RBD patients waiting years before seeing a physician

People with REM sleep behavior disorder wait an average of nearly nine years before getting diagnosed, a new study reported. REM sleep behavior disorder occurs when a sleeping person acts out vivid dreams. These dreams are often filled with action, and may even be violent.

A study out of Scotland looked at 30 REM sleep behavior disorder patients. The patients were asked why they took so long to see a physician. Most (59 percent) said they didn’t think the symptoms were serious enough. Nearly as many (56 percent) said their REM sleep behavior disorder was mild or infrequent. Other patients (47 percent) believed the symptoms would go away or they simply didn’t know enough about REM sleep behavior disorder to seek help.

The patient’s bed partner was an important influence. The decision to seek treatment for REM sleep behavior disorder was made jointly by patient and partner in 47 percent of the cases. The study appeared in the April issue of the Journal of Clinical Sleep Medicine.

REM sleep behavior disorder episodes tend to get worse over time. Early episodes may involve mild activity. Later episodes can be more violent. At some point it is likely to result in an injury. Either the person dreaming or the bed partner may be hurt.

REM sleep behavior disorder can be confused with sleepwalking and sleep terrors. Learn more about REM sleep behavior disorder and other sleep disorders. For treatment, or if you need any help sleeping, locate an accredited sleep center near you.

Image courtesy Jeezny

Sleepwalk with Me: Comedian's sleep disorder experience comes to film

Mike Birbiglia’s sleep disorder has been the basis for a book and one-man show. Now the comedian’s REM sleep behavior disorder is featured in film. Sleepwalk with Me made its premiere at the 2012 Sundance Film Festival in Park City, Utah.

The movie is presented in association with WBEZ Public Radio's This American Life. Birbiglia has appeared as a semi-regular contributor to This American Life. Its host, Ira Glass, is a producer for the movie.

Birbiglia plays a New York stand-up comedian with girlfriend issues and a sleep disorder. Birbiglia’s real-life REM sleep behavior disorder causes his body to physically act out dreams. He limits the frequency of these episodes by taking clonazepam, a drug used to treat seizures by activating parts of the brain to produce a calming effect. He also sleeps in a makeshift cocoon – wearing a sleeping bag up to his neck and mittens so he can’t open it and get up.



Sleepwalk with Me also pays homage to sleep medicine. William C. Dement, MD, PhD, can be heard narrating his own audiobook as Birbiglia falls asleep while driving. Dement in 1975 launched the American Sleep Disorders Association, now known as the American Academy of Sleep Medicine. He also served as its president for the first 12 years.

No word if the film has found a distributor. But the book is available for purchase and segments with Birbiglia on NPR are available at This American Life and Fresh Air. More about Mike Birbiglia’s story can be found in the Sleep Education Blog. Or go to the AASM’s patient education website for additional information on parasomnias, like sleepwalking and REM sleep behavior disorder.

Image: Sleepwalk With Me Publicity Photo

Mike Birbiglia Sleeps with Downy in Macy’s Window

Comedian Mike Birbiglia is putting the freshness of Ultra Downy April Fresh to the test by living and sleeping for a week behind a Macy’s store window in New York City. Proctor & Gamble is using the event to pitch Downy as the latest sleep aid.


But will a week of “clean sheet freshness” help Mike sleep better?

It will be a tough test. Birbiglia is notorious for being a bad sleeper.

“I am the worst sleeper in America,” he declared during a press conference at Macy’s.

In his stand-up routines and in his book Sleepwalk with Me, Birbiglia shares vivid details about his struggle with REM sleep behavior disorder.

People who have RBD act out action-packed dreams as they sleep. The dreamer may punch, kick, jump or get out of bed and run. All of this occurs while he or she is still asleep.

Although Downy is no cure for RBD, putting fresh, clean sheets on the bed can be one way to help create a relaxing sleep environment. But it might not be so relaxing when people on the New York City streets are watching you through a window.

Mike will find out. He moved into his Macy’s bedroom yesterday and spent the night. “This is so, so strange,” he Tweeted.

