Assaulted by a Bed Partner

Problems with dream sleep can cause violence.

Posted Aug 10, 2011

I was recently having dinner with some old friends and some of their friends. One of the gentlemen, knowing I am involved in the sleep field, started asking about a sleep disorder he has recently developed and which is of great concern to him and his wife. He had been lashing out in his sleep and on several occasions had seriously attacked his wife. On several of these occasions he had hit her in the face with his closed fists causing some degree of injury. On one occasion he had started to strangle her before awakening. This was certainly a very disturbing event for both of them. As a result he started sleeping in another room. This helped in that he was no longer attacking his wife but it did not prevent him from standing up in bed and jumping off the bed as if into a pool of water, only to split open his head as he fell and grazed the corner of a desk and fell flat on his face. This required a trip to the emergency department and some intense fear about what might happen the next time he slept. He started restraining himself in bed with bungee cords, which was somewhat successful in preventing further serious falls. He spoke to his physician and a sleep study was ordered. It showed evidence of "loss of muscle atonia" during REM sleep and a diagnosis of REM Sleep Behavior Disorder was made. Treatment with the benzodiazepine Clonazepam, has been helpful but has not fully eliminated the symptoms.

One of the most striking, if relatively rare, sleep disorders is REM Sleep Behavior Disorder. The first indication that movements acting out dreams could emerge from REM sleep, despite the usual muscular paralysis of this sleep stage, came in the mid-1960's in the form of research on cats. Lesions in an area of the brain involved with REM sleep led to the cats engaging in motor activities during REM sleep, when the cat should have been unable to move. It was not until the 1970's, however, that reports began to emerge of people who were possibly acting out dreams. By the mid-1980's a group of adults had been identified who showed this behavioral phenomenon and it was recognized as a clinical disorder.

It is difficult to awaken someone from REM sleep. Many areas in the brain are, however, as active or even more active during REM sleep than during wakefulness. Along with distinctive brain activity there are periodic eye movements, erections occur, and the body does not thermo-regulate- if cold, you don't shiver, and if hot, you don't sweat. Breathing and heart rate become more irregular. This is clearly an activated state of both brain and body. If awakened from this state, a person will typically report elements of a vivid dream. In order to prevent acting out the dream, the body is placed into a state of "atonia", or paralysis, by specific systems in the brain. If this mechanism breaks down, atonia may be lost and dream enacting behavior will occur. This has been observed in cats, rats and humans. I should say the behavior occurs in rats and cats. We only know for sure that humans dream at these times.

Recent survey data indicates that violent behavior during sleep has a prevalence of about 2% and it is estimated that about a quarter of this is due to REM Sleep Behavior Disorder. This gives an estimated prevalence of this disorder of one half of one percent.

One thing that makes REM Sleep Behavior Disorder so important, apart from the significant physical harm that can affect the sufferer or bed partner, is that research is increasingly linking this disorder to the eventual development of neurodegenerative disorders. The most common include Parkinson's disease, multiple system atrophy, and dementia with Lewy body disease. The first symptom of these diseases can be REM Sleep Behavior Disorder and it may appear more than a decade before other symptoms. Other disorders such as such as narcolepsy and stroke have also been associated with REM Sleep Behavior Disorder.

Clearly, proper identification and early treatment of REM Sleep Behavior Disorder is important. Who is most likely at risk? Men over the age of 50 are the demographic group most likely to be given this diagnosis. It is very rare among women and children.

Scientists are learning a great deal about the brain and sleep by studying REM Sleep Behavior Disorder. Because it is associated with significant physical harm and may indicate the eventual onset of serious neurological disorder, it is important that people suffering from this disorder seek treatment and not just suffer alone. There are medications and treatments that can help.