Researchers Probe Family for Sleepwalking Gene

What’s passed down from your parents, grandparents and ancestors can impact the way you sleep. In some cases, genetics can be beneficial. For instance the short-sleep gene allows people to better cope with sleep loss. Other families have less helpful genes, like vulnerability to insomnia caused by depression. And rarest of all, a few families in the world carry the ticking time bomb of a gene that causes fatal familial insomnia – a degenerative condition that blurs the boundaries between sleep and wakefulness, eventually ending in death.

Somewhere in America, a group of researchers from Washington University School of Medicine have discovered a family with four generations of sleepwalkers. Nine out of 22 members of the family have been sleepwalkers. And they may hold the key to finding the cause - and potentially a cure - for sleepwalking.

So far the researchers have been able to identify the chromosomal location that contains the family’s sleepwalking gene. Further research is needed to identify the exact gene.

It’s been long known that sleepwalking is a highly heritable condition. Sleepwalking and other parasomnias such as sleep talking and bedwetting are not uncommon in childhood. About 10 percent of children sleepwalk compared to only 2 percent of adults.

It appears researchers are closer to learning why that 2 percent still sleepwalk.

Image by Xava du

Strange Midnight Binges Haunt Sleep-Eaters

Most people scoff at the thought of eating a blend of raw bacon, egg shells and coffee grounds. People with sleep related eating disorder are no different, yet they consume such sickening concoctions without thinking twice. Or thinking at all, for that matter.

SRED involves unconscious compulsive binge-eating in the middle of the night. Sleep-walkers rapidly prepare and consume whatever they can find, whether it’s high-calorie junk food or an unusual mix of kitchen ingredients. An episode can last about ten minutes, and the sleep-eater won’t remember a thing.

43-year-old Anna Ryan once tried to eat a steel wool dish detergent pad. She’s among the estimated one million Americans with SRED.

Her story was featured on the ABC Nightline special “Secrets of the Mind” Tuesday evening. The series investigates rare conditions of the brain. Past programs have addressed topics such as narcoleptic attacks caused by strong emotions, aneurysms and pathological violence.

Ryan would go on diets but mysteriously gain weight, unaware she was consuming thousands of calories every night. She’s at-risk for weight-related conditions like heart disease, diabetes and obstructive sleep apnea.

SRED can also cause social embarrassment and physical danger. People can fall, start fires or even consume toxic chemicals while sleepwalking to the kitchen.

About 65 to 80 percent of people with SRED are women. The episodes usually begin sometime before the age of 30. Empty wrappers and missing food may serve as clues for SRED. A history of other parasomnias such as sleepwalking, sleep talking or REM sleep behavioral disorder is also a warning sign.

Ryan is on a medication to limit her midnight binges. Sleep Education reports SRED is treatable with a combination of medication and therapy.

If you think you have SRED seek treatment at an AASM-accredited sleep center immediately.

Sleepwalking into adolescence: parasomnias tend to persist past childhood

Childhood parasomnias like sleepwalking or bedwetting don’t necessarily stop at adolescence. The remission rates for these pediatric problems are actually quite low heading into the teenage years.

The research abstract (#251), presented as a poster today at SLEEP 2010, compared parasomnias incidents rates for children ages 6 to 11 over the course of less than five years.

The children’s parents completed comprehensive sleep habits surveys at the beginning and end points of the study.

Results show the remission rate for children with sleepwalking was only 1.9 percent after five years. Remission rates remained low for bedwetting (5.2 percent), sleep terrors (4.8 percent) and sleep talking (3.5).

Sleep talking was the most common parasomnia for adolescents. 22.3 percent of parents reported their child talked in his or her sleep. 15.2 percent of those cases were new.

The incidence rate was 2.6 percent for new cases of sleep terrors, and less than one percent for both bedwetting and sleepwalking.

Learn more about sleepwalking. bedwetting and nightmares at sleepeducation.com

Sleepwalking disorder at center of Colorado Springs teen murder case

The disorder that causes people to act out their dreams continues to grab media attention this month. A 13-year-old Colorado Springs boy is in court for a deadly attack on family members. His mother says he appeared to be possessed. His lawyers claims he did it all in his sleep.

On year ago, police say Daniel Gudino shot and killed his 9-year-old brother, then shot his mother in the shoulder and stabbed her multiple times. This week, a judge is hearing arguments to decide if he will be tried as an adult.

