The Lathe Of Heaven by Ursala K. Le Guin
Winner Locus Readers Poll SF Novel for 1972.
The Lathe Of Heaven is somewhat of a classic tale. It's not so much SF in the sense of hi-tech, other worlds, aliens or being based on an idea of a utopia or dystopia. One might even call it a fantasy in that the premise is based on something closer to magic than science. Still, it is not fantasy in a typical sense of the word, and it involves exploring alternatives in a sense more in the nature of SF.
It's both a story narrowly drawn in terms of significant characters, but also gives views of the rest of the world(s). There are just two main characters. George has found himself under the care of a psychiatrist. The psychiatrist has found himself with an extraordinary patient. It is their interactions that make up the main structure on which the story is built and revolves.
George has come to realize his dreams alter the universe. The dreams are not under his conscious control, and the results leave him wishing he didn't have the dreams at all. This has scared him into trying to avoid sleep. The results have led him to be placed in psychiatric care. After a while the psychiatrist comes to see that George's dreams truly do change the world. While it may be implausible that George and the psychiatrist can perceive that the world is changing but nobody else in the world can, it does provide an opportunity to explore some "what if's".
The psychiatrist decides George's world-altering dreams are an opportunity to change things for the better. We end up with a story of the temptation of power and the devious paths of the world. It's a bit like the saying "Be careful what you wish for, because you might get it." Or the old tale of "The Monkey's Paw", where wishes are always granted, but always in unexpected ways with seemingly malicious side effects.
The psychiatrist implants thoughts in George in order to manipulate his dreams. But if one suggests a need to solve overpopulation, you wake up to find a catastrophe wiped out most of the people on Earth. If one suggests a need to end racism, the newly altered world has only one ethic group of grey-skinned people. And so on.