A few nights ago, I was on the receiving end of my husband acting out in his sleep. We’ve laughed for years about him playing basketball in his dreams (he tried to palm my head thinking it was a basketball!). However, this time he dreamt he was in a fight with some guy. Needless to say, I had to defend myself. Good thing I teach boxing!
We’ve all heard Alan Alda tell his story of how he threw a “sack of potatoes” at his wife that turned out to be his pillow. I have had several clients fall out of bed and hurt their backs. It is a concerning problem and all too common with Parkinson’s. Acting out your dreams occurs in 69% of those with Parkinson’s disease and multisystem atrophy.
Has this ever happened to you or a loved one?
Why does this happen?
Normal sleep has two states: non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. During REM sleep, rapid eye movements occur, breathing becomes irregular, blood pressure rises, and there is a loss of muscle tone (paralysis). However, the brain is highly active – similar to when you are awake. REM sleep is usually associated with dreaming.
With REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent, allowing the person to “act out” his or her dreams. RBD is characterized by the acting out of dreams that are vivid, intense, and violent. Dream-enacting behaviors include talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing.
RBD is usually seen in middle-age or older males. However, many women also experience this.
The exact cause of REM sleep behavior disorder (RBD) is unknown, although the disorder may occur in association with various degenerative neurological conditions such as Parkinson’s disease, multisystem atrophy, Lewy body dementia, and Shy-Drager syndrome. In 55% of people, the cause is unknown. And in 45%, the cause is associated with alcohol or medications such as tricyclic antidepressant (such as imipramine), serotonin reuptake inhibitor use (such as fluoxetine, sertraline, or paroxetine) or other types of antidepressants (mirtazapine). Recent evidence suggests there may also be several specific environmental or personal risk factors for REM sleep behavior disorder, including occupational pesticide exposure, farming, smoking, or a previous head injury.
RBD often precedes (an average time of 12-13 years) the development of neurodegenerative diseases.
Complications:
REM sleep behavior disorder may include:
- Distress to your sleeping partner or other people living in your home
- Injury to yourself or your sleeping partner
Medication for REM Sleep Behavior Disorder
Clonazepam (Klonopin) is highly effective in the treatment of REM sleep behavior disorder (RBD), relieving symptoms in nearly 90% of patients with little evidence of tolerance or abuse. The response usually begins within the first week, and often on the first night.
The relationship between RBD and Parkinson disease is complex; however, not all persons with RBD develop Parkinson’s disease.
References:
www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/symptoms-causes
https://www.webmd.com/sleep-disorders/rem-sleep-behavior-disorder-medications
sleepfoundation.org/sleep-disorders-problems/rem-behavior-disorder