Thursday, a child psychiatrist took the stand as a defense witness. He claimed Gudino had a rare parasomnia. He says the boy thought he was shooting at shadowy ghosts inside his house. He referred to a history of sleepwalking, including an incident two years ago.

Parasomnia is a classification of sleep disorders. All parasomnias involve undesirable events during sleep.

The description given by the doctor is partly in line with the symptoms of the parasomnia REM sleep behavioral disorder. RBD causes people to act out vivid dreams in their sleep, sometimes violently.

REM sleep behavioral disorder can be progressive, starting out with mild activity, eventually becoming more violent. Only about .5 percent of people have symptoms of RBD. Most are older men.

Sleepwalking disorder might be a stronger possibility because it usually occurs early in life. Sleepwalkers may get violent, trying to escape from a threat they dreamed. Their eyes are usually open and have a confused “glassy” look. Someone with these symptoms could be mistaken for being possessed, as the suspect’s mother described her son.

Whether the boy has any disorder at all is still up for debate.

The prosecution claims his actions were far too complicated to happen in his sleep. Before he shot his brother, they say he used toothpicks to pick the lock on a gun cabinet, and then he loaded a .22 caliber rifle.

Look for further updates on this case on the AASM Twitter account: www.twitter.com/aasmorg.

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

Movie “In My Sleep” is a Sleepwalking Thriller

Coke’s recent “Sleepwalker” ad had a whimsical, humorous tone. In contrast, the new movie “In My Sleep” examines the darker side of sleepwalking.

The movie’s tagline is, “Sleepwalking can be deadly.” And the film is rated PG-13 for sexual content, violence and bloody images.



The plot was inspired by real sleepwalking stories, first-time director Allen Wolf said in a press kit. He also wrote and produced the movie.

“I had read many stories about people who had done all kinds of horrifying things while they were sleepwalking,” Wolf said. “The idea that someone could do virtually anything while sleepwalking and have no conscious memory of it was fascinating to me.

“I thought that most of us could relate to feeling like a part of our lives is out of control. I wanted to take that to the next level – what if you lost control of yourself when you were sleeping? That idea drew me to the story.”

In terms of its medical accuracy, the movie appears to be a little loose with the details. The main character is diagnosed with “parasomnia, a rare sleep disorder.”

“Parasomnia” is actually a classification of a dozen specific sleep disorders. Some of them are rare, but others are quite common. All of them involve undesired behaviors during sleep.

Nightmare disorder. Sleepwalking. Sleep terrors. Confusional arousals. Sleep paralysis. Hallucinations. Sleep-related eating disorder. These are some examples of parasomnias.

But in general, the movie is right: Sleepwalking can be a dangerous problem. Some people with REM sleep behavior disorder take sleepwalking to the extreme. They act out vivid, action-packed dreams while remaining asleep. They may shout, punch, kick, run and even jump out a window.

Other people may sleepwalk as a side effect of taking a sleeping pill. In 2007 the FDA requested that a warning about the risk of “complex sleep-related behaviors” be added to the product labeling of all sedative hypnotics.

You can get help for a parasomnia at an AASM-accredited sleep center near you. The AASM offers these Guidelines for Taking Sleep Medications.

Read more about parasomnias. The 2005 documentary “Sleep Runners” tells the true stories of people who suffer from parasomnias.

Exploding Head Syndrome: Sounds in Sleep

You’re in bed and feeling drowsy as you begin to fall asleep. Suddenly in your head you have the sensation of a loud, violent explosion.

It may seem like a loud bang, a clash of cymbals or a bomb exploding. You also may have the impression that a flash of light occurred. As a result you jolt awake with a sense of fright.

This describes a typical episode of a sleep disorder called exploding head syndrome. It is one of the sleep disorders that are classified as “parasomnias.” These disorders all involve undesired behaviors during sleep.

Exploding head syndrome can be very disturbing. When it first occurs you may think that you are having a stroke. And frequent events can cause you to have insomnia.

But the good news is that exploding head syndrome tends to be harmless. And unlike headaches, it is usually painless. Treatment should not be required.

Exploding head syndrome may be a variant of another sleep disorder called sleep starts. This involves a brief, strong jerk – or contraction – of your body while you are drowsy.

The clinical features of exploding head syndrome were first identified in the U.K. In 1989 a study described 50 people who had the problem.

