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Acting out your dreams- a sleep problem in Parkinson’s disease
Friday August 16, 2013
REM sleep disorder is a condition described as active, vivid and sometimes violent dreaming. Bed-partners describe restless dreaming that can include talking, screaming, punching and even getting out of bed to physically’ act out a dream.’ This condition occurs during REM stage of sleep when dreaming happens. During REM sleep our bodies lose muscle tone preventing movement while dreaming. During REM sleep disorder, body muscle tone or ability to move is maintained. This, coupled with active dreaming, can lead to sleepless nights and harm to the person or their bed partner.
REMSD can be present as an isolated condition or a condition associated with disease such as Parkinson’s or Lewy body disease. In fact, REMSD can predate movement problems of Parkinson’s disease and is being studied as a risk factor for developing the disease.
The active and vivid dreaming of REMSD is different from hallucinations although an individual can have both problems together. This problem should be evaluated to prevent physical harm and to improve sleep. The following tips can be helpful:
Monique L. Giroux, MD
Acting Out Dreams Is Often Early Sign Of Parkinson’s Disease
13 April 15
A rare sleep disorder that makes people act out their dreams may be an early warning of a deadly neurological illness, a new review of previous research suggests.
About half of people who have a condition known as rapid eye movement sleep behavior disorder will develop Parkinson’s disease or a related disorder within a decade of being diagnosed with RBD.
Eventually, nearly everyone with RBD will ultimately develop a neurological disorder, the study found.
“If you get this disorder and live long enough, you will almost certainly get Parkinson’s disease or a condition similar to it it’s an early warning sign,” said Dr. Michael Howell, a professor of neurology at the University of Minnesota in Minneapolis and co-author of the study, published today in the journal JAMA Neurology.
The main symptom of RBD is moving around during the rapid eye movement period of sleep, when most dreaming occurs and the muscles are usually paralyzed by the brain stem. People with RBD are thought to have a brain-stem malfunction that allows them to move during REM sleep, and thus act out their dreams, according to the study.
To find out whether RBD was, in fact, an early sign of Parkinson’s disease and similar brain disorders, Howell and his colleagues sifted through more than 500 studies on the subject published between 1986 and 2014.
The findings could help doctors find a way to treat Parkinson’s while it’s still in its early stages, Howell said.
Rem Sleep Behaviour Disorder Diagnosis
- RBD is usually confirmed by a sleep clinician at a laboratory, where a patient’s brain waves, heart rate, breathing and movements are monitored overnight
- Diagnosis is based on a combination of the patient’s movements while sleeping, dream-enacting behaviour and clinical history
- Other disorders, such as obstructive sleep apnoea and nocturnal seizures, can mimic RBD symptoms
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Rem Sleep Behavior In Parkinson Disease: Frequent Particularly With Higher Age
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Contributed equally to this work with: Heide Baumann-Vogel, Hyun Hor
Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing original draft, Writing review & editing
Affiliation Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
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Contributed equally to this work with: Heide Baumann-Vogel, Hyun Hor
Roles Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing original draft, Writing review & editing
Affiliation Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
-
Roles Data curation, Investigation, Validation, Writing review & editing
Affiliation Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
-
Roles Data curation, Investigation, Validation, Writing review & editing
Affiliation Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
-
Roles Data curation, Investigation, Validation, Writing review & editing
Affiliation Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
How Rbd Is Treated
Medications can help with the symptoms of RBD but cannot cure it.
They can quiet disruptive screaming and keep partners in the same bed, which is a wonderful thing, says Dr. Rodriguez.
The safest and easiest medicine to tolerate is melatonin. The other commonly used medicine is clonazepam, a benzodiazepine also used to treat anxiety and seizures.
Clonazepam is very effective in controlling symptoms, but many patients cant tolerate its side effects, he says. These include:
- Cognitive problems, which may worsen existing memory issues.
- Unsteadiness, which increases the risk of falls.
- Worsening sleep apnea, as the drug relaxes the throat muscles.
