Serious sleep disorders best treated by specialists

DEAR DOCTOR K:

I’ve always been very active in my sleep. I used to tell people I was a sleepwalker, but it’s really much more involved than that. I often act out my dreams, and recently I threw a lamp across my bedroom, because I dreamed I was pitching a baseball. Have you heard of a problem like this before?

DEAR READER:

If you are acting out your dreams, I’d say it’s very likely that you have a condition called REM Behavior Disorder. The type of sleep disturbances you describe certainly fit the bill.

As you’ve experienced, people can get themselves into trouble while dreaming. Although it sounds a bit like sleepwalking, this disorder involves much more than just walking in your sleep. People have been known to jump through glass windows or climb tall furniture, all while asleep.

How does this happen? When we sleep, our bodies are normally paralyzed (or nearly so). This is a good thing, because it keeps us safe and in our beds as we sleep. But in people like you with REM Behavior Disorder, the “sleep paralysis” mechanism fails.

The name REM Behavior Disorder comes from the stage of sleep when the eyes move rapidly and dreaming occurs. The stage is called Rapid Eye Movement (REM) sleep. In a sleep laboratory, these rapid eye movements can be detected with electronic devices. But you can sometimes see it happening when you look at the closed eyelids of a person sleeping. People tend to have dreams during REM sleep. The brain is extremely active, but the body is paralyzed, except for some occasional muscle twitches.

Scientists don’t know why the bodies of people with REM Behavior Disorder aren’t paralyzed, as they should be during REM sleep. This disorder can occur when people who have been drinking a lot of alcohol stop drinking, or when people stop certain medicines that they’ve been on for a long time. It also may be present for the first time in people who have developed Alzheimer’s disease. But it can also occur for no apparent reason in otherwise healthy people.

There are many medications that can help, but it may take you and your doctor some trial and error to find the one that’s right for you.

While you and your doctor try to find a medicine for this condition, there are some things you can do to protect yourself from being hurt. Make your bedroom as safe as possible. It may be a good idea to put your mattress directly on the floor, pad the corners of furniture, and remove anything fragile or dangerous from the room. If you share your bed with a spouse or partner, perhaps you should sleep in separate rooms until you get the disorder under control.

REM Behavior Disorder is really unusual, and I have never seen a patient with it. If I did have a patient with this condition, I would refer him or her to a sleep specialist.