In 1991 a Swedish study in the journal Sleep described nine people with exploding head syndrome. The authors concluded that the symptoms “may be an expression of emotional stress in the awake state.”

This year a new case report from Japan described a woman with a long history of both migraine headaches and exploding head syndrome. An overnight sleep study revealed that she also had obstructive sleep apnea.

She was prescribed an oral appliance to treat the sleep apnea. After beginning treatment the episodes of exploding head syndrome no longer occurred.

Get help for an ongoing sleep problem at an AASM-accredited sleep center near you. Read more about parasomnias.

Image by Antonio Blay

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.

Coca-Cola’s Sleepwalker Super Bowl Ad

Coca-Cola scored during last night’s Super Bowl with its “Sleepwalker” ad. It was in the Top 5 of the most popular ads according to the USA Today Ad Meter focus groups.

That may not put the ad in the same elite category as classics like Coke’s ad with Pittsburgh Steeler “Mean” Joe Greene.



But a good showing on advertising’s biggest night has to be considered a success.

In “Sleepwalker,” a sleeping man rises and goes on a sleepwalking safari across the African savanna. He unwittingly survives the perils of the African night to quench his thirst with a bottle of Coke.



The whimsical ad has a playful, humorous tone. But sleepwalking really can be a dangerous problem.

A sleepwalker may climb out a window or walk outside. On rare occasions a sleepwalker may get in the car and go for a drive.

And some sleepwalkers go to the fridge for much more than a Coke. People with sleep related eating disorder have episodes of compulsive binge eating while they are only partially awake.

Other people with REM sleep behavior disorder take sleepwalking to the extreme. They act out vivid, action-packed dreams while remaining asleep. They may shout, punch, kick, run and even jump out a window.

These are examples of a group of sleep disorders called "parasomnias." They all involve undesired behaviors during sleep.

Read more about parasomnias such as sleepwalking. Get tips for preventing parasomnias on SleepEducation.com.

Contact an AASM-accredited sleep disorders center for help with an ongoing sleep problem.

Sleep Talking Man is the Talk of the Internet

Earlier this week The Telegraph reported that a sleep talking blog has become the latest sensation to sweep the Internet.

Karen Slavick-Lennard said she was accustomed to hearing her husband Adam’s unusual comments. She even repeated them to friends for their amusement.

Then she created a simple blog to share his latest quotes with others. Now the world has become his stage.



The blog lists 3,650 followers. The hit counter reports that more than 800,000 unique visitors have stopped by. And t-shirts displaying his aphorisms are being shipped around the world.

One warning: This sleep talker often has a filthy mouth. Adam may be a mild-mannered, British advertising account director by day. But at night? He starts saying things you might expect to hear in a Quentin Tarantino movie.

Here is a brief selection of his sleeping banter:

"You can't be a pirate if you don't have a beard. I said so. MY boat, MY rules."

"Yes I'm sad, but if you stood further away, I'd be happier. No, further away.”

"Please just walk away. I don't want to have to stand here and say something so awesome that I'll have to remember it the rest of the day. Thank you!"

"You can stop clapping now if you want. Really. You'll need your energy for cheering me later. Shhhhhhhh. shhhhhhhh."

"I haven't put on weight. Your eyes are fat."

Adam’s quotes may be unique. But sleep talking is common. The AASM estimates that about five percent of adults are sleep talkers. And about half of young children talk in their sleep.

Often it is simply a normal byproduct of the brain’s activity during sleep. But sometimes sleep talking isn’t so amusing. The SleepEducation.com discussion forum is filled with complaints about it.

Sleep talking also can occur along with a "parasomnia." This is a sleep disorder that involves undesired behaviors during sleep. Examples include sleepwalking and REM sleep behavior disorder.

Sleep talking rarely requires treatment. But you should contact an AASM-accredited sleep center for help if episodes are extreme. You also should seek help if the sleep talking occurs together with unusual actions.

Visit the Sleep-Talkin’ Man Blog for more of Adam’s quotes. Watch Adam and Karen on a recent appearance on "This Morning" on itv 1. Learn more about sleep talking on SleepEducation.com.

Sleepwalking, Sleep Terrors & Dreams

A new study shows that episodes of sleepwalking and sleep terrors may be related to short, unpleasant, dreamlike mental activity. The study suggests that people with these sleep disorders may be acting out dreamlike thoughts. The results were published yesterday in the journal Sleep.

