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REM Behavior Disorder – Do You Physically Act Out Your Dreams?

Have you ever physically acted out your dreams, injured yourself and/or your sleeping partner, leapt out of the bed, had frightening dreams, kicked, punched, or ran in your sleep? If any of these sounds familiar you could be suffering from REM Sleep Behavior Disorder (RBD). People with RBD attempt to act out their dreams, which often times are violent in nature.

We typically can’t act out our dreams. The majority of people dream around 4-6 times per night during the REM (rapid eye movement) stage of sleep, the brain becomes as active during this stage as it is when you’re awake. Although the neurons in the brain during REM sleep are functioning as much as they do when you’re awake, REM sleep is also characterized by temporary muscle paralysis. Most people, even when they are having vivid, active dreams, their bodies are still. But, people with RBD are lacking this muscle paralysis, allowing them to act out the contents of their dreams.

RBD can begin by talking, twitching, and jerking while dreaming up to years before a person begins fully acting out their dreams. The risk of developing RBD increases with age and men are more likely to develop RBD than women. For about 55% of people the cause for RBD is unknown, and the other 45% is linked with alcohol or sedative-hypnotic withdrawal, antidepressants, or serotonin reuptake inhibitors. RBD also often precedes the development of some neurodegenerative diseases like Parkinson’s disease and multisystem atrophy; however, not all people with RBD with develop a neurodegenerative disease. People with RBD should consult with a doctor about their problems and can begin medication if needed to treat RBD. Patients will also be encouraged to make their sleeping environment as safe as possible by removing all sharp and breakable objects and ensuring all windows and doors are locked.

 

Maas, Dr. James B., Megan L. Wherry, David J Axelrod, Barbara R. Hogan, and Jennifer A. Blumin. Power Sleep: The Revolutionary Program That Prepares Your Mind for Peak Performance. New York : Villard, 1998.

“Causes & Diagnosis of REM Behavior Disorder.” National Sleep Foundation. Web. 8 Jan. 2015.

Boeve M.D., Bradley. “REM Sleep Behavior Disorder: Updated Review of the Core Features, the RBD-Neurodegenerative Disease Association, Evolving Concepts, Controversies, and Future Directions.” National Institutes of Health. U.S. National Library of Medicine, 1 Jan. 2011. Web. 8 Jan. 2015.

“REM Sleep Behavior Disorder.” Diseases and Conditions-REM Sleep Behavior Disorder. Mayo Clinic, 11 July 2014. Web. 8 Jan. 2015.

The Need to Know About Bedwetting (Enuresis) and How To Stop It

Enuresis is a common problem that affects more than 5 million children in the United States alone. When a child empties their bladder at an inappropriate time and/or place it is called incontinence, but when incontinence happens during the night it is classified as enuresis. Enuresis can be embarrassing, stressful, and can even cause extreme anxiety in children, which can then cause tension within the family. While most children will outgrow enuresis, it’s still important to know the different causes and possible treatment options to discuss with your doctor.

Common Causes
Doctors now believe that the majority of enuresis cases are caused by one, or a combination of the following four conditions.

  • Failure to arouse – this happens when a child does not wake up when their bladder is full or contracts spontaneously.
  • Increased production of urine while asleep – a child’s kidneys make more urine during the night than can be stored within the child’s bladder. This extra urine production is caused by a night-time lack of the hormone vasopressin, which tells the kidneys to decrease urine production.
  • Overactive bladder – the bladder tends to contract without being full leading to a smaller than normal capacity.
  • Social stress – moving to a new place, sleeping alone, starting school or changing to a new one, a family crisis, an accident or trauma can all cause enuresis in children who are genetically predisposed to the condition.

Uncommon Causes
While the following causes aren’t very common reasons for enuresis, they do serve as a reminder to get enuresis symptoms and issues checked by a doctor.

