Cornelia Collins awoke to an incessant rain of blows. As she fully awakened she saw that her husband was distressed, frightened, and lashing out. Several of the blows had landed with sufficient force to leave bruises on her face. As she shielded herself she forcefully called out his name several times. He stopped and seemed to awaken, wide-eyed with alarm. Shaken, he told her that he was being attacked and fighting off a group of hoodlums trying to mug them - but it must have been a dream. About a week later a similar series of events again unfolded and after several episodes, Cornelia needed to move to another bedroom. Her husband recognized that he needed to see his doctor to find out what was happening to him.
When Jim Collins was referred by his physician to a sleep specialist he had never heard of Rapid Eye Movement Sleep Behavior Disorder (RBD). After describing the recent nighttime episodes to the specialist, he learned that he may be suffering from a relatively rare condition, RBD. This is one of a class of sleep disorders known as parasomnias. Parasomnias are undesirable physical events or experiences associated with sleep. They can occur as people fall asleep, are asleep or when arousing from sleep. RBD is associated with Rapid Eye Movement (REM) sleep. During this stage of sleep the body is paralyzed and vivid dreams with clear story lines occur. The phenomenon of a coherent dream sequence corresponding with observable sleep behaviors is termed isomorphism and is characteristic of this disorder.
Parasomnias are often described as the "things that go bump in the night." The old Scottish prayer,
"From ghoulies and ghosties
And long-leggedy beasties
And things that go bump in the night
Good Lord, deliver us"
aptly addresses the fear and sense of danger that can accompany these sleep disorders. They include dramatic episodes such as night terrors and less obvious but potentially harmful behaviors such as grinding teeth. Treatment for parasomnias may involve prevention, taking measures to ensure safety, and medication.
Jim will need further evaluation to determine the exact nature of his problem and any treatment it will require. RBD is most commonly seen in men over 50 years of age, although women and people of any age can be affected. A number of sleep disorders may manifest in ways similar to it. For example, Jim's symptoms could be due to the disruption of REM sleep which may occur in sleep apnea. Correct diagnosis is important as RBD may be associated with neurological disorders such as Parkinson's disease or with the use of certain psychotropic medications. The prevalence of RBD is currently unknown but is estimated to be about 0.38% in the general population and 0.5% in the elderly population.
Parasomnias, insomnia, sleep apnea and a host of other sleep disorders are the problems which plague our sleep. But why do we need sleep? What could be so important that it takes up one third of our lives? What constitutes good sleep? And how much sleep do we really need?
These are vital questions facing people living in an increasingly stressful and demanding social and economic environment. Never before has good sleep been so important for maintaining mental alertness and good physical health as it is in today's world. At the same time it seems that getting good sleep is more difficult than ever given our time pressured schedules and relentless"24/7" life styles. This blog will focus on sleep and its disorders and will provide useful information about sleep, health and what can be done to avoid being "Sleepless in America."
