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Sleep disorders can trigger dangerous behaviors

About 10 percent of the U.S. population is dealing with a very serious type of sleep disorder, making their bed the last place they want to be.

Parasomniacs, as they're called, can sometimes engage in dangerous behaviors acted out during sleep.

Doctors say these disorders can affect people of all ages, and may be caused by a variety of triggers from stress to a sheer lack of sleep.

A number of people are simply scared of falling asleep.

"Some of them come to dread their bed," says Kenneth Weeks, MD, who is a sleep medicine specialist at Presbyterian Sleep Health Charlotte in North Carolina.

They are fearful of the deviant or dangerous things they might do shortly after dosing off, and then not being able to remember it when they wake up.

"They will frequently swing and punch, and reach for their loved one to try to protect them, and then they'll both get hurt," Weeks says.

Sleep punching, also known as sleep violence, occurs when the brain fails to tell the body to stay paralyzed during the deepest part of sleep.

This allows the sleeper to ‘act out' their dreams by yelling, kicking or jumping out of bed.

According to scientists, a surprising number of sleep punching sufferers later develop Parkinson's disease. Treatment ranges from behavioral therapy to medication.

As for their scared spouses, doctors recommend removing all sharp objects from the bedroom and keeping a sleep log of your spouse's aggressive attacks during the night.

This could be a helpful tool for diagnosing cases of sleep sex or unwanted come-ons when a bed partner is completely conked out.

Stress, drugs, alcohol or other sleep disorders are all potential causes of sleep sex, which ranges from groping to almost rape.

In some cases, spouses, children and relatives are told to lock their bedroom doors until the patient is treated.

A locked door or door alarm is also suggested for sleep eating.

"Perhaps, the greatest danger is falling down a flight of stairs," Weeks points out.

Sleep eaters usually suffering from stress will walk to the kitchen and, while deep asleep, will dine on everything from last night's dinner to cleaning liquids.

"The next morning, the family members find it, but they don't remember anything about it," Weeks says.

Eating a balanced, day-time diet, medication and locking up dangerous food and appliances can treat sleep eating.

If ignored, it can lead to weight gain, bizarre cuts and burns from cooking or eating something they're allergic to.

Although rare, perhaps the riskiest of all sleep disorders is sleep driving.

This occurs when a person gets out of bed, sits behind the wheel and drives onto the road while still asleep.

Several cases have been linked to insomnia drugs, so talk to your doctor before taking any of these medications.

Regardless of what the sleeping person is doing, experts say you should be careful not to abruptly awaken a parasomniac in action.

Instead, gently lead them back to bed and make arrangements to consult with a sleep doctor as soon as possible.  

Doctors say it's important for a spouse to accompany a sleep disorder patient when seeking a diagnosis. A spouse's account of what's happening at night could be critical in obtaining an accurate diagnosis of what's wrong.

Copyright 2013 America Now. All rights reserved.

Additional Information:

The following information is from Kenneth D. Weeks, MD, who is a sleep medicine specialist at Presbyterian Sleep Health in Charlotte, NC.

  • Sleep eating usually happens early in the night when a person hits a deep sleep.
  • Sleep punching is common among the elderly and those with degenerative diseases like Parkinson's Disease.

The following information is from the Cleveland Clinic's website (Source: http://my.clevelandclinic.org/disorders/sleep_disorders/hic_parasomnias.aspx).