In the week ahead Birbiglia plans to host a Yoga instructor and other special guests in his store window bedroom. He also plans to learn more about mannequin culture. And he wants to know why P&G doesn’t offer a pizza-scented Downy.

Watch live streaming video of Mike in the Window from four different camera angles on Facebook.

Sleepwalk with Me: Comedian Mike Birbiglia's Sleep Disorder Scare

Meet Mike Birbiglia. He claims he jumped out of a second-story hotel window to avoid a missile attack. Witnesses say a madman crashed through a window in the middle of the night and then stumbled badly injured into the hotel lobby.

Birbiglia was as surpised as the hotel guests when he woke up covered in gashes. The guided missile attack was a nightmare but his actions were anything but a dream. 33 stitches and an overnight sleep study later Birbiglia was diagnosed with REM sleep behavior disorder, a parasomnia that causes the body to physically act out dreams.

The series of encounters leading up to his diagnosis are the subject of a series of memoirs titled Sleepwalk with Me.

Birbiglia makes his living by standing in front of an audience recounting long, embarrassing stories about his life. His darkly humorous accounts of REM sleep behavior disorder have earned him a Nathan Lane produced one man show, several Comedy Central specials and a spot as a semi-regular contributor to NPR’s This American Life.

Along the way he’s become the unofficial face of REM behavior disorder. Fans have approached Birbiglia to tell him they’ve had similar sleepwalking experiences and won’t repeat his mistakes.

In an interview with Time Magazine, Birbiglia admitted he sleepwalked for years before he was diagnosed.

“I [often] remember thinking this, ‘This seems dangerous. Maybe I should see a doctor.” And then I would think, “Maybe I’ll [just] eat dinner.’ And I went with dinner for years.”

Birbiglia limits the frequency of these episodes by taking clonazepam, a drug used to treat seizures by activating parts of the brain to produce a calming effect. Because there is no cure, he sleeps in a makeshift cocoon. He wears a sleeping bag up to his neck with mittens so he can’t open it and get up.

Sleepwalk with Me is on bookshelves now. Look for the film version written and acted by Birbiglia coming soon.

Hear Mike Birbiglia's live full-length performance of how he leaped through a hotel window on This American Life or listen to a in-depth interview on NPR's Fresh Air.

Acting out Dreams May Signal Dementia Decades Later

The strange sleep disorder that sounds fit for a murder mystery forecasts a not-so-bright future. REM sleep behavioral disorder is a parasomnia that makes people act out their dreams, sometimes violently. A single episode can be an early sign of degenerative brain disorders, such as Parkinson’s disease and dementia, researchers at the Mayo Clinic report.

Their findings were published in the August 2010 issue of Chest. The authors searched the Mayo Clinic’s 2002-2006 medical records for cases where patients developed neurodegerative symptoms at least 15 years after a RBD-related episode.

A total of 27 patients fit the researcher’s criteria. The onset of brain disorders occurred 25 years after symptoms of RBD, on average. Some patients took as long as 50 years to develop Parkinson’s or dementia.

Cases of dementia and Parkinson’s disease were nearly evenly split. One patient was diagnosed with multiple system atrophy. Some patients with dementia had dementia with Lewy bodies, which causes waking hallucinations.

People with RBD can act out their dreams because the brain fails to keep muscles still during REM sleep. Normally the brain paralyzes most muscles during the sleep stage where dreams usually occur.

REM sleep behavioral disorder can be dangerous to the dream or a bedpartner. A person with RBD can do anything from hitting or kicking to running out of the bedroom. AASM-accredited sleep centers offer effective treatment options for people with RBD.

Sleep week at New York’s WCBS

Springs sweeps is here again, and broadcast outlets across the country are pulling out all the stops to draw viewers. In New York City WCBS hopes to get a ratings boost by airing the feature series “Sleep Week.”

In the first special report, which aired last night, health correspondent Dr. Holly Phillips profiled REM Sleep Behavior Disorder.

The story focused on the Oregon case we previously mentioned. The husband faces criminal charges because he began punching his wife while he was asleep.

He had RBD, which caused him to unconsciously act out his vivid, action-packed dreams.