In addition, says Dr. Rodriguez, some other medications seem to provoke or unmask RBD.
If a 40-year-old is starting to act out dreams after starting an antidepressant such as venlafaxine , Ill see if we can switch to an antidepressant that does not aggravate RBD called bupropion . But this solution isnt for everyone.
If your medicine helps you, switching may not be in your best interests, he notes.
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Rbd Prognosis And Communicating The Risks
The prognosis for RBD depends largely upon the subtype. Patients diagnosed with RBD secondary to medication have the most promising prognosis of RBD resolution once the causative medication is withdrawn. However, it has been shown that RBD may persist following cessation of SSRIs , and it is therefore possible that in some cases the medication simply unmasked an already underlying pathology, triggering early clinical presentation . For RBD secondary to defined lesion e.g., inflammatory plaques, the main symptoms of RBD can be controlled relatively reliably using a combination of pharmacological and behavioral treatments. As these patient’s present with chronic but stable neural tissue damage, their RBD symptoms are unlikely to change over time.
For patients with RBD presenting as part of a clinically-defined neurodegenerative condition, such as PD, MSA, or DLB, the management of their sleep disorder should form part of their holistic care. Generally, the presence of RBD marks a less-favorable disease phenotype. In PD, for example, the presence of concomitant RBD is associated with a greater non-motor burden and a more adverse prognosis . There have been no studies of whether the symptomatic treatment of RBD impacts long-term outcomes in these patients.
What Else Can I Do To Sleep Better With Parkinsons Disease
Practicing healthy sleep hygiene habits may also promote more restful sleep.
- Get outside during the day. Bright light tells your body its time to be awake.
- Keep your body moving during the day. Even if all you feel up to is a short walk or two, all physical activity offers benefits.
- Try at-home remedies, such as massage or a warm bath. Relaxing your mind may help your body fall asleep.
Dont:
- Take long naps during the day.
- Use stimulants, such as caffeine, within six hours of bedtime.
- Use your bedroom for activities other than sleeping. Go to another room to read, watch TV or work.
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Rbd May Be Earliest Marker Of The Movement Disorder
A relatively rare sleep disorder characterized by acting out dreams during REM sleep — often violently — is closely linked to the movement disorder Parkinson’s disease and may warn of Parkinson’s decades before diagnosis.
People with REM sleep behavior disorder do not have normal muscle paralysis during the dream phase of sleep. The loss of motor inhibition is generally accompanied by often frightening dreams, which are “acted out” with arm flailing, kicking, punching, and sometimes, screaming and shouting.
“If patients are running in their dream, they ‘run’ in their beds. If they are fighting with someone in their dream, their arms may flail wildly. This can be dangerous for the patient and the patient’s bed partner,” Marina Romero-Ramos, PhD, of Aarhus University in Denmark, told MedPage Today.
The prevalence of RBD has been estimated to be from 0.38% to 1% in the general population, but the sleep disorder is much more common in patients with Parkinson’s disease.
In one study, 69% of patients with a diagnosis of Parkinson’s reported symptoms consistent with RBD, while no increased risk was seen in patients with the related movement disorders essential tremor and restless leg syndrome.
Even more significant, a large percentage of people with RBD go on to develop Parkinson’s years and even decades later, said Miranda Lim, MD, PhD, of the VA Portland Health Care System in Oregon.
“Of course these studies will take a long time — probably decades,” she said.
When Do Dreams Start
We typically cant act out our dreams. The majority of people dream around 4-6 times per night during the REM stage of sleep, the brain becomes as active during this stage as it is when youre awake. Although the neurons in the brain during REM sleep are functioning as much as they do when youre awake, REM sleep is also characterized by temporary muscle paralysis. Most people, even when they are having vivid, active dreams, their bodies are still. But, people with RBD are lacking this muscle paralysis, allowing them to act out the contents of their dreams.