  • Parasomnias are disruptive sleep-related disorders during arousals from rapid eye movement (REM) sleep or arousals from non-rapid eye movement (NREM) sleep.
  • They involve undesirable physical or verbal behaviors, such as walking or talking during sleep.
  • Types:
    • Nightmares: vivid nocturnal events that can cause feelings of fear, terror, and/or anxiety. Caused by many factors including illness, anxiety, the loss of a loved one, or negative reactions to a medication. Call your doctor if nightmares occur more often than once a week or if nightmares prevent you from getting a good nights rest for a prolonged period of time.
    • Sleep Terrors: abruptly awakes from sleep in a terrified state. The person may appear to be awake, but appears confused and is not able to communicate. Night terrors last about 15 minutes, after which time the person usually lies down and appears to fall back asleep.Night terrors are similar to nightmares, but night terrors usually occur during stages 3 sleep (deep sleep). May pose dangers to themselves or others because of jumping on the bed or running around. Fairly common in children aged four to twelve. Strong emotional tension and/or the use of alcohol can increase the incidence of night terrors among adults.
    • Sleepwalking (somnambulism): most often occurs during deep non-REM sleep (stage E3), early in the night. Most commonly seen in children aged six to twelve; however, sleepwalking can occur among younger children, the elderly, and adults. Sleepwalking appears to run in families.
    • Sleep paralysis: not able to move the body or limbs when falling asleep or waking up. Sleep deprivation and irregular sleep-wake schedules can cause sleep paralysis. It is also seen in narcolepsy, a disorder characterized by severe excessive daytime sleepiness. This disorder is not harmful, but people experiencing sleep paralysis often are fearful because they do not know what is happening. An episode of sleep paralysis often is terminated by sound or touch.
    • REM sleep behavior disorder (RBD): act out dramatic and/or violent dreams during REM sleep. REM sleep usually involves a state of paralysis (atonia), but people with this condition move the body or limbs while dreaming. Usually, RBD occurs in men aged 50 and older. Potentially serious neurological disorders must be ruled out. Polysomnography (sleep study) and drug treatments are involved in the diagnosis and treatment of this disorder. 

The following information is from the National Sleep Foundation in an online article entitled, "Sleep and Parasomnias" (Source: http://www.sleepfoundation.org/article/ask-the-expert/sleep-and-parasomnias).

  • Parasomnias: all the abnormal things that can happen to people while they sleep, apart from sleep apnea.
  • Sleep-related eating disorder, sleepwalking, night terrors, sleep paralysis, REM sleep behavior disorder, and sleep aggression. Sexsomnia, sometimes called "sleepsex," is also a parasomnia.
  • Parasomnias often run in families and so there is probably a genetic factor in many cases. Brain disorders may be responsible for some parasomnias, such as many cases of REM sleep behavior disorder. Parasomnias may also be triggered by other sleep disorders such as obstructive sleep apnea, and by various medications.
  • Parasomnias affect approximately 10% of Americans. They occur in people of all ages, but are more common in children. Children are particularly vulnerable because of brain immaturity. The good news is that they are usually not associated with negative health consequences and disappear as a child matures.
  • Trying to awaken a "parasomniac in action" - especially by shaking or shouting - can sometimes trigger an irritable, aggressive or violent response. Gently redirect the person back to bed by guiding him or her by the elbow and speaking softly.
  • Door alarms can help by awakening a person during an episode.
  • Do not sleep on a top bunk, or next to a window.
  • Remove sharp objects from the bedside area and to be sure roommates and household members are aware of the problem and what to do about it.
  • Many people who suffer with parasomnias see an improvement in their symptoms simply by improving their sleep habits. Good sleep habits include keeping a regular sleep schedule, managing stress, having a relaxing bedtime routine, and getting enough sleep. There are also drug therapies that are used to control symptoms.
  • No matter how weird, bizarre, or violent the behavior, a parasomnia is rarely linked with a psychiatric disorder.

The following information is from a feature about sleep disorders on the website Medscape.com (Source: --http://www.medscape.com/features/slideshow/sleep-disorders).

