleep. A few hours into a typical night’s sleep will begin to cycle into periods of REM, with increasingly longer stints toward morning.
During REM rebound, a person can drops into REM immediately after falling asleep. Michael Breus, aka ‘the sleep doctor’, spoke with me about REM rebound. He said the majority of those who seek his help have sleep apnea, although his sleep medicine practice covers all aspects of sleep problems. The most common solution to sleep apnea is a CPAP (continuous positive airway pressure) device which keeps the sleeper’s airways open so they can breathe freely throughout the night. He has seen many patients in his sleep lab drop into several hours of REM sleep immediately upon first use of the CPAP, so hungry are their bodies for REM sleep.
Sleep rhythm will return to normal once we have made up our REM sleep debt. This can take days, weeks or even months depending on why, how long and how severely the sleep cycle has been disrupted. There is much in the literature about how to manage sleep problems associated with REM rebound, but very little in the way of help with what to do about all those troublesome dreams. Read on for some suggestions.
What is REM rebound?
First, we need a basic understanding of rapid-eye-movement (REM) sleep. This is the sleep stage most associated with dreaming. In a typical night, we have 4-5 REM sleep periods that gradually increase in length over the course of the night. In total, we spend about 90 minutes or more in REM sleep during a typical 8-hour night of sleep, with most of our REM concentrated toward morning. If we become deprived of REM, our bodies will drop into REM immediately upon falling asleep instead of moving through the progressively-deepening cycles of non-REM sleep that typically start our night. REM rebound is a natural increase in REM to make up for what was missed.
There is considerable research to support the notion that REM sleep and dreaming help to regulate emotional reactivity and to reframe negative experiences. REM sleep affects hormonal balance and sleep homeostasis. To return to the normal, restorative sleep patterns so important to all aspects of our health, we may need to go through a period of intense dreaming to allow our sleep rhythm to reset itself. My suggestion is to befriend this process. A first step is to understand that even our most frightening nightmares are trying to help us by balancing our emotional state and taking the charge out of challenging past and current life situations. We can work with them, not against them.
Substance Use and REM Rebound
REM rebound is typically caused by a return to better sleep after a period of sleep deprivation. REM rebound also happens when a person stops taking a substance that suppresses REM sleep. These include many commonly-used substances like antidepressants, alcohol, cannabis and benzodiazepines. Paradoxically, many of these substances are used to promote sleep – and while they can help you fall asleep, they disrupt normal sleep architecture, ultimately making the situation worse. (Newer sleep aids like zolpidem do not cause this problem.)
Sleep is critical to our emotional and physical health. Insufficient or poor-quality sleep is associated with poor emotional regulation, diminished ability to consolidate memory, a higher risk of psychiatric illness (depression, anxiety, PTSD), obesity, heart disease and stroke as well as increased risk of workplace and vehicle accidents. Clearly, getting a good night’s sleep is critical to all aspects of our health. Getting sufficient REM is intrinsic to this process.
The best way to overcome REM rebound is simple, yet it can also be a challenge for those with chronic difficulty sleeping well. You simply need to get enough good-quality sleep to make up the REM that your body requires. There are plenty of resources available on good sleep hygiene: things like a calming bedtime routine, limiting screen time, caffeine and alcohol before bed, and getting enough exercise are well documented and can help.
However, for some people, the intensely disturbing flood of dream imagery following the cessation of substance use can make it tempting to go back to taking the antidepressant medication or addictive substance they want to stop using. For those in this category, part of the answer is to develop a better relationship with your dreams, especially those that have returned with great intensity following a period of silence. If you have frequent and disturbing nightmares during the REM rebound period, making friends with these dreams may seem like an impossible task, but it’s not. Few people realize that nightmares are both treatable, and in many ways, also helpful in the emotional recovery process.