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Get Some Sleep: When people act out their dreams
February 22nd, 2011
03:50 PM ET

Get Some Sleep: When people act out their dreams

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

The second time Charlie was awakened by his wife’s screams because he was slapping her in his sleep, he decided to move into the guest bedroom.  The third time he hurled himself from his bed and put a big gash in his forehead, he decided to come to the sleep center.

Charlie has REM behavior disorder, or RBD.  For each violent episode, he could recall the dream that he was having that prompted him to action. It is very common, and was true in this case, that when the person with RBD attacks his bed partner, usually he is dreaming that he is saving his spouse.  In the dream, it is the bad guy he is hitting.

RBD occurs when people are able to act out their dreams or usually their nightmares.  Most of us are not able to do this because in REM sleep, which is where we have our vivid dreams, our muscles are very relaxed, almost paralyzed.   If we reason backwards from what happens in RBD, we see that this is a self-protection mechanism so that we don’t throw ourselves off a cliff fighting the saber tooth tiger.

We do not know what causes this disorder, but there is a strong association with Parkinson’s disease and similar neurodegenerative diseases.  The RBD can precede the development of the neurological disorder by as many as 10 years.  It is important that a physician treating the patient with RBD follow him closely for early signs of neurologic disease.

I keep speaking of the patient as “him” as if  it is always men who are affected.  Indeed, this disease is extremely male-dominant for unknown reasons.  Nine out of 10 cases of RBD occur in men over the age of 50.

Although, I usually have a high suspicion for RBD just from the clinical history, most sleep specialists recommend an overnight sleep study because other disorders can masquerade as RBD.  There is a phenomenon called pseudo-RBD which is caused by obstructive sleep apnea .  OSA tends to be worse in REM and when the patient has an awakening out of REM due to apnea, he can act out his dreams, and the story can be very similar to RBD.   This pseudo-RBD is eliminated when we treat the sleep apnea.   Also, there is a small chance that the person is having nocturnal seizures so the sleep study is important to rule that out.

Although it is sobering to get this diagnosis because of the connection to neurodegenerative disease, the good news is:  1. Not everyone gets Parkinson’s disease; 2. RBD is usually very well treated with low dose clonazepam.  Clonazepam is a benzodiazepine which acts as a muscle relaxant as well as a sedative and anti-anxiety agent.

Charlie is now on low dose clonazepam with no further symptoms, and he is very happy to be back in bed with his wife of 50+ years.

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Filed under: Sleep

soundoff (82 Responses)
  1. Deb

    Great, now we are going to have a whole lot of wife beaters that will wait until bed just so they can use the RBD excuse...

    February 22, 2011 at 17:18 | Report abuse | Reply
    • Not a Wife Beater

      Seriously? You're dragging feminism into this? I'm pretty sure there's a clear difference that can be proven in court between a man that hits his wife while he's awake vs. a man who suffers from this and is, ya know, asleep.

      February 22, 2011 at 18:54 | Report abuse |
    • Lighten Up

      I'm almost positive Deb was joking.

      February 22, 2011 at 19:06 | Report abuse |
    • Tyrell

      Yes this may be true, but not all men are going to do this. Some may but that is a sick way of thinking of it. RBD isn't somting that is going to just be thrown around as an excuse for men to beat their wives. Most men show that they are fully asleep when this happens ,additionally how are men supposed to go back to sleep after they have done something like that?

      February 22, 2011 at 19:20 | Report abuse |
    • Seriosly?

      Dont think that is a joke or at least it shouldn't be

      February 22, 2011 at 19:21 | Report abuse |
    • ket

      and more money to the clonazepam people. Everybody wins!

      February 22, 2011 at 20:44 | Report abuse |
    • JOY

      That's ok, Deb. In 30 yrs i've never hit my husband or vice versa. Looks like now I can slap him and blame it on the bad guy. LOL

      February 22, 2011 at 20:54 | Report abuse |
    • Jorge

      Why do you say this, has your husband used this excuse on you? LOL.

