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Thursday, June 20, 2013
Abusive Situations While Sleeping
My husband and I have been married 17 yrs. Throughout our marriage, there have been episodes where he will be verbally abusive to me at night time. When I confront him about it, he says he doesn`t remember it because he was "asleep". A couple nights ago I was up late because I was not sleepy. It was about 1:30 am.He came into the living room asking me why I was up. I explained that I was not sleepy . He went into the bathroom and slammed the door. He then went back to our bedroom and slammed the door again. I went in and asked him what his problem was. He said,"It`s you. I am your husband and you are supposed to be here in bed with me. You should not be up this late at night. There is no sense in it." There was more that was said and was very ugly and mean.He was yelling during this. All of this woke up my daughter ( who is 13). It scared her. My son who is 15 did not wake up. He pretty much demanded I get in bed with him. But I refused.
Here is my question: He denies remember doing any of this. Is it possible that he really doesn`t ? I just think it is a cop out to excuse his behavior and not take responsibility. In the past, he has even made reference to my weight and why I am not like other "women". I am not fat but do need to lose some weight. I just feel like my feelings are not validated at all. He says he is sorry and doesn`t know what else to say. He said it is not in his nature to slam doors etc. But what if next time, it escalates past slammed doors and verbal abuse? I am having a hard time just letting it go and pretend it never happened like he thinks I should. After all these years of this happening, I am at a loss as to what to do. He does have a controlling attitude with me and always has. I just hate my daughter heard all of this. I don`t even know if my questions make sense but I hope you can shed some light on this. Thanks.
First, let me apologize for the long delay in answering your question. It appears your question “slipped through the cracks” as it were. Second, I’m not sure I can fully answer your question, but you should definitely seek help for this situation and not just “write it off.”
You have a very complex situation on your hands that requires a thorough evaluation by a physician (possibly more than one), including the help of a Sleep Specialist. The type of behavior you describe, sleepwalking and violent behavior in sleep, could suggest a possible parasomnia. 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, 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.
The symptoms you describe in your husband could all represent sleep walking, though they may also suggest a possible NREM parasomnia or REM behavior sleep disorder (dream sleep-related disorder). However, before any diagnosis can be made, he will require a thorough history and examination and should undergo a sleep study (see below).
Sleepwalking, also known as somnambulism, occurs in somewhere around 1-15% of the general population with a peak incidence between the ages of 4 and 8. It tends to resolve with aging. If sleep walking starts in adulthood, it may suggest an underlying psychiatric or psychological disorder, excessive stress or substance abuse. In most cases, sleep walking is not serious and resolves over time. However, some sleep-related conditions can present with sleep walking as their primary symptom, and thus in some cases, additional evaluation and treatment is needed. Obstructive sleep apnea, a seizure disorder and REM behavior disorder all may have sleep walking as part of their presentation. Typically, in benign sleep walking, the individual does not act out violently in their sleep, though aggressive behavior may occur if the sleep walker is confronted with strong stimuli. It’s possible that this is what happened with your husband, though other issues may be present as well.
REM behavior disorder is an uncommon condition in which individuals lose the muscle paralysis that usually accompanies REM 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. Depending on the nature of the dream, this can lead to injurious behavior to the patient (from falling out of bed, running into walls or furniture or hitting objects) or their bed partner. It is more commonly seen in middle to older aged men, but can occur in women as well. The fact that your husband denies any recall of the events seems to make REM behavior disorder less likely.
It’s also possible that these behaviors may not be related to sleep and your husband is actually awake, but denying this. In this case, marital counseling and perhaps psychiatric evaluation should be considered.
In order to determine if there is an identifiable cause for your husband’s symptoms, a detailed history and physical examination are needed as well as a sleep study. It would be reasonable to have your husband evaluated by a Sleep Specialist (perhaps one with a Neurology or Psychiatry background) to make sure the appropriate type of sleep study is performed.
In the meantime, here are some general guidelines for helping to protect sleepwalkers:
1) Remove dangerous, sharp or pointed objects from the room.
2) Consider adding locks to the windows and doors.
3) Put heavy drapes in front of windows and glass doors.
4) If around when he is sleep walking, gently attempt to guide him back to bed without waking them.
5) AVOID strong stimuli - this could cause aggressive behavior. Do not directly confront him during his episodes as this may worsen the situation.
Other more specific treatments are available and will depend upon the results of your husband’s evaluation. In your situation, for your own safety, you might want to also consider sleeping in a separate locked room until this is completely evaluated.
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 be.
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University