Normally, when we go into REM sleep, we become paralyzed. The only muscles that continue to work at routine levels are the diaphragm and the eye muscles. However, there are individuals who lack this inhibition and can move while dreaming. In these folks, the dreams are frequently violent and result in harm to themselves or a bed partner.
We know that this disorder seems to be more common in middle-aged men, although by no means exclusively so. We also know that up to 40% of these people, when followed over a period of time, go on to develop Parkinson’s or Parkinson-like disorders such as dementia with Lewy bodies or multiple system atrophy.
What we did not know is why. In fact, I devote a chapter of my new book Sleep Soundly Every Day, Feel Fantastic Every Night to the topic of REM Behavior Disorder (RBD). It is a very real problem for numerous Americans, and unfortunately a source of embarrassment to many. In fact, I make it a point to ask all of my new patients “Have you ever been known to act out your dreams?” It never ceases to amaze me as to how many answer affirmatively.
We may now have the answer as to why this sleep disorder is so commonly followed by Parkinson’s disease. In a paper presented at the 2014 annual meeting of the Society of Nuclear Medicine and Molecular Imaging, scientists presented the results of an eight-year study. Twenty-one patients with REM Behavior Disorder but no evidence of Parkinson’s were followed using specialized brain scans, called single photon emission computed tomography (SPECT). These scans allow clinicians to view bodily functions as opposed to only structure. Ten of these individuals showed dopamine abnormalities at baseline and eight years later, seven of them went on to develop Parkinson’s disease or similar neurodegenerative disorders.
What does this mean? I believe it signals a very important breakthrough for those with RBD. Up until now, all I could tell my patients with this common sleep-related disorder was that they had a 30 to 40% chance of developing Parkinson’s. However, now using techniques such as SPECT, we may be able to accurately predict who is most at risk for developing Parkinson’s. Just as important is that there is research being done on medications that may halt the progression of Parkinson’s when it is discovered in the early stages. Ultimately, early recognition of RBD might go a long way to decreasing this disabling and deadly disease. Consequently, if you or a loved one acts out dreams, it is imperative to bring it to the attention of your health care provider.
In my sleep practice, I see patients with RLS on a daily basis. In many instances, they have suffered with the disease for years before getting proper treatment. Unfortunately, it is frequently overlooked or misdiagnosed as some other disorder. RLS is characterized by an irresistible urge to move the legs, usually in response to an uncomfortable sensation, and is temporarily relieved by this movement. It is more frequent in the evening and is a major cause of sleep disruption. If untreated, it can result in significant physical and emotional consequences. Because I firmly believe that an educated patient is the best patient, I will give you my list of twelve things you should know about Restless Legs Syndrome.
- Common: One in ten Americans suffers from RLS and one in five recall having it as a child. It is twice as common in women and increases with age.
- Growing pains: If you are a parent, be suspicious of those “growing pains.” If frequent and relieved by movement, your child probably has RLS.
- Nighttime neuropathies: If your neuropathy occurs mainly around bedtime, you may actually have RLS. Unlike RLS, neuropathies have no circadian rhythmicity. 25% of patients with diabetic neuropathy have RLS that is undiagnosed.
- Heredity: 40% of people with RLS have a first-degree relative with the condition.
- Iron levels: Low iron levels are a major cause of RLS and correcting it can result in cure. A simple blood test called a ferritin level can reveal this cause.
- Pregnancy: RLS is very common during pregnancy, affecting about 20% of women. Iron supplementation, stretching, and support hose can be beneficial. The good news is that in most women it resolves after delivery.
- Antidepressants and antipsychotics: Unfortunately, the majority of these medications can cause or worsen RLS. The lone exception being bupropion, an antidepressant that has actually been used to treat RLS.
- Varicose veins: RLS can be associated with varicosities. In several recent studies, treating the varicosities with sclerotherapy or laser resulted in significant clinical improvement.
- Multiple sclerosis and fibromyalgia: RLS is very common in these two disorders. Unfortunately, it is frequently ignored and mislabeled as a manifestation of the disorders.
- Augmentation: If you are on medication for RLS and find that the symptoms are coming on earlier or spreading to other parts of the body, this is referred to as augmentation. It usually requires a change in therapy.
- Renal disease: Approximately 30% of patients with advanced renal disease have RLS.
- Treatment: There are numerous safe and effective treatments now available. If you or a loved one has symptoms suggestive of RLS, bring it to the attention of your health care provider. There really is no reason to suffer with this disorder anymore.
I find it fascinating that while asleep and in a prolonged fasting state, our blood sugar does not drop. A similar period of fasting, while awake, would result in drops in blood sugar and increases in appetite. However, why is it that when we sleep this does not occur?
The answer is due in part to a decrease in muscle movement and brain activity, especially during non-rapid eye movement (NREM) sleep, thus consuming less glucose. There is also an increased production of growth hormone in the beginning of the night and cortisol at the end–both of which promote the production of glucose from non-carbohydrate sources. Finally, there is an associated increased production of leptin, an appetite suppressing hormone during sleep. Together they work to prevent hypoglycemia and hunger while we sleep.
So what is going on with people who consume large amounts of their calories after bedtime? There are two forms of this condition. One is called Sleep-Related Eating Disorder and is a type of sleepwalking. It has been seen along with several medications such as Ambien (zolpidem), as well as in sleep disorders such as sleep apnea and restless legs syndrome. In this condition, there is usually total amnesia for the trips to the kitchen and eating. In fact, many of these people wake up with food in their bed, or stove burners left on and no recollection of what happened in the morning.
In the second form there is conscious but uncontrollable eating after bedtime. This is referred to as Nocturnal Eating Syndrome. It is not unusual for these people to consume over 50% of their daily caloric intake after bedtime. Both disorders are characterized by the high intake of simple sugars and fats, thus promoting obesity in many who exhibit these abnormalities.
The good news is that they are both treatable. In the case of Sleep-Related Eating Disorder, discontinuing the offending medication, or treating the primary sleep disorder can be curative. In the case of Nocturnal Eating Syndrome, cognitive behavioral therapy, properly timed light therapy, and in some cases, antidepressants that raise serotonin levels such as sertraline (Zoloft) have been effective. Therefore, if you or a loved one is a night eater, consciously or not, there are treatments available. Talk to your health care provider and if they are not familiar with this ask for a referral to someone who is.