Do you know what you're doing while you're asleep? If you're like millions of other people, you could be talking, walking, or even having sex in your sleep. Here are some of the crazy things we do when we're asleep, and how—if you're someone who suffers from them—you can find some relief.
We've all heard of people who sleepwalk or sleeptalk, but what about sleep driving? Or sleep eating? They're both very real conditions. Some people even get into fistfights with their partners while they sleep. A british actor, recently convicted of rape, tried to use another real medical condition, sexsomnia, as a defense in his case. The jury didn't buy it, but the condition itself is actually real.
In this post we'll walk through some of these sleep conditions and some potential treatments that might help you get a better night's rest. To help, we called Dr. Nitun Verma, a specialist in sleep medicine and the Medical Director of the Washington Township Center for Sleep Disorders in the Bay Area.
The Two Types of Disorders that Rob You of a Good Night's Sleep
We've discussed some common sleep conditions like snoring, insomnia, and sleep apnea, but when it comes to those "strange things people do in their sleep," there are two types of conditions: REM behavior disorder, and parasomnias. Photo by Helder Almeida (Shutterstock).
Parasomnias
Parasomnias are a class of disorders that include most of the strange behaviors you've likely heard of. Sleepwalking, talking in your sleep (also known as somniloquy), sleep eating, and sexsomina are all parasomnias. According to Dr. Verma, they normally take place in the first half of the night, an effect of disrupted slow wave sleep. Not all parasomnias result in people getting up and moving around. Some people experience night terrors that can lead to shouting or flailing about in bed, experience restless leg syndrome, or hear loud noises that no one else can hear. A few examples:
I heard about one patient who, after getting the wrong sleep medication, sleep drove to Taco Bell, ate a ton of burritos, then returned home to bed. He didn't remember any of it but put the pieces together when he found hot sauce packets all over himself. Textbook sleepwalking, which is a parasomnia.
I remember another patient who is a high profile professor at a prestigious university. He suffered from exploding head syndrome, where he would hear a violent explosion in his head just as he started to fall asleep. Frightened since he thought he was having an aneurysm or stroke, he went to the ER, but all tests came out normal. Since it happened every day and he couldn't sleep, he quit his tenure job. After seeing many neurologists, he came to me. A targeted low dose of an appropriate medication fixed his sleep, and he went back to his job after a week.
With parasomnias, the sufferer will likely never remember or know about their condition until someone tells them or they find evidence of their activity. A person who talks in their sleep may never know they have a problem until they share a bed with someone who has the dubious pleasure of hearing their midnight speeches.
REM Behavior Disorder
REM behavior disorder, or RBD, as the name implies, takes place later in the night, during the phases of sleep where rapid eye movement occurs. People who suffer from RBDs usually "act out dreams," and remember the dream they were acting out, although they may not understand what happened when they first wake up. In the dream, their action may be completely justified, but to an outside observer, their actions may be completely meaningless or random. Dr. Verma offers an example:
A father was arrested when he dreamt his house was on fire and he 'saved' his newborn baby by throwing him out the window to firefighters below to catch. Trouble was, there was no fire, no firefighters, but he did throw the baby out the window (The baby was ok). This is a classic REM behavior disorder.
Another example comes from comedian Mike Birbiglia, who appeared on This American Life and explained his struggle with RBD and how he used to stand on the bed in the middle of the night thinking there was a jackal in the room he needed to fight off. The video here is actually the trailer to his movie, Sleepwalk With Me, a comedy that deals with the issue.
Treat Sleep Disorders with Good Sleep Hygiene (and Expert Help)
Since parasomnias range from sleep driving to simply talking in your sleep, treatments vary. People who grind their teeth may get a mouth guard, but people with night terrors may need therapy. Someone who suddenly starts fighting the person next to them in bed because they're dreaming there's an intruder should, without delay, see a physician who specializes in sleep medicine. In many cases, there's medication (ranging from prescription clonazepam to over-the-counter melatonin) that can help you stay comfortably asleep at night. Still, Dr. Verma reminds us that If you can't see a doctor for some reason or your condition is mild, upgrading your sleep rituals and habits may be the key to a better night's rest for everyone involved:
Think of the brain with many parts that don't sleep and wake in unison. So if the part of the brain that controls the legs wakes before the rest, there is a risk of sleepwalking. So while the perfect fix would be helping all the parts of the brain wake and sleep in unison, we don't really know how to do that. So what we focus on (and readers can do by themselves) is their sleep hygiene. It results in less awakenings at night, which means less chance of parasomnias.