The French study involved 43 people with severe sleepwalking or sleep terrors. Their age ranged from 11 years to 72 years. They were compared with 25 healthy controls. Sleep was monitored during an overnight sleep study.

Participants also were interviewed. They were asked, “What was going through your mind at the very moment of the episodes, whenever the night?”

Thirty-eight people were able to reliably answer questions about their mental content during the sleepwalking and sleep terrors episodes. These recollections covered a lifetime span.

Results show that 71 percent of people reported at least one incident of dreamlike mental content associated with an episode of sleepwalking or sleep terrors. The action in the dreamlike thoughts corresponded with the observed behavior.

A total of 106 reports of dreamlike mental activity were collected. The mental content was brief; 95 percent of the reports involved a single visual scene.

These dreamlike thoughts were frequently unpleasant. About 84 percent involved apprehension, fear or terror; and 54 percent involved misfortune. In 24 percent of the reports the dreamer was the victim of aggression.

People with sleepwalking and sleep terrors reported more severe daytime sleepiness. They also had four times as many arousals from slow-wave sleep.

The authors noted that dreaming typically is associated with the sleep stage of rapid eye movement sleep. REM sleep dreams tend to be long, complex and vivid.

Complex mental activity has been reported in non-REM sleep during slow-wave sleep. But are these dreamlike thoughts really dreams? The authors reported that this question is still debated.

So what does this dreamlike mental activity represent? The authors suggested that it could be the final part of a longer dream. The rest of the dream may be forgotten after waking up. Or it could be a short mental creation that is formed before or just at the time of arousal.

Learn more about parasomnias such as sleepwalking and sleep terrors. Get tips for preventing parasomnias on SleepEducation.com. Compare the common features of four parasomnias.

Image by Xava du

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

ADHD & Sleep Disorders in Children

A new study examined sleep problems in children with attention-deficit/hyperactivity disorder.

The Italian study involved 55 children with ADHD. They had an average age of about 9 years. They completed a sleep interview and were monitored during an overnight sleep study.

Results show that most of the children had disturbed, fragmentary sleep at night. The authors found a significant difference in almost all sleep variables between ADHD children and controls.

Fifty percent of the children struggled with restlessness; 21 percent had a complaint of snoring; and about 12 percent had leg discomfort at night related to restless legs syndrome.

Many of the children also had parasomnias. About 48 percent were sleepwalkers; 38 percent had sleep terrors; and almost 29 percent had confusional arousals.

In 52 percent of the children the authors also found an abnormality of the arousal process in slow-wave sleep. Sleepwalking, sleep terrors and confusional arousals typically involve arousals from slow-wave sleep.

The authors suggest that sleep studies should be part of the diagnostic screening for ADHD.

In May the Sleep Education Blog reported that sleep problems also are common in older children and teens with ADHD.

Learn more about sleep and ADHD.

To Sleep, Perchance to Dream: Or Stroll or Snack...

Former "American Idol" judge Paula Abdul told Fox News that while they were living together, her former co-star Kara DioGuardi suffered from sleep eating and sleepwalking.

Sleepwalking is typically seen as a childhood problem. While it is more common in children (as many as 17 percent of children sleepwalk), up to four percent of adults sleepwalk as well.

Sleepwalking, also known as somnambulism, tends to occur during slow-wave sleep, or when you aren’t dreaming. It is difficult to wake a sleepwalker. Sometimes they wake themselves. Other times they go back to bed, not knowing they ever got up.

Most people naturally outgrow sleepwalking. Those who wake up and find themselves in dangerous or embarrassing situations, however, may need treatment.

Sometimes sleepwalking is harmless. You may wake up somewhere other than your bed and wonder how you got there. It can also be dangerous. Children can fall down stairs and adults might even try to drive!

DioGuardi’s problem, sleep related eating disorder, is unusual. But like other eating disorders, it is much more common in women than in men.

People with SRED often prepare and eat food with no recollection of doing so. They may gain weight. Eventually they can even develop type 2 diabetes.

Sleep eating tends to occur in people with histories of alcoholism, drug abuse and other sleep disorders. People with high levels of stress and anxiety may also find themselves snacking in their sleep.

DioGuardi admits that in the past she had an eating disorder and has received professional help to overcome it.