      February 23, 2011 at 08:10 | Report abuse |
    • jillybean

      I actually am a woman and I have done this and was freaked out thinking I was a beater. Now I am glad I have some sort of explanation as I am not violent but known for my temper.

      February 23, 2011 at 16:21 | Report abuse |
    • Nievesjon

      Deb = Troll

      May 31, 2013 at 03:42 | Report abuse |
  2. dave

    one time i had a dream that i got up to take a plss and i plssed on myself. is that the same thing?

    February 22, 2011 at 17:19 | Report abuse | Reply
    • jazz

      lol. no Dave. it is not the same thing.

      February 22, 2011 at 17:30 | Report abuse |
    • Marine5484

      were you dunk as hell when you went to bed lol

      February 22, 2011 at 17:44 | Report abuse |
    • Matt

      HAHA that is the funniest thing I've read all week. Funny cause it has happened to me! I walked across the room and peed in a chair while I was sleeping, unfortunately my laptop was in the chair.

      February 22, 2011 at 18:13 | Report abuse |
    • evensteven

      Adult diapers might be worth considering . . .

      February 22, 2011 at 22:27 | Report abuse |
    • brad

      Matt...you don't lift the lid when you go?

      February 23, 2011 at 00:54 | Report abuse |
    • pikamexel

      what about dreaming that im fox in super smash bros melee and Master Hand knocks me out of the stage and then i violently fall off my bed?

      February 27, 2011 at 11:59 | Report abuse |
  3. pink

    A friend of mine actually will commit s@xual acts on his girlfriend when sleeping....no one gives him any sympathy...they all think ut's a fake condition. its a very real problem and luckily his girlfriend is understanding.

    February 22, 2011 at 17:19 | Report abuse | Reply
    • jonny quest

      Really, And she actually thinks he's asleep! DUH!

      February 22, 2011 at 17:32 | Report abuse |
    • JOY

      LMAO Yeah, right.

      February 22, 2011 at 20:55 | Report abuse |
    • josh

      This happened to my father once. He was asleep one night and for whatever reason, he whips his arm across the bed and smacks my mom in the face. My mother is a light sleeper and needless to say she woke up immediately. She ended up with a black eye. Dad felt really bad about it. hehe

      February 23, 2011 at 13:35 | Report abuse |
  4. clonazepam

    clonazepam... good luck getting off that

    February 22, 2011 at 17:20 | Report abuse | Reply
    • Patricia Frondczak

      that is truly my fear that once you start these mediciations they are so addictive that you cannot get off them!!!

      February 22, 2011 at 18:26 | Report abuse |
  5. Faisal

    they're just going to make him worse with those dirty pharmaceutical drugs

    February 22, 2011 at 17:25 | Report abuse | Reply
  6. Mike

    I think the author should have mentioned that certain medications, such as anti-depressants, can also cause you to have violent dreams. I changed me regimen to breakfast and lunch instead of breakfast and dinner and the problem is 95% gone.

    February 22, 2011 at 17:32 | Report abuse | Reply
  7. jazz

    p.s. i wanna know what happned the first time...

    February 22, 2011 at 17:33 | Report abuse | Reply
  8. Gene

    After reading this blog for several months, I've acquired TLI, Three Letter Initialism disease.

    February 22, 2011 at 17:39 | Report abuse | Reply
  9. Vulcan

    I think I have the same thing. I went to bed like any other night and when i woke i was a member of the tea party.

    February 22, 2011 at 17:42 | Report abuse | Reply
    • Balki

      Harf harf harf, is joke!

      February 22, 2011 at 17:47 | Report abuse |
    • Stefan

      That's because you drank too much tea before bed.

      February 22, 2011 at 18:10 | Report abuse |
    • Dr. Buster Bloodvessel

      Pretty Vulcan funny.

      February 23, 2011 at 10:48 | Report abuse |
  10. Patricia Frondczak

    I was diagnosed with having RBD and Doctor recommended CLORITIN which I didn't refill because first thing he said was that it was addictive...I am 61 and have never had any addictions and also heard from people that the pills make you have more vivid dreams..curious if there is another pill out there that doesn't cause addiction??? anyone believe that these pills really work to let you sleep thru the night??? I have vivid dreams at least twice or three times per week.

