Is ReM Behavior Ruining Your Sleep? Here are some tips to improve life at night: By Dr. De Leon

mv.m

This happened to my poor husband and me, as it does to nearly  1/2 of the bed partners of PD patients  around the world since REM Behavior is reported to occur in about 47% of Parkinson’s patients….

I have been having vivid dreams and talking in my sleep for years, I would not be a good secret agent as per my husband. My sleep talking (about 70% of individuals have somniloquence-talk in sleep in some point in their lives without being aware) drives my husband crazy because I usually speak in my native tongue.  As my Parkinson’s disease has advanced, my dreams have become more vivid more frequent thought the night and my sleep talking has increased. However, over the last few months I noticed that my sleep talking had become louder to the point of awakening me. Then one morning I awoke to find my husband had built a wall of pillows between us for “protection,” he said. sleep talking

“Against whom?”  I asked.

“You, of course! I always knew that you were lethal. But, now I have confirmation!” He stated in a jokingly matter. ( I guess I picked up a thing or two watching all the boxing matches with my dad who was an avid boxer and boxer aficionado!)

A few days later in the middle of the night, I again awoke flinging my arms in the air and talking. Later the same night, I awoke because I felt hit something hard.  Apparently, I had punched my husband and was pulling his t-shirt. He was desperately pushing me away without trying to hurting me. “Sorry,” I muttered and fell asleep rather quickly.

Next day, at bed time he was building a bigger barrier.

“It’s amazing how you can’t throw a punch to save your life when awake,” he said “but people better what out if they try to mess with you when you are asleep. You throw a big punch that leaves a sting like ALi.”

After laughing, I apologized feeling really guilty. I told him that I was now having REM behavior ( RDB) due to my PD which was not only  causing me to ‘act out’ my wild dreams but was awaking me from sleep frequently since I was beginning to hear myself talk, punch and flail my arms in the air repeatedly.

“You are dangerous,” he commented. “If this keeps up, I may have to start sleeping in another room for my own safety.”

I knew it was time to adjust my meds recalling several patients who had gained weight suddenly not knowing the reason why only to find out they were sleep walking and raiding their refrigerators.sleepwalking-1

Others had broken bones from suddenly jumping out of bed and tripping on objects near bed. While other patients of mine had injured themselves on open chest drawers nearby. these scenarios were causing many partners to seek separate beds at night for fear of being assaulted by Manny Pacquiao’s and Floyd Mayweather’s and other famous boxer’s impersonators everywhere.  Even frail and weak appearing PD individuals can develop the strength of 100 men when in violent rage awake or asleep. I know I have seen it first hand as a doctor, a caregiver and a patient.

Thus, not wanting to continue 1) injuring my husband; 2) risking hurting myself; 3) continuing experiencing restless nights and chronic fatigue from lack of sleep; I increased my dopamine dose and started melatonin at night. I am sleeping better once more. My husband’s barricade has decreased and he no longer sleeps on the edge of the bed but still keeps a pillow nearby for protection just in case.

Few days ago, I asked him if I was still spilling state secrets. He answered in the affirmative, I surely would make a horrible spy I thought to just myself; but at the moment it appears that my boxing days and extreme fighting in bed at least for now appear to be behind me. I feel well rested and my dreaming although vivid has quieted down.

Things to know about REM behavior:

Sleep disorders is one of the most common non motor Parkinson’s symptoms that can precede motor symptoms of Parkinson’s many years before tremors and stiffness become noticeable. They can also occur in various forms ranging from insomnia, RLS, REM behavior (RDB) as the disease progresses. REM behavior is also known as “dream enacting behavior.”

Typically in REM sleep, which is part of deep sleep, our brains are very active and we experience a lot of dreaming while our bodies remain paralyzed. We usually go through this stage many times during the course of the night. About 20% of our sleep is spent in this stage which usually occurs more commonly in the second part of the night. REM behavior is more common in men over age 50 but more women are experiencing this phenomena (perhaps this goes along with the new trend of young women developing PD).  This sleep disorder is very common  in neurodegenerative diseases like Parkinson’s, MSA and dementia of Lewy body (LBD); it is also seen in narcolepsy. It can be the initial symptom of PD and MSA as well as that of  dementia of Lewy Body.

Dream enactment differs from night terrors by way that people if awoken from an episode of REM Behavior they are fully awake not confused and remember details of the dream unlike those with night terrors who have no recollection and are not fully awake.

Symptoms of REM Behavior include :

  • kicking,
  • talking,
  • punching,
  • arm flailing,
  • jumping
  • walking,
  • laughing,
  • shouting,
  • shouting profanity
  • at times emotional out cries.

Treatment:

  • increasing dopamine dosage,
  •  intake of small doses of klonopin is highly effective in most patients up to 90% with doses of .25 mg; it has complete effect in 79% of patients and the great thing about it is that it appears to do so without building tolerance or abuse.
  • The other extremely effective medication is over the counter melatonin in doses 3-12 mg taken at dinner around 5-6 pm.
  • tegretol ( carbamazepine) has also been shown to help
  • Mattress should be placed on floor
  • Put alarms in beds
  • remove potentially hazardous objects from around bed. One patient broke his lamp because he picked it up as sword, fortunately his  spouse awoke him before he struck her with it!

Habit-of-talking-in-sleep

Sources:

http://emedicine.medscape.com/article/1188651-treatment

http://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/basics/definition/con-20036654

Categories: Parkinsons disease, parkinsons health and beauty tips, parkinsons symptoms, parkinsons treatments, sleep disorders in parkinson's, tips for sleep hygiene in PDTags: , , , ,

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s