Violent Bedfellows

For most people, dreams are a mental activity. The mind is active, yet the body is still. But for people with REM behavior disorder (RBD), the mind and the body are active. These people often act out their dreams by getting out of bed, talking, eating, shouting, screaming and, sometimes, hitting themselves and their bed partners. The disorder was first discovered in 1985 by Mark Mahowald, MD, and Carlos Schenck, MD, of the University of Minnesota. In ‘Principles and Practice of Sleep Medicine’, they chronicled case histories of people with RBD. In one, a 77-year-old minister had been behaving violently in his sleep for 20 years, sometimes injuring his wife. In another, a 57-year-old retired school principal had punched and kicked his wife for 2 years during vivid nightmares of protecting himself and his family from aggressive people and snakes. Mahowald and Schenck have found that more than 90 percent of RBD patients are men, typically over 50. Most RBD patients are placid and good natured when awake. Sleep involves transitions between three different states: wakefulness; rapid eye movement (REM), which is associated with dreaming; and nonrapid eye movement. RBD occurs during REM sleep, in which the brain’s electrical activity looks similar to the activity that occurs during waking. During REM states, the neurons in the brain function much as they do during waking. However, temporary muscle paralysis occurs. With RBD, the distinctions between different states break down. So characteristics of one state invade the others. Sleep researchers believe the neurological barriers that separate the states don’t function properly. Formal sleep studies can help physicians establish a diagnosis, and the problem can be treated with clonazepam, a benzodiazapine that curtails the disorder about 90 percent of the time. When clonazepam doesn’t work, some antidepressants or melatonin may reduce the violent behavior.