    February 22, 2011 at 18:24 | Report abuse | Reply
    • clonazepam

      chamomille, valerian root, kava kava, passion flower, catnip tea, DXM cough syrup, Tylenol PM, all have varying degrees of success in dealing with sleep-related issues... just make sure you trade off so one night you use one thing, another night you use something else. None of these will bring about physical addiction though other than possibly the DXM/Tylenol...

      February 22, 2011 at 19:03 | Report abuse |
    • clonazepam

      also before you use any herbals make sure you thoroughly research them online, because what works for sleep might be bad for blood pressure, or interfere with something else...

      February 22, 2011 at 19:04 | Report abuse |
    • Amanda

      I'm all for herbals, would much prefer homeopathic to the pharmacy any day. But, RBD is not going to be taken care of by an herbal. I have been working in the field of sleep for over a decade, and RBD is a much different animal than any run of the mill difficulty sleeping. A doctor should be able to prescribe a medication with less addictive properties. People with this disorder can truly hurt themselves and others with no intention of doing so.

      February 22, 2011 at 19:53 | Report abuse |
    • Taylor

      try ropinirole it a generic they use it for restless leg syndrome and Parkinson's for night jerks it relaxes nerves to the muscles

      February 23, 2011 at 07:36 | Report abuse |
    • Dr. Buster Bloodvessel

      Pat, use them sparingly. Worrying about habituation is a good strategy for avoiding it. Take one if you have a bad feeling or are sleeping in a atrange place. This stuff's real and I knew a guy who got into a fistfight with his reflection in a full-length door mirror. He had cuts all over his fists and was stepping in broken glass. People have jumped off balconies; recently a girl hanged herself while sleepwalking. Get the meds and don't risk your life. THEN try alternatives! I'm not a doctor but I play one on websites.

      February 23, 2011 at 10:55 | Report abuse |
  11. eric

    Hey, before we run to more drugs and excuses, let's look into subconscious intervention and dream therapy. No wait, there's not that much money in that.

    February 22, 2011 at 18:38 | Report abuse | Reply
    • Sid

      Amen!

      February 22, 2011 at 19:46 | Report abuse |
    • Dr. Buster Bloodvessel

      It's not the same thing; this is brain malfunction on a physical level. Your body is supposed to put the clutch in but instead goes back into gear. Like a face twitch you can't stop without meds.

      February 23, 2011 at 12:58 | Report abuse |
  12. Dreamer

    To dream the impossible dream...

    February 22, 2011 at 18:39 | Report abuse | Reply
  13. V Saxena

    This RARELY happens (Has been over a year since it last occurred), but sometimes I'll punch someone in my dream, only to wake up and discover I just punched the wall.

    February 22, 2011 at 18:55 | Report abuse | Reply
  14. Sikh93

    I believe this can actually be true. REM sleep is where dreams, night terrors, nightmares, and sleepwalking occur in.

    February 22, 2011 at 19:04 | Report abuse | Reply
  15. Chris

    I've had the same condition, and went to see a neurologist specializing in sleep disorders. I'd done my own research and read the same things, but was told there is no clear link to Parkinsons, especially in those not in their senior years. Mine was attributed to, in all likelihood, simple stress. No more incidents, and no medications. This is clearly a self-serving blog, and the author should clarify her position; one can only assume she benefits from writing the prescription.

    February 22, 2011 at 19:23 | Report abuse | Reply
    • Dr Shives

      Clonazepam is generic and cheap as dirt. Doctors do not benefit from writing prescriptions as far as I know.

      February 22, 2011 at 20:49 | Report abuse |
    • Amanda

      RBD differs markedly from the description of your experience, and is much less common.

      February 22, 2011 at 21:58 | Report abuse |
  16. billy

    It sucks when you wake up during REM. I did this a few weeks ago for the first time and I swear someone walked into my room but I could not move my body at all or say anything. Sometimes I have spoken in different languages, roommates heard me doing this. I don't really move around much, thank goodness so no punching or kicking. Just remember if you are peeing in the dream you are probably peeing in real life! =O

    February 22, 2011 at 19:23 | Report abuse | Reply
    • jennifer

      I once laughed out loud in my sleep from a wacky dream, and once I kicked my husband in the crotch unintentionally; I did I guess have an RBD; I thought I was kicking a poisonous frog out of my way while hiking thru a jungle! Just a couple of years ago, that one was.