  • Sleep punching: Less than 2% of the population is believed to exhibit signs of sleep violence. The condition is more likely to occur during NREM sleep, but it occasionally manifests as an RBD. The evaluation of nocturnal violence should begin with a thorough history and detailed neurological exam. Polysomnography should be used, and patients should be assessed for seizure activity and receive video monitoring. Treatment can range from behavioral modification to medication, depending on the severity of the condition and whether it occurs during NREM or REM sleep.
  • Sleep Sex: Uncontrolled and unaware sexual behaviors during sleep. These behaviors may involve masturbation and sexual behaviors with a partner. Researchers found that 48% of sexsomnia events included sleep talking and moaning; 19.4% included groping, fondling, and attempts at intercourse with a partner; and 29% involved no behaviors other than pelvic movements by the sleeper. Treatment may include behavioral modifications and medication, such as clonazepam. In August 2007, a jury acquitted a British Royal Air Force mechanic accused of raping a 15-year-old girl after he claimed sleepwalking and sexsomnia as a defense.
  • Sleep Eating: sleep-related eating disorder (SRED) involves episodes of eating after an arousal from nighttime sleep, followed by amnesia. SRED typically occurs in conjunction with other sleep disorders, such as sleepwalking, and has been identified as a potential side effect of some sleep medications.
  • Sleep driving: sleep drivers often have no memory of this behavior once awakened.

The following is from an ABC.com article entitled, "Why Sleep Disorder Sufferers May Beat Up Bedmates" (Source: http://abcnews.go.com/GMA/DrJohnson/story?id=125388&page=1).

  • "Sleep punching" is a part of an REM Sleep Behavior Disorder or "RBD"
  • Experts at the Minnesota Regional Sleep Disorders Center in Minneapolis say that 0.5 percent of the entire U.S. adult population deals with RBD.
  • For most people during REM, or the "rapid eye movement" phases of sleep, nerve cells in the brain send certain "inhibitory" signals to the rest of the body, and the only muscles that move are those for breathing and eye movement. But for those with RBD, the brain fails to send those signals, and there is no inhibition of movement.
  • Experts at the Minnesota Sleep Center have made a disturbing yet important observation. More than half these patients have gone on to develop Parkinson's disease.

The following article is from WebMD in an article entitled, "REM Sleep Behavior Disorder" (Source: http://www.webmd.com/sleep-disorders/guide/rem-sleep-behavior-disorder).

  • In a person with REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent, allowing the person to "act out" his or her dreams, include talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing. An acute form may occur during withdrawal from alcohol or sedative-hypnotic drugs.
  • RBD is usually seen in middle-aged to elderly people (more often in men).
  • The disorder may occur in association with various degenerative neurological conditions such as Parkinson's disease, multi-system atrophy, diffuse Lewy body dementia, and Shy-Drager syndrome. In 55% of persons the cause is unknown, and in 45%, the cause is associated with alcohol or sedative-hypnotic withdrawal, tricyclic antidepressant (such as imipramine), or serotonin re-uptake inhibitor use (such as fluoxetine, sertraline, or paroxetine) or other types of antidepressants (mirtazapine).
  • In one study, 38% of patients diagnosed with RBD subsequently developed Parkinson's disease within an average time of 12-13 years from the onset of RBD symptoms. Also, RBD is seen in 69% of those with Parkinson's disease and multi-system atrophy. The relationship between RBD and Parkinson disease is complex; however, not all persons with RBD develop Parkinson's disease.

The following information is from WebMD in an article entitled "'Sleep Sex' Unromantic, Even Dangerous'" (Source: http://www.webmd.com/sex-relationships/features/sleep-sex-unromantic-even-dangerous).

  • Bed partners report aggressive groping and biting, but no recollection the next morning.
  • Other cases have been documented of sleeping males accosting young children, and legal action has resulted.
  • sleep sex can be "rape or rape-like behavior." In one case, the bed partner was advised to sleep in a locked room until the patient could be properly diagnosed and treated.
  • A Stanford study indicated that as many as 2% of the general population has become violent while asleep.
  • Also known as SBS (sexual behaviors during sleep), has yet to be formally categorized as a parasomnia, although that may soon happen.
  • Many times, people who engage in sleep sex have a history of other sleep disorders such as REM behavior disorders, apnea, bed-wetting, and sleepwalking. Some have seizure disorders. All this suggests neurochemical disorders in the brain.
  • Fatigue and stress, as well as drug and alcohol use, can precipitate incidents but sexual denial or frustration does not have much to do with these behaviors.
  • Clonazepam, in the benzodiazepine family, has proved helpful. Consult a physician.