Visit an AASM-accredited sleep disorders center if you suffer from sleepwalking or have an ongoing sleep problem.

Groaning During Sleep

A new study evaluated five men and three women who have sleep related groaning.

They were monitored during an overnight sleep study. The number of groaning episodes during the night ranged from 40 to 182; the duration of these episodes lasted from two seconds to 46 seconds.

Almost 77 percent of the groaning episodes occurred during the sleep stage of rapid eye movement sleep – or REM sleep. About 63 percent of the episodes were associated with an arousal from sleep.

This may explain why some sleep groaners report having occasional restless sleep or mild daytime fatigue.

Four of the eight participants also had episodes of “bruxism” – or tooth grinding. In one person the episodes of bruxism and groaning appeared closely together.

The AASM reports that sleep related groaning is also known as “catathrenia.” It is classified as a parasomnia. These sleep disorders involve undesirable actions over which you have no deliberate control. You remain asleep or in a sleep-like state during an episode.

Groaning tends to occur nightly. An episode involves a deep breath followed by a long expiration; a monotonous, loud, groaning sound occurs as you exhale.

Moaning and “mournful sounds” also can occur. Some people have described hearing high-pitched or cracking sounds, as well as loud humming or roaring sounds.

A sleep groaner usually is unaware of the problem. It can be more disturbing for a bed partner, roommate or family member who hears the sounds.

The groaning usually stops whenever you change position in bed. But episodes are likely to resume again later.

Learn more about sleep related groaning on SleepEducation.com. Get help for a parasomnia at an AASM-accredited sleep center near you.

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.

Sleep Paralysis: The Devil, the Ghost & the Old Hag

You’re waking up or falling asleep, and suddenly you’re unable to move. Your body becomes paralyzed as if an unseen weight is upon you.

You may be unable to move your arms or legs, body and head. You can breathe and think, but you may be unable to speak.

The paralysis may last for only seconds or a few minutes. Then it disappears and you are able to move again.

This describes a typical episode of sleep paralysis. It is a common sleep disorder that is classified as a “parasomnia.” Episodes can cause you to feel intense anxiety.

Sleep paralysis occurs when the line between sleep and wakefulness is blurred. Normally your brain paralyzes many of your muscles during the stage of rapid eye movement sleep – or REM sleep. This paralysis is called “atonia.”

You may experience sleep paralysis if atonia lingers as you wake up from REM sleep; it also may occur if you transition quickly from wakefulness into REM sleep.

Sleep paralysis may occur together with hallucinations. You may imagine that you see or hear something; you even may think that someone else or something is in the room with you.

Across cultures the strange sensation of sleep paralysis has evoked some vivid descriptions. In 1664 a Dutch physician published a case history of a woman with sleep paralysis. “'The devil lay upon her and held her down,” he wrote.

In Japan sleep paralysis is called “kanashibari.” The term is rooted in Buddhism; long ago it was believed that Buddhist monks could use magic to paralyze others.

In Newfoundland sleep paralysis has been called an attack of “Old Hag.” In China it has been labeled “ghost oppression.” A new study reports that in Mexico people may say that sleep paralysis feels like “a dead body climbed on top of me.”

Sleep deprivation may trigger an episode of sleep paralysis. Other related factors may include stress and sleep related leg cramps.

Sleep paralysis tends to be only a mild problem; there are no medical complications. But it also can be one symptom of narcolepsy.

Learn more about recurrent isolated sleep paralysis on SleepEducation.com. Get tips for preventing parasomnias.

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.

Preventing Parasomnias: Get Plenty of Sleep

Parasomnias such as sleepwalking involve actions over which you have no deliberate control. You remain asleep or in a sleep-like state during an episode. As a result you are unaware of what is taking place. You are unable to make conscious decisions during the event.

This makes it important for you to act before an episode occurs. Preventing parasomnias will reduce unwanted sleep disturbances for you and those in your household.

One way to prevent parasomnias is to get plenty of sleep. Episodes of a parasomnia may be triggered by sleep deprivation.

Try to get a full night of sleep every night to keep your body and mind well rested. Most adults need about seven to eight hours of sleep per night.

Teens need a little more than nine hours of nightly sleep. Toddlers and schoolchildren need about nine to 14 hours of total daily sleep, depending on their age.

Get more tips for preventing parasomnias on SleepEducation.com.

Get help for a parasomnia at an AASM-accredited sleep center near you.