Thursday, June 18, 2015

REM Sleep Behavior Disorder (RBD) and Lewy Body Dementia/Parkinsons

There is nothing like a good, fitful, uninterrupted sleep without the use of any sleeping aid to ensure it.

But, what if that wasn't possible?  What if you had a condition that didn't allow for the conditions that would lead to a peaceful night and a bright, shiny morning?

Two of the symptoms for Lewy Body Dementia can be (not always)  Restless Leg Syndrome (RLS) or REM Sleep Behavior Disorder (RBD).    These occur earlier than the onset of the disease but can be seen as possible precursors.

During a regular night's sleep, the average person will fall into two distinct states:  Non-Rapid Eye Movement (NREM) sleep, and Rapid Eye Movement (REM) sleep.

In order to fully understand the impact of the RLS and RBD, one must also be able to understand how sleep works.  The following is an abbreviated primer:

NREM sleep has three stages:
1)  Beginning of the sleep stage with slow eye movement.  This is sometimes referred to as "Relaxed Wakefulness".  This stage lasts for up to 10 minutes, and also includes hypnic jerks in which the person may awaken and have no idea they had even fallen asleep.  This stage accounts for approximately 5% of the sleep time.
2)  No eye movement and dreaming is quite rare. Any consciousness of the environs decreases as do the muscular activities of the body.    There are bursts of activity from the brain, but there is no realization of the surrounding environs.   This stage is passed through several times during the sleeping process and accounts for about 45-50% of the sleep time.
3)  This stage has a longer duration during the first part of the night and comes in stages.  During this phase, the sleeper is more prone to dreaming than the other two, although it is not REM sleep stage.  This is the phase in which the sleeper is more prone to parasomnias such as Sleep Walking, Bed Wetting, Sleep Talking, and Night Terrors.   One must also note that the breathing and blood pressure have also slowed greatly, and the body is now coming into a stage of full paralysis for the normal sleeper.

Now, we enter the REM zone.

Mind you, during the NREM phases the body has relaxed as has the breathing.  But during REM the body enters complete paralysis as a sort of insurance against self-harm in acting out the dreams.  The breathing becomes irregular and the heart rate also increases.  The brain activity begins to soar, as well.   This phase lasts approximately 20-25% of the sleep duration and lasts from 90 - 120 minutes for each cycle.   This decreases with age, as infants tend to have dreams for 80% of the sleep duration so these numbers reflect those of an adult.

With  RBD, the paralysis that should occur during REM sleep is either absent or incomplete due to some neurological disorder.   Sometimes it could be the person is in withdrawal from alcohol, or sedative-hypnotic drugs.  The actions that characterize the behaviors can be vivid, intense, and violent.   Actions that a person with the disorder may demonstrate are:


  Punching, Yelling, Kicking, Grabbing, Jumping, Sitting, Walking, and others.

This is one of the symptoms that can lead to a diagnosis of LBD.

If it were present, you would most likely know.

With RLS, the person feels the impulse to keep their legs moving.  It's as though there is energy that is locked up and is attempting to burst out.    This occurs at regular intervals and can keep the person from falling into deep REM sleep, and wakes them up during Stage 3 NREM.  The consequences are fatigue and impaired daytime function.

While there are treatments, if you believe you have this condition, you should pay a visit to your doctor to ensure it isn't linked to another condition such as kidney failure, diabetes, or peripheral neuropathy.  It is not directly linked to Parkinson's (PD), but can be a precursor, just the same.

Also, they have discovered genetic markers for these conditions, as well.  However, these conditions usually present during middle-age or later.  Despite their presence, too, they don't always lead to a debilitating condition, such as LBD or PD, but they could also indicate some other problem, as stated earlier, so you should troop yourself into the doc and get the 411, just for peace of mind.

For more information on this topic, below are some links to information that was used to write this article:

Restless Leg Syndrome - National Institute of Neurological Disorders and Stroke

Sleep Behavior Disorder - Web MD

Non-Rem Sleep Stages - How Sleep Works


REM Sleep   - How Sleep Works 


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