Sleep Soundly Every Night, Feel Fantastic Every Day (31 page)

Furthermore, through dream symbols and metaphors, scientists have found solutions to complex problems they could not uncover while awake. German chemist August Kekulé went to bed one night, frustrated with his lack of success on his latest project. Kekulé dreamed about two snakes whose tails and mouths met to form circles, and upon awakening he realized that the structure of the compound he searched for was not a straight line but a circular one. This is even more incredible when one realizes that, at the time, all known organic compounds were linear. Thanks to his dream, Kekulé went down in history as the man who discovered the benzene molecule. Others have also achieved success after awaking from REM sleep. Inventor Elias Howe's dream aided him in inventing the sewing machine, and Jack Nicklaus improved his golf game after he found himself holding his club differently—in a dream.

Are you wondering why you haven't had some magical dream that led you to a groundbreaking discovery? The answer may lie in the above examples. These people were dreaming about things they were very passionate about in their waking lives. This passion may have sparked the revelations in REM sleep.

Clearly, there are many benefits of REM sleep—it helps us integrate, consolidate, and learn information we've collected throughout the day. Through REM sleep, we process our emotions. Studies also show that when people don't get enough REM sleep their bodies play catch-up or get “rebound” REM sleep.

When REM sleep is missing or interrupted, people lose the opportunity to process the emotional events of their day. This explains why those suffering from disorders that interrupt REM sleep, such as obstructive or central sleep apnea, often develop secondary disorders such as anxiety, obsessive–compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). (For more information on this, please see
chapter 7
on apneas or
chapter 12
on PTSD.)

When one considers the short amount of time spent in REM sleep, as opposed to non-REM sleep or waking, the effects of REM sleep deficiency show how critical REM is for mental and physical well-being. A lack of REM sleep affects nearly every physiological process, most notably in persons with clinical depression. Lack of REM sleep can also impair memory and inhibit certain kinds of learning.

Less REM sleep means more non-REM sleep when norepinephrine and serotonin levels are higher, but not as high as during wakefulness. People who are deficient in REM sleep are more reactive to stimuli than normal. However, lack of REM sleep does not make one overreact to a stimulus that normally does not affect them.

New evidence establishes RSBD as a predictor of neurological diseases such as Parkinson's, Lewy body dementia, and others. Thirty to forty percent of those with RSBD are diagnosed with a neurological disease. A team at the Mayo Clinic (Rochester, MN) analyzed the brain autopsy findings from 172 patients with a RSBD, of which 83% were men. The mean age was 62 years for the RSBD onset, and the diagnosis preceded Parkinson's by a mean of 6 years in 151 patients. The diagnosis preceded death by an average of 13 years.

Patients come to the sleep clinic to explore the acting out of dreams, such as leaping, diving, and running, usually in bed and sometimes violently, during REM sleep. The acting out behavior can be directed toward a partner, and the patient can also wake up or be awakened.

The best way for a sleep specialist to diagnose RSBD is the use of video polysomnography, where the sleeping person is recorded for a full night's sleep. The sleep specialist evaluates the study to see if there is increased paradoxical movement during REM sleep. The sleep specialist determines if there are other disorders such as sleepwalking, seizures, or agitated arousal out of REM sleep due to sleep apnea that could explain the abnormal behaviors. If a patient or family member complains of violent behaviors during sleep that is associated with dreaming, we are looking for increasing muscle movement in REM sleep. That confirms it.

If needed, the sleep specialist will collect information through clinical interviews as well as screening questionnaires regarding the person's sleep history. The patient's sleep partner will verify the answers concerning:

  
The frequency of the motor attacks or behaviors

  
The amount of time between the events or attacks

  
How long they last

When a diagnosis of RSBD has been made, your treatment may include:

  
Physical safeguards to prevent injury: These may include adding pads to your floor or barriers to your bed. For example, one man in his sixties had a tendency to be
so active that he often threw himself out of bed while asleep. A simple harness-type halter around his chest and connected to the bedpost kept him from violent injuries.

  
Medications: A tranquilizer of the benzodiazepine class such as clonazepam, is usually prescribed. Recently, melatonin has been found to be very effective.

Q.
 
My husband has violent dreams. Over the last few months, he has begun flailing and screaming in his sleep. If I awaken him, he says he was fighting for his life. This started about the time he was placed on an antidepressant. Could this be the cause?

A.
 
Yes, it is quite possible. What you are describing is called RSBD. It is the loss of the normal state of paralysis during dream (REM) sleep that occurs in most us. It has been associated with many neurodegenerative diseases. However, it is also seen in association with some antidepressants. Several antidepressants including paroxetine, fluoxetine, imipramine, and venlafaxine, as well as some blood pressure medications called beta-blockers have occasionally been implicated. I would bring this to the attention of your health care provider at once.

Q.
 
My husband has been acting out his dreams for several years and I have been injured several times. Consequently, I now sleep in a separate bed. He had a sleep test that confirmed that he has a disorder called RSBD. His doctor,
on the advice of the sleep specialist who read his sleep study, placed him on a medication called clonazepam. Unfortunately, it has not worked. We have since moved to another state. Any ideas? Is there anything else that might work?

A.
 
I would suggest that you seek out a board-certified specialist in sleep disorders as they are familiar with the latest therapies. Several studies have shown success in treating this disorder with melatonin and also a drug called pramipexole, the latter commonly used in Parkinson's disease. There are anecdotal reports of other medications that are effective, but the aforementioned are the best alternatives. Additionally, it is important to make sure that he is not taking any medications that can cause or exacerbate the condition. In several of my patients and in the sleep literature, discontinuation of these medications can result in an improved response to medical treatment.

Q.
 
I have a habit of acting out my dreams. I've been doing this for many years. In fact, my wife sleeps in another room rather than risk injury. I saw a sleep specialist and he told me I'd have to have an overnight sleep study to make a diagnosis. My question is, why do I need a test? Isn't it obvious what I am doing?

A.
 
Unfortunately, these things are not that clear-cut. The specialist thinks you have a disorder called RSBD. This is a condition characterized by the ability to move during dream sleep (REM). It is present in about one out of 200 people. Unfortunately, there are other sleep disorders such as sleepwalking and seizures that can look just like this disorder. That is why it is necessary for you to be studied in a sleep lab. The therapies for these various disorders are by no means the same.

Q.
 
My 60-year-old husband has been acting strangely in his sleep. Several times a week he starts screaming and thrashing about in his sleep. On several occasions, I have had to get out of bed to avoid being struck by him. He tells me he was dreaming. This is frightening me, as I am worried he will hurt himself or me. I spoke to my health care provider who suggested my husband see a psychiatrist. What could be going on here?

A.
 
It sounds as if your husband is suffering from RSBD. This is a condition where people are able to move during dream sleep. Normally, when we enter dream sleep, also known as REM sleep, we become paralyzed. That protects us and those around us from our acting out of our dreams. This disorder is more common in older men and is treatable. I recommend you have him see a sleep medicine specialist.

Q.
 
My husband is 52 years old. During the last year, he has become violent while sleeping. He kicks and punches. This happens about four times a month. I have had to move into a separate bedroom. A friend tells me her husband was doing this and he was placed on a medication called clonazepam. Should I request that my health care provider put my husband on this medication?