Andrew Colsky on The Psychology of Sleep and Dreams

The relationship between sleep and the mind is far deeper than most of us imagine. Dreams, anxiety and emotional stress shape how we rest, while sleeplessness in turn reshapes our mental health. In this second feature of our four part series, Andrew Colsky explores the psychology of sleep and dreams, offering a rare look into how our nights reflect our inner world.

Colsky discusses why anxiety and insomnia are inseparable, what nightmares may reveal about unprocessed trauma, and how therapies such as cognitive behavioural treatments can transform the way we approach sleep. His perspective reminds us that the night is not only a time for rest but also a crucial space for emotional balance.

In your view, how closely are mental health and sleep connected? Well, it's not my view actually, it's the scientific studies that tell us that.

Number one, I think that the main issue that impacts most people when they have a sleep problem is anxiety. So you have this mental health issue of anxiety that's preventing people from sleeping. But then you also have the flip side, which is people who don't get good sleep are stressed out. They have additional anxiety because they haven't been sleeping. It can also interfere with other mental health issues.

And so you can't really pick one or the other. There's sort of a yin and a yang thing going on with sleep.

Someone who does not get sleep and is sleep deprived will develop psychosis. This is actually something that's used for interrogation techniques and other things. We know that the body does not react well when it doesn't get the appropriate sleep. So there's no question that sleep and mental health are directly connected. Question two.

Nightmares are often dismissed as meaningless. What do believe they reveal about us? This is a good question, and it's certainly more on the esoteric side right now. While I am trained to treat nightmares, the purpose of the nightmare coming about is a more difficult question to answer.

A lot of times nightmares are tied to traumatic experiences in our lives.

If we don't properly process our trauma, then we can have a consistent and recurring nightmare theme. Properly treating nightmares requires us to address that theme and modify it in terms of creating a new script for ourselves.

So in general, I would say that what nightmares reveal about us is that we probably had a traumatic experience. Now I'm sure people could quote examples where they're not aware of any traumatic experience and they have nightmares and that may very well be the case. I think there's a lot more learning that we need to do in that field. 

Could you explain how therapies like CBT for insomnia or nightmares can help transform a person's relationship with sleep? 

Well, absolutely. CBTI or CBT, cognitive behavioral therapy for insomnia is the gold standard treatment for insomnia. And CBTN or cognitive behavioral therapy for nightmares is a primary treatment for nightmares. They both have been scientifically studied and they both work very well.

These are some of the primary treatment methodologies used by behavioral sleep medicine practitioners.

In CBTI, what we find is that people have developed a fragmented sleep schedule due to their own schedule, due to their work schedule, due to staying out with friends because electric light allows us to stay up later, or TV watching, or whatever it may be. And so they go into bed at different times and they don't have a regular schedule. And then when they get into bed, they find that they can't sleep.

So they pick up their phone and they begin to scroll social media and oftentimes read about other people who aren't sleeping well. So they take their anxiety and they amp it up, which now makes it harder for them to sleep. And then they feel that there's something wrong with them because they're not sleeping. And so the natural result is to go and take a sleeping pill, which in my opinion are given out way too easily by the medical community.

And if they don't take a prescription sleeping pill, they'll go and they'll take some other over-the-counter aid, making themselves believe again that they don't have the ability to sleep and they need some sort of a crutch. The reality is if they had a consistent schedule, they followed proper sleep hygiene, ⁓ and they got rid of all the crutches, they would be able to come back into alignment and get a regular night of restful sleep. And that's what CBTI trains them to do. CBTN for nightmares specifically addresses nightmares that a person is having and it's a very particular process that the person works through in several sessions and it helps them to change their relationship with the thoughts that they have in the nightmare scenarios. When they do that they're able to put the nightmares to bed and move past that.

Why do you think people struggle to separate emotional stress from their nighttime rest? 

Well, I think this answer falls heavily into the concept of social media use. If you're laying in bed having trouble sleeping and then you rely upon social media to help you figure out why and you get a lot of misinformation, then your stress goes higher, which means that your ability to sleep goes lower. So when you ask why people struggle to separate emotional stress from their nighttime rest, it's because they've created this loop for themselves. So not only do they initially get into bed and then find that their regular anxiety from the day is preventing them from sleeping,

So they have this concern that I can't sleep. And then they go and they look up social media to read about sleep and they get more hyped up and amped up. Now they develop a, what we call anticipatory anxiety so that they're anticipating the next night that when they get into bed, they're going to have anxiety, which will not allow them to sleep. So they lay in bed doing what they call trying to sleep, which, I’m not sure what that actually means, honestly, and I always tend to ask my patients, what do mean by trying to sleep? And often the response is, well, I was reading social media, amping myself up, getting a lot more distressed, and then surprisingly finding it harder to fall asleep.

What role do you see dreams playing in our emotional processing?

This is a good question and probably best left to a dream expert. I don't consider myself to be a dream expert. I think it's an entirely different discipline than actual behavioral sleep medicine. And I wouldn't even want to speculate at this time about this particular question.

Do you think the way we talk about sleep in culture and media still carry stigma or misunderstanding? 