The reporter also interviewed another man with a strange case of REM Sleep Behavior Disorder. The French immigrant would get up and dance during his dreams. The next morning he’d wake up with mysterious cuts and bruises from apparently falling over or bumping into objects.

You can go to CBS-2’s website to view the entire report.

Tonight, Sleep Week continues at the New York news station with a feature on “The Six Sleep Wreckers”, things that guarantee you a bad night’s sleep. We’ll be sure to post the link after it airs.

New movie “In My Sleep” a sleepwalking murder mystery

It’s a classic setup that hails back to Alfred Hitchcock. A man waking up in bed, covered in blood next to a knife. He doesn’t know how he got there, or if he killed anyone.

The protagonist of the new film “In My Sleep” knows he sleepwalks. But was he capable of murder or was it all a setup?

Opening in limited theaters in New York City last weekend, the film so far has inspired a tepid response from critics. In its early goings “In My Sleep” only has a 33 percent score on metacritic.

Since last month when we previewed the film, a real-life case mirroring the plot has drawn national attention.

An otherwise loving husband was arrested when he hit his wife in the face three times. He had REM Behavioral Disorder, a sleep disorder that causes people to act out their dreams, sometimes violently. The husband was charged with assault, and barred from seeing his family.

“In My Sleep” doesn’t reference REM Behavioral Disorder specifically. The doctor in the preview calls the main character’s sleepwalking “parasomnia”, which is actually a broader classification of sleep disorders.

Nightmare disorder, Sleepwalking, Sleep terrors, Confusional arousals, Sleep paralysis, Hallucinations and Sleep-related eating disorder are all parasomnias.

Read our preview for “In My Sleep”

Or learn treatments for REM Behavioral Disorder and other parasomnias.

Living a Nightmare: True Stories of REM Sleep Behavior Disorder

Alarming behavior during sleep is more than just a plot device for movies. It’s a nightly reality for people who suffer from REM sleep behavior disorder.

People with RBD act out vivid, action-packed dreams while remaining asleep. They may shout, punch, kick, run and even jump out a window.

The dangerous sleep disorder can put dreamers and their bed partners at risk of injury. Yesterday The Chicago Tribune shared some of their stories.

For 16 years Lawrence Neumann screamed, punched and kicked in his sleep before he was finally diagnosed with RBD. One time he even suffered a concussion when he dove out of bed head first.

Carl Pope’s wife described how she watched him kick the wall and fight off imaginary attackers. John Chadwick had to restrain himself in bed so that he wouldn’t injure his wife.

"I was living a nightmare," Chadwick told the Tribune.

AASM member Dr. Carlos Schenck described some of the people he has helped. Some men have jumped through windows while asleep. Others have knocked themselves unconscious while acting out violent and aggressive dreams.

Schenck was one of the authors who first reported cases of RBD in the journal Sleep in 1986. He also is executive producer of the documentary “Sleep Runners.” It tells the true stories of people who suffer from RBD and other parasomnias.

Recently the AASM published a best practice guide for the treatment of RBD. Injury prevention and treatment with medication can help subdue RBD.

Last year the Sleep Education blog reported that RBD may intensity over time. The disorder is most common in men over the age of 50. But another study confirmed that it can occur in other people as well.

Contact an AASM-accredited sleep center if you or someone you know acts out dreams during sleep. Read more about REM sleep behavior disorder.

Image by Balazs Sprenc

Treating REM Sleep Behavior Disorder: Best Practices

People with REM sleep behavior disorder act out vivid, action-packed dreams while remaining asleep. They may shout, punch, kick, run and even jump out a window.

RBD was first reported in the journal Sleep in 1986. Sixteen years later a follow-up report was published by the same research team.

Recently the AASM reviewed all of the current research and developed a best practice guide for the treatment of RBD. It was published last month in the Journal of Clinical Sleep Medicine.

The guide recommends two steps in the treatment of RBD. The first step is injury prevention. The second step is the ongoing use of medication to control the symptoms.

People with RBD often injure themselves or their bedpartner during sleep. So it is important to create a safe sleeping environment.

