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Sleep Disorders

Serious sleep issues

02/26/2008

Question:

I live in Cincinnnati, OH. My ex-husband has a serious sleep disorder that I have witnessed on more occasions than can be counted when we were married. He would talk in his sleep, walk around in his sleep and more times than not, physically attack me (jump on top of me and hold me down like he was restraining me, jump of top of me and smack me hard across the face or just plain put his hands around my neck and strangle me). I have always been able to get him off of me and have not suffered permanent physical damage. I have known this man since we were small children and we grew up in the same neighborhood. He is one of the most gentle people I have ever met and I have never seen a violent side of this man while he is awake. Almost two years ago while going through our divorce, my ex-husband met a woman at a bar, took her home, drank with her for hours and then fell asleep. He did the same thing to this woman that he had done to me in his sleep, only this time he bit her in the face causing permanent disfigurement. He is currently in prison serving a sentence for felonious assault.

Here are my concerns: 1. Our daughter thrashes, talks and sleeps with her eyes open (same things her dad would do). Is this hereditary? 2. When he gets out of prison in July, (no health insurance, income, or vehicle) since he has been in jail for two years, how does he get treatment so that he doesn`t hurt someone else? Is there anywhere in Cincy he can go? a free clinic? a free sleep evaluation and treatment? I cannot support him when he gets out. I have gone without child support for two years and support myself and our kids on my income only so I cannot pay for his healthcare expenses. 3. I`m scared to death for the life of our children. I have a long-term plan of supervising all visitation myself but do you know of any options I have, who to contact? The last thing I would ever dream of doing is putting my children in danger. We have shared parenting now, but that will change soon. What if he falls asleep during the day with my kids and attacks them?

I know this sounds outlandish but if you can give me any information I would be eternally grateful to you. My family is in crisis and I`m scared to death. I`m no doctor, but I have witnessed this behavior myself so many times and I know that he is asleep when he is doing these things.

Answer:

It sounds as though you have a very complex situation on your hands that really requires your ex-husband undergo a thorough evaluation by a Sleep Specialist. The type of behavior you describe, violent behavior in sleep, suggests 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, 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.

The symptoms you describe in your ex-husband strongly 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. As such, before any diagnosis can be made, he will require a thorough history and examination and should undergo a sleep study.

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 (though 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 the diagnosis in your ex-husband 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 his health and well-being. Third, these conditions are generally treatable once a diagnosis is made. And fourth, it’s important for the safety of others he is around to identify and treat his condition.

In order for your ex-husband to get diagnosed, you should discuss his symptoms with his doctor and/or the doctor in charge of the facility he is staying in. They should be able to get him evaluated, even while in prison. 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. There are a number of sleep centers in the Cincinnati area and you can locate these on the American Academy of Sleep Medicine website. I cannot tell you about the specifics of how they handle patients with a limited ability to pay, though there should be a “safety-net” hospital he can be evaluated at in your area.

As far as you daughter goes, it’s unlikely she has REM behavior disorder as this is unusual in women, especially those of a younger age (I’m not sure how old your daughter is, but based on the information you provided, I would assume she is a child). It is possible that she may have another type of a parasomnia as some parasomnias are more common in children and can present with some of the symptoms you are describing (thrashing about, sleep talking. Regardless, this may require an evaluation as well and her symptoms should be discussed with her doctor as referral to a Sleep Specialist may be needed. Good luck!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University