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Acting Out Motions While Sleeping
Hello, I wondered about something new I’m seeing with my mom. When we’re watching a movie or a lecture, and she dozes some, sitting up, she is beginning to act out motions, as though she was pouring something or sewing something, etc. Tonight, she started responding out loud, like sleep talking, but woke herself up. I am starting to worry if this could lead to sleep walking or acting out her dreams in a way where she could hurt herself. Is this common? She’s really not on medication yet, except for the SSRI Zoloft and supplements.
Thank you,
Is melatonin among the supplements she takes? If not, I’d say give that a shot. I haven’t gone leaping out of bed since I started taking it, although I still yammer in my sleep.
Thank you, no she does not take melatonin. Do you know if sleep/dream acting out is a thing for Parkinson’s? It certainly seems like people are experiencing lack of sleep. Many thanks, Sarah
It is definitely a thing for Parkinson’s! At my first appointment with my current neurologist I didn’t know what was wrong with me . She was asking whether I had experienced various symptoms, and I hadn’t connected the dots between them. When she asked whether I ever woke myself up screaming or hollering, my heart sank, because I had been doing that very thing and had been utterly mystified by it.
Hi is the melatonin you take a prescription? Or over the counter? Tgsnjs
Over the counter. Is there a difference?
Vivid Dreams And Parkinsons
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Parkinsons disease affects neurons in the brain that release a molecule called dopamine. Dopamine helps to regulate our movements, emotions, and sleep. Damage to these neurons can affect your motor function, the way you think, and the way you sleep.1
More than 75 percent of those living with Parkinsons report having issues with their sleep. There is a lot of variation, but common issues include broken sleep and vivid dreams. This difficulty sleeping can affect daytime function too. Those living with Parkinsons often report excessive sleepiness during the day.1
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What Impact Can This Symptom Have On The Lives Of People With Parkinsons
Sleep disturbance is associated with increased severity and frequency of non-motor features of Parkinsons, such as depression, and poorer subjective motor performance. Injuring their bed partners and themselves, while asleep, is very common. Sleep disorders can also greatly impact daily life.
Since REM sleep behaviour disorder can be one of the first symptoms of Parkinsons, there is now growing recognition that the use of experimental neuroprotective agents may be more useful at this stage. In future, this could provide an effective pathway to future developments and opportunities for early intervention.
A Switch In The Brainstem
Normally, our bodies are paralyzed during REM sleep .
But in RBD, because a switch in the brainstem is no longer immobilizing you, your muscles are free to carry out the actions in your dreams, says sleep medicine specialist Carlos Rodriguez, MD.
So you act them out and you may do so with screaming, violence or foul language that are completely out of character.
Patients can injure themselves diving out of bed into a chest of drawers, running into a wall or hitting a window, he says.
They can accidentally strike a bed partner ironically, while trying to protect them from danger in their dream.
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Rem Behavior Disorder Strongly Linked To Other Brain Disorders
It sounds too strange to be true, but it is actually possible for people to begin to act their dreams out. This can manifest in bizarre and astonishing ways. Though typically episodic, when dream enactment occurs it can cause serious harm to the afflicted person or a bed partner. These behaviors are most commonly associated with REM behavior disorder . Interestingly, these unusual episodes may predict the later development of other neurodegenerative conditions such as dementia and even Parkinsons disease. Learn about the relationship between acting out dreams and the incidence of these subsequent neurodegenerative conditions.
What Causes Vivid Dreams
Vivid dreams are a common Parkinsons symptom. Like all dreams, these may be pleasant, odd, or even frightening. They may also be upsetting or disturb your sleep.2
Most dreams happen during rapid eye movement sleep, though some can occur in non-REM sleep. Dreams during REM sleep are often more vivid. During this time, your brain sends signals to your body to keep your muscles still. This makes sure that you do not act out your dreams.2
Dopamine is a very important molecule that works all over your brain. Experts believe that the damage to brain cells that release dopamine can occur in the areas of the brain that control sleep. Damage to these areas is thought to cause vivid dreams.3 Other things that make vivid dreams more likely include:2
- Broken or fragmented sleep: Waking up during or right after a dream can make it easier to remember. Broken sleep is also another Parkinsons symptom, which may explain the connection.
