Acting Out Dreams and Parkinson’s

Actor Alan Alda’s recent announcement that he’s living with Parkinson’s disease (PD) brought the disease into the public eye. But what caught many people’s attention was what led him down the path to diagnosis: acting out his dreams, or REM sleep behavior disorder (RBD). This sleep condition is a lesser-known symptom of Parkinson’s that, in some people, can precede movement symptoms (tremor, stiffness, slowness) and diagnosis by years or even decades.

What Is REM Sleep Behavior Disorder?
In REM sleep behavior disorder, a person acts out their dreams. Because these dreams often involve being chased or attacked, people will yell, punch, kick or even leap out of bed.

REM is the period of sleep during which we dream. Normally, the brain inhibits muscle movement during this time. In RBD, the brain pathways that suppress muscle activity are disrupted, and people are able to move to act out their dreams.

How Is RBD Diagnosed?
The diagnosis of RBD rests on your story and a sleep test. A sleep doctor will ask you and your bedpartner about behaviors during sleep. An overnight sleep study records brain waves and muscle activity while you sleep and may also include taking a video to show you acting out your dreams.

REM is the period of sleep during which we dream. Normally, the brain inhibits muscle movement during this time. In RBD, the brain pathways that suppress muscle activity are disrupted, and people are able to move to act out their dreams.

What Is the Treatment for RBD?
If RBD causes injury or poses risks of harm to you or your bedpartner, your doctor may suggest medication and safety measures. Some medications (such as certain antidepressants or pain drugs) can cause RBD, so your doctor may change those medicines before adding another.

Commonly prescribed medications for RBD are clonazepam and melatonin. Clonazepam can cause confusion and falls, so doctors prescribe it cautiously in people with memory and thinking changes or walking and balance problems.

Safety measures may include adding a bed rail, padding corners of furniture, and removing potentially dangerous objects (such as guns or sharp objects) from the bedroom. Sometimes the bedpartner may need to sleep in a separate room until RBD is controlled.

How Is RBD Connected to Parkinson’s Disease?
Sleep problems, including RBD, are common in people who’ve been diagnosed with Parkinson’s. But studies suggest that REM sleep behavior disorder also can be one of the first symptoms of PD, occurring years before motor symptoms. (Other possible early signs include constipation, depression and smell loss.) These studies demonstrate a strong link between having RBD and later being diagnosed with Parkinson’s or related conditions such as dementia with Lewy bodies or multiple system atrophy, which have PD symptoms. Not everyone with RBD goes on to develop PD, though.

What if I Have RBD?
If you act out your dreams, talk to your doctor. Other sleep problems may mimic RBD, so it’s important for a sleep specialist to confirm the diagnosis. If you do have RBD, you may want to see a movement disorder specialist (a neurologist with expertise in Parkinson’s and other movement disorders) who can check for Parkinson’s motor symptoms and talk through your risk of developing PD or related conditions. Your movement disorder specialist may recommend regular visits to repeat the examination and monitor for changes.