Absolutely it does. I think there's a lot that's unknown about sleep. Not only in the sleep community, but then when you get outside of the sleep community, there's really very little that is known about sleep. So.

If we don't know the scientific basis behind what's going on, then we just repeat what we hear in the media.

You know, one of the stories that really is concerning to me is there's something called shift work sleep disorder. And it applies to people who do shift work and typically have to work at night when they normally would be sleeping and then they have to sleep during the day when they normally would be awake. And it throws their system off and you can imagine puts their circadian rhythm out of of sync and lots of issues can arise from it.

Now take a person like that, put them in a workplace. They're working at night with either heavy machinery or flying an airplane or driving a bus or putting out a fire or whatever it may be. These jobs, you know, can have a lot of dangers associated with them. So the person is not properly awake, the dangers go even higher. There's a quote that I love from Michael Perlis, which is, “it's a terrible thing to have to be awake when your brain is sleeping.” 

And basically what he's saying is that your brain is not designed to be awake at the nighttime hours, it's designed to be awake during the day. And if you have to be awake when your brain is sleeping, it's pretty hard to function. So I think there's a tremendous amount of misunderstanding in workplaces and I've spoken to many professionals in workplaces who have never heard of shift work sleep disorder and seem to dismiss it as their employees are lazy and just looking for a reason to get out of discipline because they were caught sleeping on the job. Well, why do you think they were sleeping on the job? Did they come to work deciding that they were going to just sleep and get caught? Or perhaps there's a reason that they fell asleep.

I think it's something that people need to pay more attention to,

If someone is anxious about falling asleep, what is the first step they can take to calm their mind? 

This is a good one, because this is one that is having to be addressed by sleep professionals all the time. And basically, we're talking about anxiety or anticipatory anxiety related to going into bed. So one of the most important things, obviously, is to address the underlying cause of the anxiety. Because if we can do that, then we get rid of the anxiety that comes from it. But a lot of times we don't have the ability to do that, or maybe we're not aware of what it is. So we can turn to techniques such as breathing techniques. And there's multiple types of breathing techniques out there that people can use to kind of ground themselves and help them calm their bodies prior to sleep. 

There's also other exercises like progressive muscle relaxation, is heavily touted to help people relax their bodies prior to sleep. Then we get into journaling, which is taking the issues that are rolling around in your mind and don't want to calm down and putting in a journal next to your bed so that your mind knows that those things are there. You're not going to forget about them.

And it's okay to fall asleep at night because when you wake up, you can pick right back up with the issues in your journal. That also ties into the concept of setting worrying time. You can set a certain time of day that you will worry and then you leave the worry within that time block. And another one, when we talk about journaling, which is kind of important, is not just journaling and putting the journal by the bed. But if you take the journal.

You write down your worries in the journal and then you literally lock up that journal in a box or some sort of a safe area where it's locked away. The act of literally closing it away in a box or locking it up triggers something in our brain that allows us to know that our worries are safe, our concerns are safe, and they'll be there when we come back to them the next day.

So we can now take our time to get some needed rest. So those are a number of the different types of activities that people will engage in related to their anxiety. And then I've developed one of my own that I call the Four Seasons. And this is for people who have anxiety where their brain is on high alert, they're laying in bed,

They can't turn their brain off, and it just keeps ruminating or cycling through things. And what I tell them to do is if they can picture a square box in front of them. And on each corner of that box, they have one season, winter, spring, summer, and fall. And for each season, they picture a scene that is relevant to them. So in other words, if they happen to go on a certain ski trip every year in the winter time, then maybe they picture the ski lodge where they stay because they know that place. Or summertime, maybe they go to a certain beach and stay in a certain beach house, whatever it may be. 

And the idea is that if they find that their mind is racing and they want to stop the racing, if they are laying in bed, for example, with their face towards the ceiling. Then they close their eyes and they picture this box in front of them. And they literally move their eyes to the corner of the box that they're going to focus on. So their head remains still, but let's say the upper left corner is winter. They will lay still. They will move their eyes in their head, even though their eyes are closed, they'll physically move their eyes to the top left corner of that box. And then in their mind, they will picture their winter scene, whatever it is that they've chosen. 

And they will pay attention to that winter scene and they will look at excruciating detail about what they're seeing. So they're not seeing a general scene of someone on skis in the snow, but how many people are there? How close are they to each other? What kind of clothes are they wearing? What are the colors? How old are they? What type of skis are they using? Are there snowboarders there? And on and on and on and on. And the act of physically moving your eyes and having something else to focus on makes it almost impossible to be thinking about whatever it was that was causing you the anxiety. And if you do that, you break that anxiety loop and you should be able to eventually then get back to rest.

This conversation with Andrew Colsky highlights that sleep is never simply physical. It is a psychological process interwoven with stress, trauma and the narratives we carry into the night. From the power of nightmares to the stigma that still surrounds sleep disorders in culture and workplaces, Colsky demonstrates why understanding the psychology of sleep is vital to improving both health and performance.

The series will continue by looking further into the science and practical solutions that can help reclaim nights of genuine rest, building on the foundation laid here in The Psychology of Sleep and Dreams.