Wednesday, September 17, 2008

Food Aggravating RBD?

Interesting article from discussing the possible aggravating effects of chocolate (and caffeine) on RBD. My Dad was advised by Dr. Avidan to give up all caffeine, which he has done, included his beloved Mocha Chip Ice-Cream!

Chocolate: the stuff of nightmares


Chocolate could be aggravating the sleep disorder which causes sufferers to act out violent nightmares, according to scientists in a recent New Scientist report.

The disorder, called rapid eye movement sleep behaviour disorder (RBD), affects around one in 200 people, and is more commonly experienced by men. Those affected are said to thrash about while sleeping and shout as they dream.

Robert Vorona of the Sentara Norfolk General Hospital in Norfolk, Virginia, the study leader, said that the caffeine in chocolate blocks the normal atonia process, which paralyses people during dreams, and the sleeper is more likely to move.

Vorona reports on a case-study in which the sleeping behaviour of one man was directly affected by what he had eaten previously. The man, who lashed out in his sleep during recurrent nightmares, experienced the problems after eating chocolate biscuits, ice cream or syrup.

While the symptoms were found to be a result of a former head injury in a car accident, chocolate appeared to make the problems much worse.

Tuesday, September 16, 2008

There is Help... and Hope!

During the course of several months I saw my Dad's health (emotional & physical) decline. Not only was he was sleeping poorly but he was exhibiting extreme fatigue during the day which was consequently manifesting itself in depression. Something had to be done. And so in a desperate attempt to find some help, I contacted Dr. Carlos H. Schenck and asked for a referral in our area. He recommended a Dr. Alon Y. Avidan at UCLA Medical Center.

I could go on and on and on (and on!) about our experience with Dr. Avidan, but for the sake of brevity I'll share an email I sent to to Dr. Schenck immediately upon returning home from the appointment which I believe sums things up nicely...

" Several months ago you were kind enough to give me a referral to Dr. Avidan for my father who has RBD. Yesterday we (my Father, Mother & I), finally met with him and I just wanted you to know how absolutely wonderful he was. Aside from the fact he felt he could help improve on my Father's present situation, he treated us with so much care, kindness, respect and dignity. It was truly a phenomenal experience and I just can not thank you enough for steering us to him. I'm getting married on Sat. and it was the greatest gift. We have so much to celebrate!"

And just for the record, my Dad is presently following the treatment outline prescribed by Dr. Avidan and I'm elated to report that he is doing better than he has in a very, very long time. His (and our) hope has been restored and I will never be able to thank Dr. Schenck and Dr. Avidan enough for their help, expertise and above all, kindness.

Monday, September 15, 2008

Melatonin for the Treatment of RBD

I first learned about the use of melatonin in the treatment of RBD in Dr. Carlos Schenck's book entitled "Sleep: The Mysteries, The Problems, And The Solutions". I literally ran to the computer and Google'd every combination of search terms involving RBD and melatonin I could think of. What I found was quite promising. But the truth is, just the fact that someone was talking about something other than Klonopin (Clonazepam) was enough to give me some much needed hope!
And the reason is this...

My Dad was put on Klonopin when he was first diagnosed. In fact, he was told it was a "absolute requirement". Initially the Klopin worked quite well, his RBD episodes decreased in intensity and frequency. But the problem was that over time his body had built-up a tolerance to it and the dose had to be continually increased. Fast forward to the time I learned about melatonin and let's just say my Dad was in BAD shape. The side effects of the increasingly higher doses of Klonopin were literally ruining his life. He was groggy, drowsy, fatigued, depressed, anxious, confused, shakey and showing blatant signs of ataxia (loss of balance & coordination). He was almost a shadow of the Dad I knew. I was beyond desperate to find an alternative.

It was at this time that I reviewed just about every website I had visited that mentioned RBD and sent out emails to everyone from the administrator of a sleep site I frequented to several health professionals. Finally someone replied and said they could put me in touch with Dr. Carlos Schenck himself! It was Christmas eve 2007 and I couldn't think of a better gift. I remember shaking when I got his email address and trying to compose an email to convey how badly I needed help without sounding like a nutcase!

Dr. Schenck replied with a referral to a specialist in our area and in answer to my question about the benefits of melatonin in the treatment of RBD (I was ready to start my Dad on it NOW!), he advised that we discuss the issue with the doctor.

Fast forward several weeks and we took my Dad to see that doctor and he literally changed my Dad's life, which you can read about here: There is Help... and Hope!

More can be read on the use of melatonin in the treatment of RBD here:

Melatonin Effects in a Patient with Severe REM Sleep Behavior Disorder

Melatonin Helps Alleviate Violent Sleep Disorder Symptoms

Melatonin for Treatment of REM Sleep Disorder in Neurologic Disorders

And also at Monika Woolsey's blog here:

Melatonin & REM Sleep Behavior Disorder

Sunday, September 14, 2008

My Post to a Parasomnia Message Board

The following was a post I wrote (one of many actually!) to a Parasomnia Message Board in an attempt to get some online support or help.

