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The first series of cases of RBD was described in 1985 by Mark Mahowald, MD, and Carlos Schenck, MD, of the University of Minnesota. In Principles and Practice of Sleep Medicine (W.B. Saunders Company, 2000), they outlined several case histories of people with RBD: • A 77-year old minister had been behaving violently in his sleep for 20 years, sometimes even injuring his wife. • A 60-year old surgeon would jump out of bed during nightmares of being attacked by "criminals, terrorists and monsters." • A 62-year old industrial plant manager who was a war veteran dreamt of being attacked by enemy soldiers and fights back in his sleep, sometimes injuring himself. • A 57-year old retired school principal was inadvertently punching and kicking his wife for two years during vivid nightmares of protecting himself and family from aggressive people and snakes. "Past history and current neurological and psychiatric evaluations were unremarkable, apart from the findings reported," the authors noted. "All four men were known by day to be calm and friendly individuals."
Drs. Mahowald and Schenck and others have found that more than 90% of RBD patients are male, and that the disorder usually strikes after the age of 50, although some patients are as young as nine years old. Most RBD patients are placid and good-natured when awake; however, many of them display rhythmic movements in their legs during non-REM and slow-wave sleep. A telephone survey of more than 4,900 individuals between the ages of 15 and 100 indicated that about two percent of those surveyed experience violent behaviors during sleep; Mahowald and Schenck estimate that one-quarter of them were probably due to RBD, which means it may be experienced by 0.5% of the population. What causes RBD? Studies of animals may explain REM behavior disorder. Animals who have suffered lesions in the brain stem have exhibited symptoms similar to RBD. Cats with lesions affecting the part of the brain stem that involves the inhibition of locomotor activity will have motor activity during REM sleep: they will arch their backs, hiss and bare their teeth for no reason, while their brain waves register normal REM sleep. "REM behavior disorder underscores the importance of basic science research in animals," says Mahowald, "because without the information obtained in basic science animal research, the disorder could never have been identified. Sleep is such a young field that we have the opportunity to take advantage of the fact that there is a close collaboration between basic science and clinicians." How is RBD diagnosed? Because a number of parasomnias may be confused with RBD, it is necessary to conduct formal sleep studies performed at sleep centers that are experienced in evaluating parasomnias in order to establish a diagnosis. In RBD, a single night of extensive monitoring of sleep, brain, and muscle activity will almost always reveal the lack of muscle paralysis during REM sleep, and it will also eliminate other causes of parasomnias. How is RBD treated? Clonazepam, a benzodiazapine, curtails or eliminates the disorder about 90% of the time. The advantage of the medication is that people don't usually develop a tolerance for the drug, even over a period of years. When clonazepam doesn't work, some antidepressants or melatonin may reduce the violent behavior. However, it's a good idea to make the bedroom a safe environment, removing all sharp and breakable objects. What other disorders are associated with RBD? Drs. Schneck and Mahowald have conducted research indicating that 38% of 29 otherwise healthy patients with REM behavior disorder went on to develop a parkinsonian disorder, presumably Parkinson's disease (PD), a degenerative neurological disease characterized by tremors, rigidity, lack of movement or loss of spontaneous movement, and problems with walking or posture. Other studies have found associations between RBD and other neurodegenerative diseases related to Parkinson's. "We don't know why RBD and PD are linked," says Dr. Mahowald, "but there is an obvious relationship, as about 40% of individuals who present with RBD without any signs or symptoms of PD will eventually go on to develop PD." Should patients with RBD be concerned about developing Parkinson's? "People with RBD will understandably be concerned about the possibility of the later development of PD, given the statistics," says Mahowald. "We are not aware of anything that can be done to prevent or delay the development of PD in those destined to do so. We recommend an annual evaluation by a neurologist, so if PD is going to develop, it can be detected and treated at the earliest possible time. "Given the fact that the majority of patients with RBD who went on to develop PD were already taking clonazepam, it is unlikely that clonazepam will reduce the likelihood of developing PD in those so predisposed." Fighting Sleep Apnea by Dr. Joseph J. Berke, M.D., Ph.D. Sleep apnea is a serious medical condition that currently affects approximately eighteen million Americans. Unfortunately, this sleep disorder is often ignored due to the fact that the leading sleep apnea symptom is simply loud snoring, which many people do not consider a concern severe enough to warrant a consultation with a physician. There are two forms of sleep apnea; obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea is normally seen in people who are overweight or have a narrow throat or enlarged tonsils or adenoids. This disorder is seen more often in men and older people, although anyone of any age or weight can suffer from this condition. Other factors attributed to causing obstructive sleep apnea include heredity and the use of chemicals that relax the throat muscles, such as alcohol or sedatives. This form of sleep apnea is literally caused by the relaxation of the throat muscles, which then prohibits the proper amount of oxygen necessary to supply the body from flowing through the airway. Central sleep apnea is usually caused by medical conditions that can prohibit the brain from functioning properly in regard to sending signals to various parts of the body that control the breathing rhythm. These medical conditions include, but are not limited to, disorders such as Lou Gehrig’s disease, muscular dystrophy, stroke, injury to the spinal cord, and brain tumors. A non-medical cause would be visiting and sleeping in a high altitude environment, to which your body is unaccustomed. The result of either form of sleep apnea results in a severe lack of quality sleep. Not only is a person unable to comfortably sleep and dream, one will often wake with sore muscles or a stiff neck. Feeling fatigued throughout the day is also common. Sleep apnea can cause more serious medical complications as well, including cardiovascular conditions and poor or negative responses to medications and even surgical procedures. Sleep apnea treatment is varied and is dependent on the severity of the individual condition. It could be resolved simply by losing weight and reducing the intake of alcohol and sedatives. Sleeping properly with a comfortable sleep pillow that properly supports the neck and head is extremely important. Because of this, “memory foam” pillows are commonly being recommended to sleep apnea patients by their doctors. Sleeping on one’s side can also be beneficial. For other people, surgery might be necessary to remove unnecessary tissue from the airway. There are devices that supply increased oxygen pressure which have been found effective for people suffering from sleep apnea, and also dental devices worn at night that assist in opening the airway. If you are experiencing the symptoms of sleep apnea, be sure to consult with your physician. The disorder can be so severe that a person might find themselves falling asleep at work or while driving. Once treatment has been discussed with a doctor and implemented by the person suffering from the disorder, the individual will usually begin to experience immediate symptom relief and will begin to sleep better and establish a proper sleep pattern. written by Dr. Joseph J. Berke, M.D., Ph.D. Dr. Joseph J. Berke is an author and inventor dedicated to helping people get a better night rest. For more information For a list of accredited sleep centers, contact the: Or, contact the following: National Center on Sleep Disorders Research (NCSDR)
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