The bedpartner may need to sleep in another room. Other examples of how to modify the sleep environment include:

• Placing your mattress on the floor
• Using a sleeping bag
• Moving furniture away from the bed
• Adding soft padding to the corners of furniture
• Securing and blocking windows
• Removing weapons and sharp objects from the bedroom

These methods of injury prevention should be continued while taking medication. One drug that is suggested for the treatment of RBD is clonazepam.

A typical dose is 0.25 mg to 2.0 mg, taken 30 minutes before bedtime. But a dose as high as 4.0 mg has been reported.

There can be significant side effects when taking clonazepam. These may include morning sleepiness, confusion and memory problems. It should be used with caution in people with dementia.

Clonazepam also can increase the severity of obstructive sleep apnea. So it should be used with caution in people with OSA.

Melatonin also is suggested for the treatment of RBD. The effective dose may range from 3 mg to 12 mg at bedtime.

An advantage of melatonin is that there are few side effects. Dose-related side effects may include morning headache, morning sleepiness and hallucinations.

A variety of other medications may be useful in treating RBD. But the evidence is limited.

Treatment for RBD should be supervised by a board-certified sleep specialist. You can get help from a board-certified sleep specialist at an AASM-accredited sleep center near you.

Read more about REM sleep behavior disorder.

Acting Out Dreams: Fear and Laughing

A new study shows that healthy young adults are likely to report dream-enacting behaviors. The results were published today in the journal Sleep.

The Canadian study involved 1,140 first-year college students. About two-thirds of participants were women. They responded to different types of questions about dreaming.

One group answered questions that described specific types of dream-related behavior. Results show that 98 percent reported experiencing one of these behaviors at least “rarely” in the last year.

“Fear” was the most common behavior subtype. Ninety-three percent reported that they had felt signs of fear in their body after waking from a scary dream.

But not all dreams were frightening. Seventy-two percent reported smiling or laughing while waking from a happy dream.

Sexual arousal also was common. Seventy-eight percent reported that they had felt sexually aroused after waking from an erotic dream. This was more common in men than in women.

Each of the other behavior subtypes was reported by more than 50 percent of participants. They woke from a dream to find that they were talking, crying, punching or kicking, or making other motions such as waving or pointing.

Some of the behaviors were more common in women. They reported more fear, smiling and laughing, talking, and crying than men.

Lead author Tore Nielsen, PhD, noted that these were “normal” behaviors. They were unlike the extreme actions that occur when a person has REM sleep behavior disorder.

People with RBD act out vivid, action-packed dreams while remaining asleep. They may shout, punch, kick, run and even jump out a window. Injuries may occur to the dreamer or a bedpartner. Vigorous or violent episodes typically occur about once a week.

In contrast, the dream-related behaviors reported in the study were less intense. And they tended to be rare, occurring only once or twice a year.

“Normal episodes are usually extremely mild,” Nielsen told the AASM.

Read more blog posts about REM sleep behavior disorder. Learn more about dreaming.

Image by Krisztina Tordai

Violent Dreams: RBD May Intensify Over Time

A small study in the Sept. 1 issue of the journal Sleep involved the long-term follow-up of 11 people with REM sleep behavior disorder – or RBD.

What is RBD? It is a sleep disorder that causes you to act out vivid dreams as you sleep. Normally your brain paralyzes most muscles during the sleep stage of rapid eye movement (REM) sleep. RBD occurs when the brain fails to keep the muscles still.

Does this excessive muscle activity during sleep increase over time? To find out the researchers from Spain studied nine men and two women with RBD.

The participants were evaluated by two overnight sleep studies: once at diagnosis and again after two to eight years. At follow-up, they had an average age of 73 years; their RBD symptoms had been present for an average of 11 years.

The study measured “tonic” and “phasic” muscle activity during REM sleep. Tonic activity involved sustained muscle tone in the chin; phasic activity involved intermittent muscle twitches of the chin, arms and legs.

Results show that after an average of five years, tonic activity in the chin increased from 30 percent to 54 percent; in two people it was higher than 93 percent. Phasic activity in the chin, arms and legs increased from 38 percent to 59 percent.

