Stop punching me in your sleep!

This is written for anyone who has been punched or kicked or slapped by their nightmare-suffering sleeping partner. You’re sleeping peacefully, probably in some blissful place where chocolate improves muscle tone and you’re about to walk down the aisle to accept the Nobel Prize for Greatness, and your partner, unknown to you, is instead, being chased by a thug with a machete. So he (or maybe she) lashes out in the dream and pummels you, bringing you violently back to reality and making you think, once again, that those separate beds from the 1950 movies weren’t such a bad idea. Your partner apologizes, explains the whole machete thing, and is back to sleep in a moment. It’s quite annoying, right? But did you know that it is also not normal, and is a very early indicator of particular diseases?

This syndrome is called RBD, for REM Behavior Disorder.  In normal REM sleep where dreams occur, the body is paralyzed, so even when frightening dreams happen, the dreamer can’t move.  They can’t respond to the violent presence by actually hitting or punching. The fact that your partner can do this means something is amiss.

RBD was first identified by Dr. Mark Mahowald in 1985.  It is correlated with Parkinson’s Disease (15% of these patients have it), Multiple System Atrophy (75%) and Lewy Body Dementia (85%).  It can occur in people 25 years before symptoms of these diseases present themselves. Parkinson’s Disease is well-known by the public, and its awareness has been boosted by the noteworthy efforts of the Michael J. Fox Foundation.  Multiple System Atrophy is extremely rare.  But Lewy Body Dementia has the unfortunate distinction of being very common (it is second only to Alzheimer’s Disease in the list of elderly dementias) and being almost unknown.  Sadly, many doctors, especially primary care physicians, aren’t knowledgeable about the disease either. Recent studies have shown that as many as 50% of people diagnosed with Alzheimer’s actually had Lewy Body Dementia or Vascular Dementia. An elderly patient with dementia who has RBD is five times more likely to have Lewy Body Dementia than Alzheimer’s.

I won’t go into the details of how Lewy Body Dementia is different from Alzheimer’s, Vascular and Frontal Lobe Dementia—that will be another piece.* But there is one detail that should not go unmentioned. For most people, and even some doctors, knowing what type of dementia is irrelevant, since none of them are curable, and the same drugs are used to treat patients’ symptoms.  However, there is one aspect of Lewy Body Dementia that is different and it can lead to a very dangerous outcome.  Many people with LBD have a rapid and disastrous reaction to common traditional antipsychotic medications, like Haloperidol (Haldol).  The administration of these drugs, which are often given for hallucinations, another symptom of LBD, causes this reaction in 25% to 50% of LBD patients. It can lead to a catatonic state, a rapid decline in cognitive function, sedation, increased or possibly irreversible acute onset parkinsonism , and even death. So, it is important, if your sleeping buddy is kicking dirk-wielding transgressors, that you get them to a neurologist for an evaluation. Medications help the condition 90% of the time, allowing you to sleep uninterrupted again.  And it wouldn’t hurt to meet with a neurologist early on.  Studies are being done to diagnose and treat these diseases before they are irreversible later on.

October is Lewy Body Dementia Awareness month and I will be bringing you first-hand stories from patients and caregivers as they deal with this disease.

* If you are interested in learning more, I recommend going to www.lbda.org, which is full of information for caregivers, patients, doctors.