  • Urinary Tract Infections
  • Structural or Anatomical Issues
  • Neurological Issues
  • Kidney Disease
  • Hormonal Disorders such as Diabetes or Hypothalamus issues

Treatment Options

  • Stopping/limiting fluids before bedtime – typically one of the first things parents try, just make sure your child is drinking a few extra glasses of water in the morning and at lunch and then limit evening drinking intake to quench thirst only.
  • Dietary changes – enuresis can be caused by constipation, dietary changes or laxatives can eliminate constipation and in return the enuresis as well.
  • Scheduled night waking – while labor intensive and often not recommended, parents wake children 1-3 times during the night to take them to the bathroom.
  • Bladder training exercises – mainly used for adults who suffer with various forms of incontinence, typically not recommended for children.
  • Alternative therapies – acupuncture and hypnotherapy has had encouraging research and results, while homeopathy, herbal remedies, and chiropractic practices have all been tried, but have no proven effects or research to back them.
  • Enuresis alarms – often called wetting alarms are small electronic devices that use a small sensor that attaches to underwear or pajamas that then connects to an alarm clipped to the child’s clothing(wireless options are also available now). When the sensor becomes moist the alarm sounds in hopes of the child waking while the bladder is still full and making it to the bathroom. If it is used correctly the chance of success is approximately 75% after 1-2 months of continuous treatment. Wetting alarms cost around $60 to $120.
  • Desmopressin acetate (DDAVP) – humans naturally produce the hormone vasopressin that causes the body to reduce urine production. In many children with enuresis, this surge of vasopressin is absent, so the vasopressin hormone has been analyzed and synthesized as the drug desmospressin, and is available as a pill, nasal spray, or as an under the tongue option.
  • Medication – there are a few other medications on the market that could help with enuresis, but like any medicine they can come with side effects. The most common side effect for children is constipation, which, in itself, may cause the enuresis to reappear. Be sure to consult with your doctor about all treatment possibilities.

 

“Bedwetting (Nocturnal Enuresis) in Children.” Bedwetting (Nocturnal Enuresis) . Boston Children’s Hospital, 1 Jan. 2014. Web. 30 Dec. 2014.

“Urology Care Foundation The Official Foundation of the American Urological Association.”Urology Care Foundation. 28 Mar. 2013. Web. 30 Dec. 2014.

“When Bed-Wetting Becomes A Problem.” Nation Kidney Foundation. Web. 30 Dec. 2014.

Exploding Head Syndrome – A Scary Sounding Sleep Disorder

Exploding Head Syndrome (EHS) may sound like something you would read straight out of a Sci-Fi novel, but in reality it is a surprisingly common sleep disorder. While EHS is a largely overlooked phenomenon in the medical field, it is estimated that about as many as one in ten people will be effected at some point during their life. People with EHS may only have one attack in their lifetime, while others can experience around seven attacks a night. Many only experience one attack, and some suffer from attacks over weeks or months, and a few will experience attacks daily for years.

Below is a list of common EHS symptoms, if you are experiencing any of these you should consult a doctor or sleep specialist.
• Noises are loud and jarring, resembling the popping sounds of firecrackers or gunshots, the slamming sound of a door closing violently, or the boom of an explosion.
• Sometimes the sounds of EHS are accompanied by flashes of light.
• These sounds may be perceived in one or both ears.
• EHS may also cause a mild headache and sensations of heat.
• J
erk or ‘jumping’ limbs at the same time.
• The disorder is known to be twice as common in women and typically affects ages 50 and older, though it has also been reported in children as young as ten.

The good news is that while EHS can be scary, it is generally harmless. It’s still unclear why EHS happens and what could be causing it. Dr. Sharpless says the most likely explanation for EHS is that there is some kind of temporary blip in the nerve cells of the brain during the switch from being awake to sleeping. When we sleep, our brains coordinate a switching off of various regions responsible for movement, vision, sound and so on. EHS could occur because of a delay in this shut-down process, resulting in a burst of activity, which could be perceived as loud noises and flashes of light. Other possibilities could stem from ear problems or rapid withdrawals from certain drugs such as benxodiazephines and certain types of anti-depressants.