The results indicate that RBD involves a progressive dysfunction of the brain structures that suppress muscle activity during REM sleep. A greater extent of brainstem impairment may occur over time.

The authors suggest that RBD may represent an early stage of a neurodegenerative disease. Many people with RBD go on to develop other neurologic diseases; these include Parkinson’s disease, dementia with Lewy bodies and multiple system atrophy.

In June the Sleep Education Blog reported that there are effective treatment options for people with RBD. Contact an AASM-accredited sleep center if you or someone you know acts out dreams during sleep.

Taming Violent Dreams: Treating REM Sleep Behavior Disorder

A new study in the Journal of Clinical Sleep Medicine reports that there are effective treatment options for people with REM sleep behavior disorder.

People who have RBD act out vivid, action-packed dreams while remaining asleep. Injuries to the dreamer or a bed partner are common.

RBD often is treated with clonazepam, a long-acting sedative. But the study reports that some side effects of this drug may be more prominent in older adults. Since RBD usually emerges after the age of 50 years, treatment can be problematic.

The small study involved a review of 39 people with confirmed RBD who were treated at a sleep center in the U.K.; 38 of the patients were men. They had an average age of 66 years; the youngest patient was 34 years old.

Thirty-six of the patients began treatment with clonazepam. Fifty-four percent took the medication successfully; but 58 percent reported moderate or severe side effects. The most common side effects were morning grogginess, confusion and cognitive impairment.

Zopiclone, a shorter-acting hypnotic, was used by 11 patients; nine used it alone, while two used it together with another medication. It was effective and well tolerated in eight of the 11 cases.

Two patients used melatonin; one used it while taking two other medications. Both people found it to be effective.

The authors conclude that it is important to consider the potential side effects when treating RBD in older adults. Shorter-acting hypnotics may be a useful treatment option.

Learn more about medications for sleep disorders on SleepEducation.com.

Contact an AASM-accredited sleep center if you or someone you know acts out dreams during sleep.

Violent Dreams: Who Has REM Sleep Behavior Disorder?

People who have REM sleep behavior disorder act out vivid, action-packed dreams as they sleep. Who is likely to have RBD?

It is most common in men over the age of 50. But a new study from London confirms that it can occur in other people as well.

The study reviewed a sleep center’s case files from the previous seven years. Ninety-one people had been diagnosed with RBD during that time: 62 men and 29 women.

The average age of people with RBD was 52 years; 39 of the people were under the age of 50 years.

In people with RBD over the age of 50, the ratio of men to women was 3:1. The male to female ratio dropped to 1.4:1 in people under 50 years of age.

RBD occurred together with narcolepsy in about 38 percent of people in the younger age group. In the older age group, about 29 percent of people also had a “synucleinopathy.” These are neurological disorders such as Parkinson’s disease and dementia with Lewy bodies.

A person with RBD may punch, kick, jump or get out of bed and run - all while he or she is still asleep. Cuts, bruises or broken bones may occur to the dreamer or to a bedpartner.

Contact an AASM-accredited sleep center if you or someone you know acts out dreams during sleep.

Violent Sleep: Acting Out Dreams & Nightmares

CBS 2 News in Los Angeles reports on REM sleep behavior disorder, or RBD. Note: Parents should be aware that the video on the CBS Web site may not be appropriate for children.

People who have RBD act out vivid dreams and nightmares as they sleep. The dreams tend to be action-packed. The dreamer may punch, kick, jump or get out of bed and run. All of this occurs while he or she is still asleep.

Injuries are common. Cuts, bruises or broken bones may occur to the dreamer or to a bedpartner.

"It is violent, moving nightmares,” Dr. Carlos Schenck told CBS. “It is what happens during sleep, and they end up hurting themselves or bed partners."

Schenck and colleague Dr. Mark Mahowald first identified RBD, reporting on it in the journal Sleep in 1986. Sixteen years later they filed a follow-up report.

Schenck also is executive producer of the documentary Sleep Runners. It tells the true stories of people who suffer from RBD and other parasomnias.

