Dear Dream Doctor,

My boyfriend has a recurring dream that disturbs him and myself greatly. He is going down an enclosed flight of stairs towards a doorway. He recognizes this stairwell as one in the house he lived in as a child. When he reaches for the doorknob, it is cold and wet and the stairwell fills with mist or fog.

Suddenly the grim reaper is tickling him and he is laughing but there is no sound. He cannot cry out or make any noise and he cannot breathe. He also tries to pull on the hood to reveal the creature but is unsuccessful. He does not jolt awake but rather struggles to get free before he finally wakes up gasping for air and sobbing and suffering from a terrible headache.

Sometimes he walks in his sleep and has fallen and even broken his nose while having this dream. He does snore loudly and I wonder if he suffers from sleep apnea. This would account for him not being able to breathe, but the theme of this dream is chilling and worrisome. It bothers me even more that he has experienced this same dream since he was a child. Can you help us?

—Emily, Age 35, Single, USA

Hi Emily—

Your boyfriend’s dream confirms what we’ve known about REM for a long time. Events occurring in the physical body often are incorporated into the “story-line” of on-going dreams. In your boyfriend’s case, his difficulty breathing during sleep is causing him to dream of being short of breath! He’s also dreaming of having a meeting with “the grim reaper.” Does this mean that your boyfriend’s sleep apnea is a life-threatening condition? The answer is yes! His dream is a cry for help!

Snoring is always a sign of difficulty breathing during sleep. Your boyfriend’s snoring is caused by a partially collapsed airway (the air is being sucked through the relaxed tissues of the neck, which creates the snoring sound), while the gasping for air and headaches both indicate severe oxygen desaturation.

The fact that he has experienced this dream since childhood suggests his difficulty breathing is long-standing. (If he still has his tonsils and adenoids in, he may want to consider removing them, to open his airway). The stairwell he descends most likely is a clever, and accurate, dream metaphor for steadily decreasing oxygen levels during these periods of apnea. The presence of the grim reaper? The grim reaper signals danger—in any language!

The great news about sleep apnea is that it is very easy to treat effectively—and without surgery. Because your boyfriend may not be functioning at 100% capacity (tired during the day, difficulty remembering dates and keeping appointments) I encourage you to take it upon yourself to make an appointment for him at a sleep disorder center near you. If possible, try to go to the appointment with him. Your account of his sleep behavior—the snoring, stopping breathing, gasping and awakenings—will be very valuable to the physician.

Your boyfriend most likely will be asked to spend a night in a sleep lab, where he will be allowed, at some point during the night, to try a remarkable breathing device called a Nasal CPAP. This mask will eliminate the apnea, and the snoring. (Lucky you!) Once your boyfriend’s apnea is treated, his dreams of the grim reaper will vanish, and that will be a welcome sign of recovery!