REM Disorder May Explain Violent Sleep Behavior

Article excerpt

CHICAGO -- Psychiatrists should rule out rapid eye movement sleep behavior disorder when a patient presents with dramatic or violent behavior during sleep, according to a panel of experts who addressed the joint annual meeting of the American Academy of Sleep Medicine and the Sleep Research Society.

"Too many patients are misdiagnosed as having a psychiatric disorder such as nocturnal PTSD while the sleep-related component of their disorder has not been thoroughly evaluated," said Dr. Carlos Schenck of the Minnesota Regional Sleep Disorders Center in Minneapolis.

Patients who suffer from rapid eye movement sleep behavior disorder (RSBD), often called "night-flyers," experience behavioral dyscontrol due to the absence of the atonia that usually characterizes REM sleep. Under ordinary circumstances, movement is actively inhibited during REM sleep so as to overcome the powerful phasic motor activity that occurs during dreaming.

The chief complaint for 79% of patients affected is self-injury during sleep; 21% of patients complain of general sleep disruption. Sometimes it is the spouse or partner who requests treatment for the patient because the patient's wild behavior disturbs both parties' sleep.

Diagnostic criteria include either a history of problematic motor behavior (such as restless leg syndrome) during sleep or observed integrated motor activity during the REM stage. These must be coupled with intermittent or persistent electromagnetic augmentation during REM sleep, signifying a loss of atonia, Dr Schenck said.

Most patients experience more vivid dreams, often of being chased or attacked. They generally become alert quite rapidly upon awakening and also have rapid recall of their dreams. Interestingly, these patients are exceedingly well rested in the morning, Dr. …