Contact an AASM-accredited sleep center if you or someone you know acts out dreams during sleep.

When Dreams Come Alive: “Bizkit the Sleep Walking Dog”

By now you may be one of the millions of people who have seen “Bizkit the Sleep Walking Dog.” The dog is the latest YouTube sensation.

What can we learn from Bizkit?

Well, the video is pretty good evidence that dogs have dreams. In fact, YouTube is littered with similar videos. They all show sleeping dogs in various states of twitching, whimpering and moving. But few of them can match Bizkit’s full-throttle “sleep sprint.”

Of course, we may never know for sure that dogs dream like we do. They can’t exactly tell us about their dreams after they wake up. Unless your dog is Scooby Doo or Astro, that conversation is unlikely to happen.




But there is something even more important that we can learn from Bizkit. The dog’s behavior is an example of what can happen when dreams come alive.

Normally the brain paralyzes most of our muscles during the stage of rapid eye movement (REM) sleep. This prevents us from jumping out of bed and acting out our dreams.

Cats and dogs have a sleep stage that is similar to REM sleep. Sometimes it is called “paradoxical sleep.” This is the paradox: The animal appears to be asleep; but brain waves and eye movements look like the animal is awake.

Studies have found movement disorders during sleep in cats and dogs, as well as a disorder of REM sleep in a cat. Early studies also found that cats with lesions in certain brain areas would display complex behaviors during sleep. While sleeping they might even search for and attack an imaginary prey.

This animal research led to the discovery that some people have REM sleep behavior disorder (RBD). They act out vivid, action-packed dreams while remaining asleep.

People with RBD may shout, punch, kick, run and even jump out a window. Usually their eyes remain closed during the episode. Once they are awake they often report having a dream that describes their unusual actions.

Injuries may result from an RBD episode. Both the dreamer and a bed partner are at risk of being hurt. This is why it is important to seek medical help at an AASM-accredited sleep center if you suspect that you or a loved one may suffer from RBD.

As for Bizkit, the dog’s behavior looks a lot like RBD. It wouldn’t be the first time; a 2004 study reported on the diagnosis of RBD in a dog.

In fact Bizkit may be the latest in a line of famous dogs with RBD. It has been suggested that dogs in the movies “Cinderella,” “Lady and the Tramp,” and “The Fox and the Hound” all may have had RBD.

When Dreams Come Alive: REM Sleep Behavior Disorder

Dreams that come to life are the stuff of fantasy novels and horror movies. But it’s also a reality for people who suffer from REM sleep behavior disorder.

People who have RBD act out vivid dreams as they sleep. The dreams tend to be action-packed. The dreamer may punch, kick, jump or get out of bed and run. All of this occurs while he or she is still asleep.

The disorder may sound funny. But injuries are common. Cuts, bruises or broken bones may occur to the dreamer or to a bedpartner.

Why does RBD occur? Normally your brain paralyzes most muscles during the stage of rapid eye movement (REM) sleep. This is the stage of sleep when you have most dreams and nightmares. RBD occurs when the brain fails to tell the muscles to remain still.

RBD is similar to sleepwalking. But a sleepwalker tends to be confused upon waking up. Once awake, a person with RBD usually has clear recall of a vivid dream.

Sleepwalkers also are more likely to get up calmly, have their eyes open and walk out of the room. RBD actions tend to be more intense and dramatic.

RBD was identified and reported in the journal Sleep in 1986. Sixteen years later a follow-up report was published by the same research team. People with RBD are at risk for developing Parkinson’s disease.

RBD appears to be rare, affecting less than one percent of people. It is more common in older men. A new study followed 93 people with RBD. Participants had an average age of 65.4 years; 80 percent were men.

But stand-up comedian Mike Birbiglia is evidence that RBD can strike when you are younger. During his routines he often shares true stories of his RBD episodes. He is even starring in an off-Broadway show called Sleepwalk with Me.

Laughter is good medicine; but people with RBD should seek medical help. Contact an AASM-accredited sleep disorders center if you act out your dreams while you sleep.