- Relax before bed. Making time for a little meditation or even just some quiet time to destress from the busy day can work wonders and lead to a deeper, fuller night's sleep with fewer inturruptions, whether they're dreams so vivid that you start talking out loud or get up and walk around your house. Photo by Sarah G..
- Get regular exercise. While it's not a direct relationship between exercise and sleep disorders, good, regular exercise does improve the quality of your sleep, and can lead to fewer arousals overnight, which in theory should keep you in bed, quiet, and sleeping deeply longer.
Cut back on screen time before bed. We've said this before a few times, but study after study all point to the notion that electronic devices mess with our sleep cycles. If you're an otherwise normal sleeper, you may be able to muddle through this, but if you have a sleep disorder like a parasomnia, maintaining a solid, healthy sleep cycle is imperative. Turn off the screens at least two hours before bed, Dr. Verma recommends, or at least don't let the last thing you see before you close your eyes be your smartphone or tablet. Don't worry, it'll be there when you wake up. While you're at it, put it on silent so it doesn't wake you up in the middle of the night. Photo by Miramiska.- Cut back on alcohol, caffeine, and cigarettes. All three can seriously disrupt your sleep cycles, especially alcohol and caffeine. This study compared the effects of all three, and for someone with a serious sleep disorder, eliminating these—at least in the hours before sleep—will be one of the first things your doctor asks you do to.
- Tweak your bedroom for optimal sleep. Heavy, light-blocking curtains, soft surfaces, and a comfortable bed will do a lot to improve your overall quality of sleep, which will in turn help you beat back some of these disorders, especially when they're mild. A deeper, more restful sleeper is usually one who doesn't talk in his sleep, for example.
For more sleep hygeine tips, check out our guide to getting better sleep. Better sleep hygiene can go a long way, but it shouldn't stop you from seeking the help of an expert on the matter even if you think your condition is mild. Sometimes the solution may be behavioral, or as simple as a melatonin supplement before bed.
How to Help Someone with a Sleep Disorder
So far we've discussed what to do if you're the person suffering from an RBD or a parasomnia. If you're the person sleeping next to someone who talks in their sleep or sleepwalks, Dr. Verma explains the best thing you can do is treat them with a gentle hand:
Roommate sleep walking? Gently guide them back to their bedroom. If they are going for a knife, intervene aggressively! If they already have the knife, run aggressively! The reason people say "don't wake the sleepwalker" is because since they aren't fully alert, they may respond aggressively to you. I have never done restraints because they will hurt themselves with those too.
For mild occasional sleep walking, take precautions: place heavy curtains on windows (so you don't cut your self if jumping out), install an alarm on your doors, sleep on the floor, sleep on the first floor of the house, hide any keys or knives.
Trying to restrain someone who's known to sleepwalk, or move the snacks away from someone who sleep eats is usually counterproductive. A sleepwalking person may struggle so hard against their restraints that they injure themselves, or if the restraints are part of their dream, they may ignore pain to break free. Putting the snacks on the top shelf will just make the sleep eater try to get to the top shelf, and potentially hurt themselves. Instead, gently guide the sleepwalker back to bed and help them get comfortable. Photo by auremar (Shutterstock).
Speak softly to them and don't try to wake them from their slumber. The reason people say you shouldn't wake a sleepwalker is because when we wake up, we're naturally disoriented as we move from unconsciousness to consciousness. What may be clear as day while we're asleep is difficult to comprehend as we wake up, and a sleepwalker who wakes mid-stroll may be confused, disoriented, or frightened. They may even react violently out of fear. A sleep driver on the other hand should be urged to pull over as soon as possible—call the police to find and escort the vehicle if possible, and hide the car keys next time.
People do some really crazy things while they're asleep, and unfortunately we just don't understand how the brain works enough to really pinpoint why and how to stop it proactively before symptoms manifest. That doesn't mean that there's nothing you can do though. In some cases, getting into a healthy relationship with sleep is the best way to ease sleep disorders and feel more rested in the morning as a result. For serious conditions or mild ones that persist no matter what you do, never hesitate to see an expert.
Dr. Nitun Verma, MD is a specialist in sleep medicine and the Medical Director of the Washington Township Center for Sleep Disorders in the Bay Area. He has offered his tips for better sleep here before, and he graciously volunteered his expertise for this piece as well. We thank him, and you can follow him on Twitter at @nitunverma.
Title image made using yskiii (Shutterstock) and stv777.
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