Post Subject: My Dad's RBD Experience
Posted: December 24, 2007

First, my heart goes out to all who suffer from or love someone with a parasomnia, particularly RBD as that's the disorder I am most familiar with. I know all too well the emotional and physical pain it can bring to all involved.

My Dad is 64 and was diagnosed with RBD about 6 years ago. His story is very similar to those described. He's done everything from jump through a window, to cut open his head from throwing himself out of bed, to severely damage his hands by beating up the floor and the walls, to throw furniture, to most devastating of all to him, harm my Mom when they were sharing a bed (which they no longer can do because of the danger this disorder can pose to bed partners).

Aside from the sheer terror he felt, he was also exhausted, confused, growing increasingly depressed and truly feared he was losing his mind. It took 3 doctors before one even suggested RBD and then a sleep study confirmed it. He was prescribed Klonopin and then later they added Remeron, both of which he is still taking to date. He was also prescribed Cymbalta for depression. He was also diagnosed with sleep apnea and put on a CPAP machine.

Another thing perhaps worth mentioning is that is was discovered that my Dad has a large (literally the size of a pear) arachnoid cyst in his right frontal lobe. It is benign and they believe it has probably been there since birth, although obviously they can't be sure. Whether it has anything to do with the RBD they have no idea and I haven't been able to find much information saying that it in fact could.

Today my Dad's sleep has definitely improved, but by no means is his RBD a non-issue. He still has episodes about 4-5 x month. They're virtually impossible to predict, but there does seem to be a relationship between them and stress. Whether that's true or not, I don't know, but it certainly seems that way. He sleeps in a different room than my Mom and that room is pretty much barren except for a table and a mattress on the floor on which he sleeps. Every night he wears thick, padded gloves to bed to protect his hands in case he beats the floor and he often ties his ankles and his wrists together in an effort to restrain himself and thus prevent himself from being able to cause himself any physical harm. Strange as it sounds, he actually feels better when he restrains himself because then at least he knows he'll be somewhat protected from himself should he have an episode. On top of all that he's also hooked up to the CPAP. It's a sad sight to say the least.

I hope both to find and offer support here in this forum. Of course I also wish to learn more, to keep abreast of any new research and to offer as much help as I possible can to my wonderful Dad.

Monday, September 1, 2008

What RBD is NOT

RBD is not curable.
RBD is not a psychological disorder.
RBD is not a psychiatric disorder.
RBD is not a weakness of character.
RBD is not the same as night terrors or nightmares.
RBD is not the same as sleepwalking.
RBD is not something that only occurs in men.
RBD is not always a precursor to neurodegenerative diseases.
RBD is not something to be ashamed of.
RBD is not something that a person can control.
RBD is not something to ignore or take lightly.
RBD is not caused by repressed emotions, feelings (i.e., anger), and/or unresolved issues.
RBD is not something that anyone should have to face alone.

REM Sleep Behavior Disorder (RBD) Defined

There are lots of definitions available for RBD and all pretty much say the same thing (some are just a little easier to understand than others!), but here's the general idea...

REM behavior disorder (RBD) is a sleep disorder first described in 1986. Dr. Carlos Schenck is credited for identifying RBD as a new category of parasomnia (a condition that occurs during sleep and creates a disruptive event), along with Dr. Mark Mahowalk, his colleague at the University of Minnesota and the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center in Minneapolis. They published their findings on RBD in the article "Chronic Behavioral Disorders of REM Sleep: A New Category of Parasomnia" which was published in the journal "Sleep".

There is no known cause for RBD. It is, however, known to occur during rapid eye movement (REM) sleep.

Patients with RBD act out and react to situations occurring in their dreams (which are often very dramatic and/or violent), during rapid eye movement (REM) stage sleep. It is similar to other sleep disorders that involve motor activity, such as sleepwalking and periodic limb movement disorder, but unlike these conditions, RBD movements occur during rapid-eye-movement (REM) sleep, which is usually characterized by a state of atonia, or sleep paralysis.

In a person with REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent, allowing the person to "act out" his or her dreams. RBD is characterized by the acting out of dreams that are vivid, intense, and violent. Dream-enacting behaviors include talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing.

Normal sleep consists of a series of REM dream episodes. They occur about every 1 ½ to 2 hours each night. This means that an RBD episode tends to first appear at least 1 ½ hours after falling asleep. Episodes may continue to occur until waking up in the morning. Active RBD episodes may appear as many as four times per night. They may also occur as rarely as once per week or per month. RBD does not normally appear during a nap.

An RBD episode often disrupts the sleep of a bed partner. This is how a person with RBD may become aware of the problem. People with RBD are not more aggressive or violent than others when awake. RBD is a medical problem. It is a neurological disorder. It is not a psychiatric disorder. People with RBD do not normally have a mental problem.

Click on the photo below for REM Behavioral Disorder's Diagnostic Criteria:

And for a more in depth explanation of RBD and it's history, I recommend this article from the Sleep Review Journal by Theresa Shumard : Defining REM Sleep Behavioral Disorder.

The National Sleep Foundation also offers an easy-to-comprehend explanation here: REM Behavior Disorder and Sleep.