      February 23, 2011 at 08:34 | Report abuse |
  17. REM LOVER

    OMG! I love that band, REM! My fav song by them is probably... STAND! I will forever <3 REM! Wait was this article about people having REM? Awww dang it!

    February 22, 2011 at 19:43 | Report abuse | Reply
  18. steve

    this is false, every one knows that bad dreams are caused by demons and that the only cure for said demons is god. science is false and god is real believe in god or you will have nightmares too only god can save you cause god is the god of all gods that ever were gods.

    February 22, 2011 at 19:47 | Report abuse | Reply
    • Justina

      ? Authentic science and data reveal reality and prove there is Creator God. It's science fiction writers' conclusions that are wrong.

      February 22, 2011 at 20:02 | Report abuse |
    • huh?

      You are a fool...troll somewhere else.

      February 22, 2011 at 20:30 | Report abuse |
    • Quizzle

      Yeah, and everyone "knows" the cure for demons is a sound whipping. That's what they used to do, in the old days. Or they still do it, in places like Pakistan. I'm not just saying that – I have a psychiatrist friend undergoing residency in the U.S. who witnessed such treatment.

      February 22, 2011 at 22:21 | Report abuse |
    • billy

      Justina, they do not prove there is a Creator God, NOTHING DOES!! Water god destroys creator god 5x out of 6!

      February 23, 2011 at 01:15 | Report abuse |
  19. T3chsupport

    I did it a couple of times... supposedly. I don't remember anything about it, I just woke to find my partner grumpy on the couch, instead of in bed where I last seen them. Apparently I just sat up, beat the crap out of him, and went back to sleep. Only happened 2 or 3 times though, when I was 18.

    February 22, 2011 at 19:54 | Report abuse | Reply
  20. JingleJangle

    I sometimes start talking in my sleep, and then hear that I am talking...in my sleep... then I wake up and wonder if I did say it aloud or did I just dream it? Usually happens when I crash after 18+ hour shifts.

    February 22, 2011 at 20:11 | Report abuse | Reply
  21. Bridget

    That's happened to me before it was terrifying! My college boyfriend grabbed me and started shaking me in my sleep I was screaming for him to stop and when he finally awoke he said he was dreaming that he was trying to save me from an alligator.

    February 22, 2011 at 21:28 | Report abuse | Reply
  22. Quizzle

    I had a boyfriend who would dream that he was getting attacked, and he would start thrashing around in bed. His motion was never coherent enough to hurt me. One time he clapped himself (and me) awake. Also, one time he went "aaaaah" because he was dreaming he was at the doctor getting his throat looked at. And once he was shrieking like a baby – it was a terrifying sound in the middle of the night, to hear an adult man like that - full on screaming in a really high pitch. I woke him up because I thought he must be dreaming about something horrible. He said he was dreaming about a baby crying – I don't quite get how that works. Pretty freaky, but sometimes entertaining.

    February 22, 2011 at 22:19 | Report abuse | Reply
  23. Willow

    I have a sleep disorder, narcolepsy. Also have hallucinations when going to sleep or waking up. I have woken up to my actions of sewing on a button, tossing a fishing line in the stream, etc. I take Xyrem as a medication to keep me in sleep and it helps a lot. but I can dream a long protracted dream in a 5 or 10 minute nap.

    February 22, 2011 at 22:49 | Report abuse | Reply
  24. Man

    It's nice that the author of this article only uses men as the aggressors that hit and only use women as the victims and then puts out a nice fat, fake statistic to justify her lies. I'm sure she wanted to continue to bash men for no reason.

    February 23, 2011 at 01:08 | Report abuse | Reply
    • Yo, Man

      What makes you think the statistic is false? Why are men so paranoid about "feminism?" It's as if you are trying to see it in every article, Man.