- Stress: Studies have shown that stress during the day can result in upsetting dreams. These are often more memorable.
- Medications: Some drugs can interrupt your sleep or cause vivid dreams. Scientists believe that Parkinsons drugs can do this because they increase dopamine. Dopamine can help relieve your symptoms but also may act on areas of the brain responsible for dreams.
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What To Do If You Have Rbd
Safety is paramount if you or your partner have REM sleep disorder.
The most important thing to consider is modifying your sleep environment, says Dr. Rodriguez. You have to make the bedroom a safe place.
Options to try include:
- Putting your mattress on the floor so you have less distance to fall.
- Moving furniture away from the immediate vicinity so wont hit anything if you run or dive.
- Padding the corners of your bedroom furniture.
We also want your partner to consider sleeping in another bed, or room, until your REM sleep disorder is under control, he says.
Time Of Night Is Also A Clue
We cycle through each stage of sleep every 90 to 120 minutes, says Dr. Rodriguez. And each time we do, our REM sleep progressively lengthens.
So RBD tends to happen during the last half of the night, while sleepwalking and night terrors tend to occur during the first third of the night.
If a sleep disturbance occurs within 60 minutes of falling asleep, its probably not RBD, he says.
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The Hope Of Rem Behavior Disorder
There is also a silver lining to the association between RBD and these other conditions. It may allow for research to prevent the later development of the related neurodegenerative disorders. In the future, early interventions may help to forestall the other diseases.
In the meanwhile, it is important to take appropriate safety precautions to prevent harm when the behaviors begin. There are also effective treatments, including the use of higher doses of melatonin and the prescription medication called clonazepam.
If you experience behaviors out of sleep associated with dream content, seek further evaluation by a sleep specialist and get the diagnosis and treatment that you need. Long-term neurological follow-up may allow prompt intervention to treat other symptoms and may one day allow therapy to reduce the likelihood of developing the other associated disorders.
How To Treat Rem Sleep Behavior Disorder
Safety measures need to be addressed first. Some bedroom safety precautions include:
- Moving objects away from your bedside, including nightstands, lamps, or other objects that could cause injury.
- Moving your bed away from windows.
- Placing a large object, like a dresser, in front of windows.
- Storing any objects that can be used as weapons.
Any factors known to aggravate RBD symptoms should be avoided or treated. Your treatment plan may include:
- Maintaining a normal total sleep time. Sleep deprivation will increase RBD.
- Avoiding certain medications and alcohol. They can cause or increase RBD.
- Treating all other sleep disorders that disrupt your sleep and increase RBD. Untreated sleep apnea may worsen RBD symptoms.
- Regular monitoring for any neurologic symptoms, such as tremors or other Parkinson symptoms.
RBD tends to respond to treatment with medications. Your sleep doctor can prescribe the medications that are appropriate for you.
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Sleep Disorder Predicts Risk
To establish the strength of the connection between the two conditions, the researchers whose recent findings appear in Brain: A Journal of Neurology worked with 1,280 people with REM sleep behavior disorder across 24 centers of the International RBD Study Group.
The researchers assessed the participants motor function, cognitive abilities, and sensory abilities for a number of years. After a 12-year follow-up period, they found that 73.5 percent of the people involved in this study had developed Parkinsons disease.
Moreover, participants who had started experiencing motor function issues in this period had a threefold increase in the risk of developing Parkinsons disease or related conditions, such as dementia with Lewy bodies.
Also at high risk were participants who had developed cognitive impairment or started experiencing problems with their sense of smell.
These findings confirm that the presence of RBD is, indeed, a strong predictor of Parkinsons disease. All the more so, since the researchers conducted the study in centers across North America, Europe, and Asia, which means that the results apply to diverse populations.