By Denise Mann
Reviewed By Brunilda Nazario
A lawyer and mother of three wakes at 2 a.m. and eats fistfuls of cat food. In the morning, she has no idea how the Tender Vittles ended up all over the kitchen floor.
A husband wakes to find his partner perched by an open window, trying escape from an armed assailant, but there is no assailant and they live in the 20th floor.
One 45-year-old man makes unwanted, violent advances toward his slumbering wife. Their sleeping teenage child hears screams and calls the police to their quiet, residential neighborhood at 3 a.m.
For 40 million Americans, sleep disturbances such as sleep apnea (obstruction of breathing while asleep) and sleepwalking are linked to 84 official sleep disorders, but 10% of us have strange, yet medically-documented disturbances called parasomnias (unusual behaviors during sleep).
"These conditions are very under-diagnosed and most people who have them have not brought them to the attention of a physician and often when they do, they have the complaint dismissed," says Mark Mahowald, MD, director of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center and a professor of neurology at the University of Minnesota Medical School, both in Minneapolis.
That's unfortunate, he says, because treatment is available and in some cases, these behaviors may be early warning signs of serious disease.
Here's what researchers do know about some of the more common parasomnias:
Rapid eye movement behavior disorder (RBD). This occurs when sleepers act out dramatic and/or violent dreams during rapid eye movement (REM) stage sleep. First described in medical literature in 1986, RBD, or sleep terror, can involve yelling, screaming, punching, and kicking in the night.
"They tend to be brief episodes because if they terminate by falling out of bed or injuring oneself, the person is immediately awake," Mahowald explains. The main difference between sleepwalking and sleep terror, he explains, is that sleepwalkers don't remember walking when you wake them, but when you awaken someone in an RBD-related behavior, they are immediately awake and alert and remember dreaming something that directly correlates to the incident."
More than 90% of RBD patients are male and the disorder usually strikes after the age of 50, Mahowald says. The latest research on RBD suggests that it may be an early sign of Parkinson's or other neurodegenerative diseases. "In fact, RBD may be the sole manifestation of the disease and it can be up to 10 years before other symptoms develop," he says. "We don't know why RBD and Parkinson's are linked but there is an obvious relationship as about 40% of individuals who present with RBD without any signs or symptoms of Parkinson's will eventually go on to develop the disease."
Night eating. You wake up with cookie crumbs in your sheets and when you go to the kitchen to brew your morning java, it looks like a tornado blew through. If you accuse your husband and he has no idea what you are talking about, you may have nocturnal sleep-related eating disorder (NSRED), which affects an estimated four million Americans.
"We are talking about messy, indiscriminate, and chaotic eating," says NSRED researcher Lea Montgomery, RN, of the Texas Christian University in Fort Worth, Texas. "It's very primitive and certainly not fine dining," she says. "The strangest concoction that I have heard of is a woman who ate cat food, but traditionally people with NSRED eat food items that they don't eat in daytime such as butter or salt and pepper sandwiches," she says. Calling NSRED a hybrid of a sleep and an eating disorder, Montgomery says some people consume as many as 3,000 calories a night and some eat several times a night.
What's more, NSRED poses several health hazards including choking, trying to maintain blood sugar, eating foods you may be allergic to, or cutting yourself with a knife. "You are also not sleeping well, so work productivity and your relationships with family and friends will suffer," she says.
While no one is sure what causes NSRED, Montgomery says, "We can only hypothesize that an internal stimulus such as restless legs may activate the satiety center of brain (the hypothalamus) and people go eat," she says. But treatment with mild anti-anxiety medications can be effective. In addition, certain medications including the Parkinson's drug Sinemet inhibits involuntary body movements so the internal stimulus to get out of bed is not activated, Montgomery explains.
Sleep-sex or atypical sexual behavior during sleep. This can run the gamut from moaning to rape-like behavior and violent masturbation that leaves bruising or soreness. People will have no memory of what occurred in the morning, according to researchers at Stanford's Sleep Disorders Clinic in Stanford, Calif. The condition can be treated with anti-anxiety drugs and certain treatments used for breathing disturbances.
Nocturnal seizures. Instead of shaking, foaming at mouth, and turning blue, nocturnal seizures are marked by screaming, shouting, and pedaling leg movements. Nocturnal seizures can also mimic sleepwalking, says Clete Kushida, MD, PhD, director of the Stanford Center for Human Sleep Research. Treatment with anticonvulsant medication is usually effective, he says.
Sleep-related groaning. "It's very loud groaning, and people come to us who whose groaning has been present lifelong but they are changing living situations where it is all of a sudden it's apparent and that will be bothersome," Mahowald says.
Rock-n-roll. Body-rocking rhythmic movement disorder involves "unusual motion such as head-banging, body-rolling, and body-rocking that usually occurs right after you fall asleep and can continue for minutes or an hour, "says Kushida. "It can be associated with autism and mental retardation."
What to do?
"There are a number of causes of complex behaviors arising from sleep and you can't be sure what parasomnia it is, until you are evaluated," Kushida says. "If you suspect your bed partner is having unusual behaviors in sleep and they cause sleep loss and excessive daytime sleepiness, discuss it with a sleep specialist or primary care physician -- especially if it is very frequent, persistent, and there is a violent component to it, " Kushida says.
"Occasional nocturnal behaviors do not need to be evaluated, but if you are falling out of bed, raising or breaking windows when trying to escape, you need an evaluation by sleep center," Mahowald agrees.
Published March 3, 2003.
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