      February 23, 2011 at 07:29 | Report abuse |
  25. Jorge

    Was it just me or has any other guy gone through a string of erotic dreams during his teen years in which just as you were about to consummate, someone would barge into your room screaming, "WAKE UP, YOU'RE GONNA BE LATE FOR SCHOOL!!!"

    February 23, 2011 at 08:15 | Report abuse | Reply
    • Dr. Buster Bloodvessel

      No, just you. It probably means you have Ed Zachary Syndrome.

      February 23, 2011 at 10:46 | Report abuse |
  26. Jorge

    This one goes out to the author. I got this dream that I'm naked and an ugly, rabid feminist in a dirty nun's habit is chasing me with pruning shears in an old, abandoned building, we run over a rickety part of an upper floor, I make it through but the floor gives way just as she passes over, because she is huge and dumpy and the boards can't take her weight, so she crashes to her death. I then wake up feeling surprisingly relaxed and happy. Does that count as RBD?

    February 23, 2011 at 08:29 | Report abuse | Reply
  27. Dr. Buster Bloodvessel

    My God! So THAT'S why I woke up on top of the house, wearing a gorilla suit and waving my kid's Bratz doll and beating my chest! Hmmm . . . this explains a lot. Maybe I can get the charges dropped for that thing with the neighbor's dog.

    February 23, 2011 at 10:45 | Report abuse | Reply
  28. I'm full

    I had a dream last night I ate a giant marshmallow. Woke up and can't find my pillow. I think someone stole it and everyone is in on it.............

    February 23, 2011 at 13:55 | Report abuse | Reply
  29. Joyce

    I noticed a lot of jokes about this, but seriously my brother-in-law suffers from this or something similar. He has tried to pick my sister up in the middle of the night because there are snakes, a burgler, etc in the house. This has not happened once or twice, it happens several times a week. He has no controll over what he is doing in his sleep. They have small children, which is a concern.

    February 23, 2011 at 14:26 | Report abuse | Reply
  30. Brooke

    I find it interesting that this article only lists men with this problem. I'm a 26 year old female who is currently being treated for something very similar. I have very very vivid dreams at night in which I've punched, kicked, screamed at or pushed my boyfriend while completely asleep. It's very disturbing because not only are the dreams traumatic and memorable but it makes it hard to fully relax and go to bed the next night because I know what's going to happen. We do joke about it even though it's a serious condition. I got my boyfriend a football helmet to wear to bed one Christmas.

    February 23, 2011 at 15:59 | Report abuse | Reply
  31. erica

    Ok, so i have a question.....it seems kind of similar. can war veterans suffer from this disease especially if theyve been diagnosed with ptsd (post traumatic stress disorder)?

    February 24, 2011 at 23:08 | Report abuse | Reply
  32. pikamexel

    what exactly is a vivid dream? is it one you act out or one that is so realistic that you can actually feel like youre there?

    February 27, 2011 at 12:17 | Report abuse | Reply
    • patricia frondczak

      A vivid dream is when you are truly having an unsual episode on some crazy place, like on a mountain full of trees and someone is chasing you and when you confront that person, you try to defend yourself and say you kick that person, in the face, as I did in my last dream,then, in actuallyeventhough you are still asleep you kick the bed post instead at that same moment and wake up hurting...I had to immmediately put ice on my foot(big toe to be exact) and the following days it was black and blue, swollen and had to stay home as no shoe fit...omg!!!

      May 21, 2011 at 12:07 | Report abuse |
  33. Mystic

    Poor dude. i feal sorry for him.

    February 28, 2011 at 03:54 | Report abuse | Reply
  34. Peaze On Earth

    Hi. i am a sleepwalker. i believe it is a curse form the witch doctors on the Byu. i hate sleepwalkig it always leads me to hot surfer dudes but i am atracted to dreadlocked hippies. what should i do?

