Granny, what of your dreams?

Do Androids Dream of Electric Sheep? – is the name of Philip K Dick’s novella which was most recently translated into the Blade Runner 2049 movie. My son’s Blu-Ray DVD arrived in the post this afternoon.

It has been said that dreams are under attack from modernity – from our reduced and erratic sleep patterns, interference from artificial light, handheld devices and SSRIs all of which exert an effect on the shift from light to deep to REM sleep, the latter being where the business takes place.

Today, on a ward round, an older patient told me about her dream. The vivid notion that her husband had been to visit her, but who had in reality not been, nor had he called and, her anxiety that although this was a dream, she felt there was likely to be something amiss with him. She is 94 years old. I offered to ring him. She said he didn’t use the phone because of his hearing. She, stuck in bed, he, somewhere else, but, at least a dream.

We didn’t touch on the real nightmare of her being immobile in a hospital bed.

I had somehow considered that as people age they have fewer dreams.

Dreams – belonging to the youth, to people with a lifetime before them, both metaphorically ‘I have a dream,’ and physically – phasic movements of sleep, eyes fluttering, brain-wave patterns facilitating the emergence of our unconscious.

Older people also, because of the nature of their infirmities – perhaps lack of exercise, struggles with continence, pain, combined with daytime naps, leading to an altogether impoverished experience.

It seems my patient’s dream was genuine.

And, so too discussions about dreaming – there tend to be fewer topics as dull as listening to someone retell their dream (please see this episode of TAL). ‘I saw a shark talking with a wizard snake-man and the sky was blue before a priest sounded the matins prayers,’ kind of thing – incomprehensible, unless you are partnered though decades of Freudian Analysis.

Nevertheless, my patient’s experience was fascinating.

Revealing.

Perhaps the problem is that we don’t talk enough about dreams and, my patients in their 80s and 90s are getting along with just as many, if not more dreams than those of younger generations.

The purpose of dreams is not clear – it is apparent that most people dream most nights, our recollection is however, variable. Just because you can’t remember your dream doesn’t mean it hasn’t happened. What if, with dementia, or even mere forgetfulness your dream connection is extra-disjointed?

We know, or at least, so I have heard, if dreams are regularly disturbed – if, you take a person, a monkey or rat and shake them awake every time they enter REM sleep they subsequently develop depression and a variety of physical and psychological ailments; dreams serve a purpose, supposedly helping our unconscious minds re-run the day’s events or preoccupations; perhaps we should instead of dismissing, pursue them, integrate the dream-sequence into routine clinical history taking – for this you’d need to provide patients with dream diaries.

‘Hi Mrs Smith, here is your nurse call, over there the toilets and this is your dream diary.’

The lesson from this?

Our patients, whether they are young or old, or very, very old, experience the same range of emotional highs and lows as us; the objectification of ‘patient’ does not diminish an individual’s experience – in all likelihood, the opposite occurs; pain, feeling, fear, homesickness are all increased; and, what if dreams are too – during these periods of emotional and physical upheaval, approaching the end of life or a move to unfamiliar places; what if our dreams are enhanced?

My suggestion; the next time you are on the ward and you see an old man or woman, their eyes roving to and fro behind fluttering eyelids, imagine where they are; consider that their dream state is likely as transformational as ours and, start the conversation;

‘Did you sleep well last night Mrs Broon? Any interesting dreams?’

The Flower pot technique is sadly a real thing; if the rat falls asleep it loses muscle tone, drops into the water and wakes-up. Gah.