Possible REM Sleep Behavior Disorder?

By Kristina Randle, Ph.D., LCSW

I’m a 46-year-old male. I am concerned I may have REM Sleep Behavior Disorder. Recently, I began acting out dreams. I would wake up as if talking on the phone (actually holding an invisible phone to my ear), pretending to eat or smoke, reaching for something in a dream, etc. I never became violent, jumped out of bed, etc., and I also remembered this behavior, as I was often still doing it as I began to awake.

Important: This turned out to be related to a prescription drug (Seroquel). Once I stopped taking Seroquel, the acting out stopped.

However, I still talk a lot in my sleep and have done that for ten years or so. Also, I notice that when I Google sleep talking, I always read that people don’t remember having talked; for me, much like the acting out, I often remember, as I hear myself when I’m half awake and laugh that I’m talking out loud once awake. Usually, it’s something silly and never night terrors. I don’t know why I recall my sleep talking when everyone else doesn’t.

I’m often quite fatigued in the day despite a fairly-light schedule. Also, when driving on the highway, I have for at least the last six or so years begun to fall asleep after 45 minutes or more of driving. I can only barely hold my eyes open and my eyelids begin to flutter. I never completely fell asleep, but I’ve came close on many occasions.

MAIN QUESTION: Because of all these factors, I’m wondering if the acting out, though it stopped after I quit taking the Seroquel, was just an exaggerated aspect of an REM Sleep Behavior Disorder that already existed (with the talking and the falling asleep at the wheel, etc.) But since I’ve never acted so violently or actively as the disorder is usually described, I’m hoping it’s not REM Sleep Behavior Disorder.

I’m primarily worried about this because REM Sleep Behavior Disorder apparently increases a person’s chances of eventually developing Parkinson’s by 40 percent. I have considered sleep apnea as a possible cause, but I usually don’t snore unless drinking, or on fairly-rare occasions. It’s definitely not the norm.

Further, I don’t have health coverage for a sleep study, and I don’t even think I can afford to see a neurologist. I know a general MD is just going to refer me out.
While I was recently switched from Klonopin to the equal dosage of Valium (30 mgs — 10 mg three times per day), all that I have mentioned started before the switch to Valium; I don’t think that switch had any effect. I am not sure whether the talking started before or after the Klonopin — I know the driving problem did.

Obviously, my main concern is not the sleep disorder itself but the Parkinson’s issue. I’ve no early symptoms of Parkinson’s. I know you can’t diagnose me over the Internet, but perhaps you can estimate whether what I’ve described matches the disorder I’ve discussed and, if not, suggest some alternative possibilities.

A. As you noted, the main symptom associated with REM Sleep Behavior Disorder is acting-out behavior while sleeping. That was a symptom you experienced until the Seroquel was discontinued. Although you cannot be certain, it’s reasonable to conclude that the Seroquel was causing the problematic behavior. This would indicate that you do not have REM Sleep Behavior Disorder.

You no longer act out your dreams but you sleep talk and are not sleeping well. Your sleep problems remain.

I can speculate about what type of sleep disorder you may or may not have but the bottom line is you need to have a sleep study. Until that occurs, you may not have reliable answers to your questions.

I understand your predicament. You have limited financial resources and no health insurance. This makes it difficult to afford a sleep study. Without health insurance, a sleep study could cost $1800-$3000, possibly more depending on the facility. Because that is not an option for you, I have searched and found a few resources, listed below, that may help you access a sleep study.

Here is a link to Community Health Services. They are a facility in Florida whose primary goal is “access to care for those individuals who are uninsured or underinsured, or those who do not have the financial resources to receive specialty care elsewhere.” They list “sleep disorder clinic” as being one of the possible services they can refer their patients to.

Here’s another link to an organization that may be able to connect you to a sleep disorder specialist. I would suggest calling the facility, presenting your situation and asking if there is any help or suggestions they can offer you.

Another consideration is to see if you’re eligible for a sleep disorder clinical trial. Some people are able to gain access to a sleep study by participating in a clinical trial. Throughout the United States, there may be ongoing sleep disorder studies looking for eligible participants. Here’s a link to the National Institutes of Health Clinical Trial webpage.

In the meantime, here are two ideas that may help you explore and better understand your sleep problems:

  • Videotape yourself at night. If you do not have a video recorder then use an audio recorder. This might give a clear indication of what exactly you are doing or saying at night.

  • Start a sleep diary. This might help you identify sleep patterns and shed light on your sleeping problems. Keep track of the medication you take and the times you take them. You may also want to keep a record of your alcohol and caffeine consumption, and whether or not you exercise.

You mentioned that you take Klonopin and Valium. Those medications may be affecting your sleep in unknown ways. They are powerful drugs. Because you are taking prescription medications, it may be difficult to determine the exact cause of your sleeping problems.

I understand your frustration. Not being able to sleep can significantly disrupt your life. I wish that I could offer you a more definitive answer. I hope you’re able to find help with the aforementioned suggestions. Thank you for your question.

Photo

 

 

Last reviewed: By John M. Grohol, Psy.D. on 16 Mar 2010

APA Reference
Randle, K. (2010). Possible REM Sleep Behavior Disorder?. Psych Central. Retrieved on October 22, 2014, from http://psychcentral.com/ask-the-therapist/2010/03/16/possible-rem-sleep-behavior-disorder/