    February 28, 2011 at 03:55 | Report abuse | Reply
  35. Peaze On Earth

    HHHHHHHHHHHEEEEEEEEEEEEEEEELLLLLLLLPPPPPPPPPPPPPPPPPP me i want a dreadlocked HOTTIE HOW DO i get away form hot surfer dudes. right now i have 3 boyfriends.anybody want one if so just ask

    February 28, 2011 at 03:58 | Report abuse | Reply
    • patricia frondczak

      peaze on earth...peaze on you this isn't funny get off the blog!!!

      May 21, 2011 at 11:30 | Report abuse |
  36. Bari

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    March 2, 2011 at 05:40 | Report abuse | Reply
  37. Deb

    Seems like not many people here are taking this very seriously. As someone who suffers from Sleep Apnea ( yes I wear a CPAP) ,very vivid dreams which I constantly act out, as well of episodes of what I refer to as sleep paralysis, where my mind is dreaming actively in a very real way, I am in danger, and cannot move or even yell for help, which is terrifying, I cannot make jokes about this. Last night my partner woke me up after I screamed in my sleep and was "kicking a door open" and the night before I was being attacked by a street person whom I attacked back, kicking straight for his most vulmerable area. My partner has even woken up with a black eye he did not have when we went to be. I have flung myself from the bed and slammed into the wall severely bruising my hip in my attempt to throw myself away from an alligator that was about to snap its jaws around my middle. These are NOT fun disorders. And yes, the concern about the correlation between these disorders and Parkinson's weigh on my mind greatly, as my father died from Parkinsons.

    March 9, 2011 at 18:30 | Report abuse | Reply
  38. patricia frondczak

    Wow DEB how sad about your Dad but didn't the doctor who has this blog say that RED and Parkinson's might not be related??? that because you sleep walk or have vivid dreams, you might not necessarily get Parkinsons...I got back on this blog because I was dreaming that I had kicked this woman on the face wanting her to fall down a precipice, but in real life I kicked the bed board and now, today I am off work due to a swollen toe, all black and blue and unable to wear a shoe...my daughter has a master's in MENTAL HEALTH and she is upset at the Doctor that recommened me to filll the prescription of
    klonopin .05 she says I probably would be better of going to a psychotherapist....any thoughts??? need to get this under control before I hurt myself some more...don't sleep with hubbie anymore...he even joked that I might take a kitchen nife and use it on me or him???? he said I'll keep my door closed and you close yours....WOW this is absurd!!!! help good info needed a.s.a.p.

    May 21, 2011 at 11:37 | Report abuse | Reply
  39. Tricia

    can anyone tell me if taking thyroid medication will increase the chances of having nightmares?

    May 25, 2011 at 11:06 | Report abuse | Reply
  40. Laura

    I can't stand it anymore. I am so glad I found this site because it really IS an actual disorder! My fiancee sings in his sleep, talks in his sleep, yells in his sleep, shoots people in his sleep, slaps me in his sleep, and even gives me lengthy quizzes! last night he was quizzing me, asking me how long it takes me to walk from here to the door, to put my shoes on, to eat a hamburger...and then he said "wanna know the result?" I said "yes." He said "you're a dummy because only a dummy keeps time..I'll explain it in the morning." One night he even demanded that i learn spanish words and would DRILL me over and over till I got them right, hollering and scolding when I missed the word. I can't take it anymore. i'm going to have to go move to a different room or something. He is on meds for anxiety and depression and other health issues. Could this be the problem?

    January 28, 2012 at 07:03 | Report abuse | Reply
  41. Jackson Kubinski

    Although most black eye injuries aren't serious, bleeding within the eye, called a hyphema, is serious and can reduce vision and damage the cornea. In some cases, abnormally high pressure inside the eyeball (ocular hypertension) also can result.;:.`

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    June 8, 2013 at 23:39 | Report abuse | Reply
  42. Jenny

    This i very strange. I have a cold and reached to my side of bed to get a tissue, but grabbed my heating pad. i remember thinking how oddly it was shaped and wondered why i couldn't find any tissues. I bit a hole through the heating pad and felt foam, and realized it wasn't a box of tissues. The next morning I woke up and realized what I had done, but was fully conscious of it as i was doing it while I was sleeping.

    October 28, 2013 at 15:16 | Report abuse | Reply

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