Abnormal sleep behaviors may require medical intervention

Abnormal sleep behaviors

Dear Doctors: My boyfriend says that lately I've been talking in my sleep and sometimes acting out my dreams. One time I actually hit him. He says it may be something called an REM sleep behavior disorder. This has been kind of scary, and I would like it to stop. Would going to a sleep clinic help?

Dear Reader: Sleep disorders are estimated to affect up to 70 million people living in the U.S. They include insomnia, which is the most common sleep disorder, restless leg syndrome, obstructive sleep apnea, narcolepsy and parasomnias. REM sleep behavior disorder, also known as RBD, falls into that last category.

The term parasomnia refers to abnormal behaviors that occur during sleep. Sleep talking, sleep paralysis, bed-wetting, repetitive tooth grinding, sleepwalking and nightmare disorder are also considered to be parasomnias.

REM is short for “rapid eye movement.” REM sleep is one of the four stages of a complete sleep cycle. During REM sleep, the majority of dreaming occurs. Scans of sleeping individuals show a significant amount of brain activity during REM sleep, almost as much as what the person would exhibit while awake. At the same time, signaling mechanisms within the brain induce a type of muscle paralysis in the sleeping individual. This is known as atonia. Sometimes referred to as REM sleep muscle paralysis, atonia is a normal, and even necessary, part of REM sleep.

When someone has REM sleep behavior disorder, it means that the safeguard of atonia, or sleep muscle paralysis, has been breached. This allows the person to physically respond to, or act out, their dreams. The resulting activity can range from small movements, such as waving a hand, to vigorous, full-body engagement. When it is the latter, it can put the sleeper, as well as those around them, in danger. Someone with RBD may thrash, kick, hit or punch. This can potentially cause injury to themselves or to their bed partner. When they awake, they will also often clearly remember the dream they had been having.

Diagnosis of a sleep disorder typically includes a medical history and a detailed sleep history, and may also involve a physical exam and a neurological exam. A sleep study, during which the individual's physiological and behavioral data are recorded, is also often requested.

When someone has RBD, the data collected in a sleep study will often reveal a lack of atonia, or sleep paralysis, during REM sleep. Treatment of the condition focuses on changes to the sleep environment to make it safer, and on the use of medications. These can include melatonin, a hormone that helps regulate the sleep cycle, and certain anti-anxiety medications.

The causes of RBD are not yet understood. In some cases, they have been linked to neurological disorders and to the use of antidepressants. Some people find that the episodes are temporary and recede on their own. If your symptoms persist, you should consult with your health care provider. If needed, they can refer you to a sleep clinic for an in-depth assessment and any necessary treatment.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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