Q: I am a healthy, very active female age 67 who has had REM behavior sleep disorder for a long time and it is getting worse. Recently I threw myself out of bed and had to go to the emergency room for five stitches on my face. Now I have to tie myself securely in bed and am taking gabapentin and melatonin at night. Luckily, I live alone. I am quite groggy during the day. Anything you can suggest to help would be much appreciated.
A: REM stands for rapid eye movement. Normal sleep has two states – non-rapid eye movement (NREM) and rapid eye movement (REM). During the latter stage of sleep, breathing becomes irregular, there is a loss of muscle tone, rapid eye movement occurs, and blood pressure rises. This phase of sleep accounts for about one fourth of a person’s sleep period and is generally the time when an individual dreams.
In REM sleep behavior disorder, the loss of muscle tone that normally occurs is incomplete or absent entirely, allowing the individual to move about and act out his or her dreams that may be violent, physical and intense, depending on the subject matter of the dream. The person may kick, punch, yell, and jump from the bed, which is apparently what you experience. This sleep behavior is seen most often in men more than in women and during middle age and older individuals. Unfortunately, the exact reason for this sleep phase to occur is unknown; however it may precede some neurological disorders such as Shy-Drager syndrome and Parkinson’s disease. Shy-Drager is a rare condition that causes progressive damage to the autonomic nervous system which controls involuntary body functions such as breathing, heart rate, and body temperature. Parkinson’s disease is a degenerative disorder of the central nervous system One study revealed that almost 40% of individuals diagnosed with this sleep disorder developed Parkinson’s in just over 10 years from the onset of symptoms.
The gabapentin you have been prescribed is an anti-convulsant that affects the chemicals and nerves in the body involved with some types of pain and seizures. The melatonin is a sleep aid that is found naturally in the body but can be synthetically produced in a laboratory. It is available without prescription. Individuals in specific situations such as swing-shift workers and those who travel through different time zones have found this medication useful in “re-setting their clocks”.
My initial reaction is that if you aren’t already, you should be under the care of a superb neurologist who can review your case and determine if all the bases have been covered with your two medications or through a sleep medicine program at a medical center. Second to that, you were fortunate not to have injured yourself worse than you did when you acted out your dream and fell out of bed; however, I may have an alternative rather than tying yourself down at night. Consider going to a durable medical equipment facility that rents out hospital beds, night stands and the like. Rent side rails for your bed that resemble those you would see in a hospital setting or on a child’s bed to prevent him or her from falling out of bed. The sides can fold down easily when you choose to get up, and should keep you from flailing across your bedroom in the middle of a dream. Lastly, there has been some success using benzodiazepine drugs such as clonazepam.
Readers who would like related information can order Dr. Gott’s Health Report “Sleep/Wake Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
