Wednesday, December 11, 2013
Falling Out of Bed
I am 55 years old and I been falling out of bed. I fall hard on my left knee and only remember two things: First, I remember I am running away from something. Second, I have a hard time breathing. It feels as though my breasts are suffocating me. What can I do? What is happening to me?
While it’s impossible to know for sure what is causing your problems based on the limited information in your question, it’s possible that your symptoms could be related a parasomnia. The symptoms you describe could suggest possible REM behavior sleep disorder (dream sleep-related disorder). However, there are other sleep disorders that can present with symptoms that mimic REM behavior disorder, including seizures, nonREM parasomnias (non-dream sleep) and even obstructive sleep apnea (where individuals struggle to breath in their sleep). As such, before any diagnosis can be made, you will require a thorough history and examination and should undergo a sleep study.
Parasomnias are a group of disorders characterized by undesirable physical events or experiences that occur during entry into sleep, within sleep or during arousal from sleep. There are a number of different parasomnias, ranging from sleepwalking and sleep terrors to behaviors associated with dreams to a number of other sleep-related behaviors (such as eating during sleep, bedwetting, acting violently etc). The causes of these parasomnias are not entirely known. Many cases of these conditions are idiopathic, meaning we don’t know for sure what causes these behaviors.
REM behavior disorder is an uncommon condition in which individuals lose the muscle paralysis that usually accompanies REM sleep (dream sleep) and thus may act out their dreams. This tends to occur later in the night and most individuals have some recall of what they were doing (thought they do not have control over it). Depending on the nature of the dream, this can lead to injurious behavior to the patient, such as from falling out of bed, running into walls or furniture or hitting objects, or their bed partner. Frequently, the nature of the dreams is violent (such as fighting or struggling to get away from someone or something), even in nonviolent individuals, and thus they may be prone to harming themselves or others. Certain factors may help to precipitate episodes, such as being sleep deprived, using alcohol or illicit substances or having an acute illness. It is most commonly seen in middle to older aged men. It can occur in women as well, though this is fairly uncommon.
Determining your diagnosis is extremely important for a number of reasons. First, it needs to be established if indeed this is REM behavior disorder or another condition mimicking REM behavior disorder. Second, the diagnosis may have long-term implications for your health and well-being. Third, all of these conditions are generally treatable once a diagnosis is made. And fourth, it’s important for the safety of others around you to identify and treat REM behavior disorder if this is indeed the diagnosis.
In order for you to be evaluated, you should discuss your symptoms with your doctor. An evaluation by a Sleep Specialist (perhaps one with a Neurology or Psychiatry background) will be required to make sure the appropriate type of evaluation, which will include a sleep study, is performed.
If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it.
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University