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Acting out your dreams- a sleep problem in Parkinson's disease

Friday August 16, 2013

REM sleep disorder is a condition described as active, vivid and sometimes violent dreaming. Bed-partners  describe restless dreaming that can include talking, screaming, punching and even getting out of bed to physically' act out a dream.' This condition occurs during REM (rapid eye movement) stage of sleep when dreaming happens.  During REM sleep our bodies lose muscle tone preventing movement while dreaming. During REM sleep disorder, body muscle tone or ability to move is maintained. This, coupled with active dreaming, can lead to sleepless nights and harm to the person or their bed partner.

REMSD can be present as an isolated condition or a condition associated with disease such as Parkinson's or Lewy body disease. In fact, REMSD can predate movement problems of Parkinson's disease and is being studied as a risk factor for developing the disease.

The active and vivid dreaming of REMSD is different from hallucinations although an individual can have both problems together. This problem should be evaluated to prevent physical harm and to improve sleep. The following tips can be helpful:

  • First, inform your healthcare provider about this problem
  • Review your use of bedtime medicines such as Benadryl and antidepressants that can influence REM sleep.
  • Review timing and type of Parkinson's medicines as medicines that increase confusion and hallucinations may also increase your risk of this problem.
  • Avoid alcohol before bedtime.
  • Make your time before bed a relaxing time. Avoid watching violent movies, stressful tasks or the evening news. Relax and unwind instead with gentle stretching and music.
  • Remove furniture and clutter from the room that would be a trip hazard in the event you 'act out your dreams.'
  • Use you sleep mask or oxygen as prescribed if you have sleep apnea.
  • When needed medical treatment can help. Melatonin is sometimes helpful as is a prescription medicine called clonazepam. Clonazepam is similar to Valium so does have additional risks of sedation, confused imbalance.
  • Talk to your doctor is you are experiencing thinking or cognitive problems as these problems can be associated with REMSD.

Monique L. Giroux, MDMonique L. Giroux, MD
Medical Director, Northwest Parkinson's Foundation

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