There are drug treatments for EHS that may be effective, but are generally reserved for patients with frequent and prolonged symptoms.

Sorensen, Eric. “‘Exploding Head Syndrome’ a Real, Overlooked Sleep Disorder – WSU News.” WSU News. Washington State University, 6 May 2014. Web. 2 Dec. 2014. <https://news.wsu.edu/2014/05/06/exploding-head-syndrome-a-real-overlooked-sleep-disorder/#.VH3QmzHF_d2&gt;.

“Exploding Head Syndrome – Overview & Facts.” Exploding Head Syndrome. American Academy of Sleep Medicine. Web. 2 Dec. 2014. <http://www.sleepeducation.com/sleep-disorders-by-category/parasomnias/exploding-head-syndrome/overview-facts/&gt;.

Sleep Studies

A wide range of tests are used during sleep studies, but here are a few of the most common sleep tests that you can expect.

  • Polysomnogram (PSG) is the most common test used to diagnose sleep disorders. A PSG is often recommended for patients who are suspected of having sleep apnea, narcolepsy, REM sleep behavior disorder, periodic limb movement disorder, unusual behaviors during sleep, and unexplained chronic insomnia. During a PSG you will have wired, sticky patches containing sensors called electrodes that are placed on your scalp, face, chest, limbs, and a finger; these sensors will record a patient’s brain waves, blood oxygen level, heart rate, breathing, as well as eye and leg movements while sleeping and will allow your doctor to give a diagnosis. A PSG can also be used to help adjust or create treatment plans for patients that have already been diagnosed with a sleep disorder.
  • Multiple Sleep Latency Tests (MSLT) show different stages of sleep and how long it takes you to fall asleep, you will be asked to relax and try to fall asleep in a dark, quiet room every two hours throughout the day. MSLT’s are usually performed the morning after a PSG and involves sensors placed on your scalp, face, and chin. These sensors will record brain activity and eye movements to help diagnose sleep disorders like narcolepsy, idiopathic hypersomina, and other sleep disorders that cause daytime tiredness.
  • Maintenance of Wakefulness Test (MWT) is typically performed the day after a PSG and takes most of the day. Like the previous sleep studies, the MWT uses sensors to measure when you’re awake and asleep. You will be asked to sit quietly and comfortably in a chair and look straight ahead, then all you have to do is try to stay awake for 40 minutes, then you will get a 2 hour break in between each MWT.
  • Home-Based Portable Monitor Test will require you to go to a sleep center where they will show you how to set up and use the equipment that you will be taking home, or in some cases you can have a technician come to your house to help prepare for the sleep study. You will take the equipment back to the sleep center when you finish and then should have the test results back from your doctor within a week or two.
  • Actigraphy is a small device that is typically worn like a wristwatch so you can go about your day normally; just make sure to remove it before swimming or bathing. The actigraphy measures your sleep/wake behavior over a 3-14 day period. Results from the actigraphy will give your doctor a better idea of your sleep habits, including daytime naps, bedtimes, hours of sleep, and even if the lights are on while you’re asleep.

 

“Polysomnography (sleep Study).” Why It’s Done. Mayo Clinic, 6 Dec. 2011. Web. 5 Nov. 2014. <http://www.mayoclinic.org/tests-procedures/polysomnography/basics/why-its-done/prc-20013229&gt;.

“UCLA Sleep Disorders Center.” Preparing for a Sleep Study. UCLA.edu. Web. 15 Oct. 2014. <http://sleepcenter.ucla.edu/body.cfm?id=59&gt;.

“What To Expect During a Sleep Study.” – NHLBI, NIH. National Heart, Lung, and Blood Institue. Web. 15 Oct. 2014. <http://www.nhlbi.nih.gov/health/health-topics/topics/slpst/during.html&gt;.