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Chronic behavioral disorders of human REM sleep: a new category of parasomnia
C H Schenck1, S R Bundlie, M G Ettinger
1Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, University of Minnesota, Minneapolis 55415.
Abstract:
Four men, aged 67-72 years, had 4-month to 6-year histories of injuring themselves or their spouses with aggressive behaviors during sleep, often during attempted dream enactment. A 60-year-old woman had disruptive though nonviolent sleep and dream behaviors. Polysomnography did not detect seizures but did document REM sleep pathology with variable loss of chin atonia, extraordinarily increased limb-twitch activity, and increased REM ocular activity and density. A broad range of REM sleep behaviors was recorded on videotape, including stereotypical hand motions, reaching and searching gestures, punches, kicks, and verified dream movements. Stage 3-4 slow wave sleep was elevated for age in all patients. NREM sleep was devoid of harmful behaviors, although three men had periodic myoclonus. There was no associated psychiatric disorder, whereas serious neurologic disorder was closely associated in four cases: olivo-ponto-cerebellar degeneration, Guillain-Barré syndrome, subarachnoid hemorrhage, and an atypical dementia. Two patients had immediate and lasting sleep behavioral suppression induced by clonazepam, and another patient had the same response with desipramine. All instances of drug discontinuation prompted immediate relapse. In four cases there was associated dream hyperactivity, which resolved with behavioral control. These REM sleep neurobehavioral disorders constitute another category of parasomnia, replicate findings from 21 years ago in cats receiving pontine tegmental lesions, and offer additional perspectives on human behavior, neurophysiology, pharmacology, and dream phenomenology.
Insights
This study identifies a new category of parasomnia involving REM sleep behavior disorder. Patients exhibit aggressive or disruptive actions during sleep, often linked to underlying neurological conditions.
Area of Science:
- Neurology
- Sleep Medicine
- Neurophysiology
Background:
- Investigates REM sleep disorders characterized by dream enactment and aggressive behaviors.
- Examines the link between sleep pathology and neurological conditions.
Observation:
- Patients displayed violent or disruptive behaviors during REM sleep, including punching and kicking.
- Polysomnography revealed REM sleep pathology, such as loss of muscle atonia and increased limb activity.
- Elevated stage 3-4 slow wave sleep was noted in all patients.
Findings:
- REM sleep behavior disorder is identified as a distinct parasomnia category.
- Neurological disorders like cerebellar degeneration and dementia were associated with these sleep behaviors.
- Clonazepam and desipramine effectively suppressed sleep behaviors, with relapse upon discontinuation.
Implications:
- These findings offer insights into human behavior, neurophysiology, and pharmacology.
- Understanding REM sleep disorders can improve diagnosis and treatment of associated neurological conditions.
- The study highlights the importance of polysomnography in diagnosing complex sleep disorders.