The following information was obtained from The Washington Post (Source: http://www.washingtonpost.com/wp-dyn/content/article/2007/03/14/AR2007031401027.html)

  • The FDA has uncovered more than a dozen reports of sleep driving related to insomnia drugs and is worried that more are going uncounted.T
  • The makers of 13 sleep drugs must put warnings on their labels about two rare but serious side effects: sleep-driving, along with other less dangerous "complex sleep-related behaviors" like making phone calls, fixing and eating food, and having sex while still asleep, and life-threatening allergic reactions, as well as severe facial swelling, both of which can occur either the first time the pills are taken or anytime thereafter.
  • Ambien isn't the only insomnia drug that can cause sleep-driving. Any of the class known as "sedative-hypnotics" can.
  • Never take any prescription insomnia drug along with alcohol or any other sedating drug. Also, don't take higher-than-recommended doses of the pills.
  • Some insomnia drugs that may be linked include: Ambien; Butisol sodium; Carbrital; Dalmane; Doral; Halcion; Lunesta; Placidyl; Prosom; Restoril; Rozerem; Seconal; Sonata.
  • Fewer than one in 1,000 patients in studies of Ambien reported somnambulism, a scientific term that includes the sleep behaviors flagged by the FDA. The side effect has remained similarly rare since widespread sales began.

The following information is from the American Sleep Association's website in an article entitled, "Sleep Eating" (Source: http://www.sleepassociation.org/index.php?p=sleepeating).

  • Sleepeaters can be extremely difficult to rouse from their state, like sleepwalkers, and trying to do so may result in them getting angry or irritable with you.
  • Sleepeaters tend to have at least one episode every night, and these usually occur regardless of possessing any actual feelings of hunger or thirst detected by the brain.
  • Sleepeaters also tend to eat foods high in calories or sugar, and may eat foods while sleepeating that they normally would not eat on their own, or which would not be seen as socially acceptable to eat on their own, such as peanut butter on its own, or sugar or syrup on its own. The food is also consumed much quicker than it would be during waking hours.
  • Subjects may injure themselves while trying to prepare a hot dish using appliances or may accidentally cut themselves while hurriedly chopping up ingredients.
  • The mess left behind is usually the best hint of sleep eating.
  • Ingestion of bizarre and/or dangerous combinations of food: cigarettes, coffee beans or cleaning liquids.
  • More likely to develop slowly, with occasional nights of eating, but may start off with consistent sleepeating episodes right from the start, usually brought on by recent changes to diet, or issues related to stress or depression. Sleepeating may also develop in people who have recently quit smoking or drinking alcohol, with the use or discontinued use of certain medications, or those with sleeping disorders while awake.
  • People with other sleeping disorders, such as obstructive sleep apnea, restless legs syndrome, and sleepwalking itself are at a higher risk of developing sleepeating.
  • More common in women, and usually develops in early adulthood, often in conjunction with dieting, anorexia or stress. When the issue that resulted in the commencement of the sleepeating is dealt with, the sleepeating will usually cease as well, though this is not always the case.
  • Potential undesired weight gain, injury, disrupts sleep
  • You may need to take a polysomnogram sleep study test to ascertain the number of parasomniac activities you are engaging in, and if any other sleeping disorders may be causing the problem.
  • Sleepeating is effectively treated with medications to suppress both sleeping parasomnias.
  • Any dangerous foods or substances should be kept away from the kitchen. The path to the kitchen should also be cleared of anything that could be tripped over or crashed into.
  • Having a proper, well balanced diet overseen by a dietician is also important, this will limit the body's cravings.


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