You’re in a store, and suddenly you notice that no one is wearing a mask. Well, at least you have your mask on.

But then you reach up to your face, and you’re not wearing a mask, either. “Help! How do I get out of here?”

And then you wake up. It was just a dream. You’re safe.

The pandemic has taken the realm of anxiety dreams — common occurrences — to a new level.

To understand more about anxiety, sleep, and dreams, we spoke with Dimitri Markov, a Thomas Jefferson University Hospital physician and assistant professor of psychiatry and human behavior who specializes in sleep medicine.

How does anxiety affect our sleep? Why do we have anxiety dreams?

People who have high levels of anxiety and stress do not sleep as well. Anxiety is linked to insomnia. When a person is anxious, all sorts of hormones and chemicals are activated in the brain, so the brain becomes more activated, making it more difficult to ease into sleep.

Honestly, we don’t fully understand even why we sleep, let alone why we dream. There are a lot of theories about dreaming. But what is true is not known.

Freud was one of the original people to start dealing with dreams. He thought that dreams represented unconscious wishes. But right now, we are dealing with the reality of COVID-19. It’s a real threat. It’s not unconscious. Dreams do help us consolidate memories. But what that all means is hard to say. Some theories say that dreams help us process our emotions.

Everyone’s dreams could be seen as being a part of their personal experience. But you really have to know the person. That’s where analysts come in. They know the person. They listen to them talk for a while, and then they start to be able to explain the meaning, or suggest a possible meaning. That suggestion may become meaningful to the person.

What anxiety dreams are people experiencing relative to the pandemic?

Many different types. It’s a very stressful time. People are dreaming of getting COVID-19 themselves. They are dreaming about passing it to their family members and loved ones. Some people have dreams about being attacked by bees or mosquitoes. After all, the coronavirus could be seen as a bug. People who are isolating themselves are dreaming of being stuck on an island or being in jail.

I know of a jeweler who dreamed that robbers entered his store without masks, shook his hand, and stole all his paper towels, not the jewelry.

A chef dreamed that his restaurant was full. Everyone loved his food, but no one was wearing a mask. Everyone wanted to shake his hand and hug him or have him join their table, and he was just trying to get away.

For health-care workers, it is a special situation because they are exposed to a lot of trauma now. They have really terrible dreams: patients dying of COVID-19, of not being able to help them, not being able to get ventilators, feeling guilty about not being able to save them. “The family wants to see the patient, and I’m in the way.” The patient dies alone. These are scary, traumatic dreams.

Do COVID-19 dreams present any intriguing avenues of research?

There are researchers who collect dreams, and they will eventually try to sort these dreams out into different categories. In terms of a clinical setting, it’s not unknown that in a time of stress, people are going to sleep worse, and some of them are going to need help. So this is new and, in a way, not new.

One thing we know is that working from home, people have a little more time available for sleep. So, oddly enough, their sleep hygiene tends to suffer. People tend to spend more time in bed. Then, their sleep pattern becomes much less regular and less consistent. People need to understand that their brains need to know when it’s time to sleep and when it’s time to be awake. A sleep routine needs to be followed.

What does that entail?

The main thing is to keep a consistent routine. Go to bed at the same time and get up at the same time. If your wake-up times are variable, your brain doesn’t know when it’s time to sleep and time to wake up. If you always wake up at the same time, you will train your brain.

Don’t spend too much wakeful time in bed. If you spend a lot of time in bed in wakefulness, sleep becomes shallower. You don’t get into a deeper sleep.

Don’t read in bed. Don’t do electronics in bed. Don’t watch TV. If we do, then our minds start to associate the bed and bedroom with those activities, and not with sleep. Use the bed for sleep and intimacy only.

Some people check the time when they wake up at night. “How much time do I have left? It’s 3 a.m. Why am I still awake?” There is no benefit to knowing the time when you’re in bed. Plus, the clock is a light. Light stimulates you to wake up.

Sometimes it’s better to try to stay awake. It’s called paradoxical intent. The more you try to go back to sleep, the harder it is. It’s because of this pressure, this performance anxiety. If you tell the person to try to stay awake, it will be easier to fall asleep.

For the most part, it’s better to avoid naps. A person needs a certain amount of sleep in a 24-hour period. If you nap, it will take time away from sleep at night. For the elderly who need to nap, it’s OK, but limit it to 30 minutes or less.

Sleep is one of the most powerful forces in nature. Everything sleeps. Cockroaches sleep. Soldiers can march and sleep. It really cannot be stopped. It’s like hunger. A reasonably healthy person with a reasonably good routine might have a bad night here and there, but for the most part, you’re likely to do OK.

Are bad dreams ever a good thing?

Having a COVID-19 dream is a shot of reality. We live in a COVID-19 time. So it’s on your mind during wakefulness and during sleep. We cannot escape it. It’s a real threat, and everyone is anxious. It is to be acknowledged. The fact that you dream about it is a reflection of your daytime. It’s just reality. We can look for meaning, and for each person, it could have a different meaning. One could say it makes it easier for you to deal with the stresses of COVID-19.

In the end, anxiety dreams are a reflection of everyday concerns. It’s a little safer to see them in your dreams, when you’re actually not getting COVID-19, you’re in bed. These dreams can help you process this emotion in the safe environment of your bed.

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