Parasomnias: The Science of Unsound Sleep
Some suffer from unwanted sleep behavior, such as eating cat food sandwiches.
Nov. 27, 2007 — -- By day, Mike Doyle is a mild-mannered bank executive who lives with his wife in a suburb of Minneapolis.
By night, he wanders the house in a deep slumber, acting out his strangest and wildest dreams.
"I ran down the hallway and jumped from the top step and landed somewhere near the bottom," Doyle said. "I got up and went back to bed and the following morning I didn't realize what I had done, until I sat down on the wooden chair in the kitchen. And I thought I was gonna die because of how bad it hurt to sit."
Doyle is among millions of Americans -- as many as 4 percent -- who suffer from parasomnias: unpleasant and unwanted behaviors during deep sleep.
"What happens with parasomnias is that the brain tells the body to move, to walk, to have sex, to eat, to become aggressive, to become violent," explained Dr. Carlos Schenck, a sleep disorder specialist and the author of "Sleep: The Mysteries, The Problems, and the Solutions." "It's the brain that directs the muscles in the rest of the body to engage in these activities." (For more information on sleep disorders and on Dr. Schecnk's new book on parasomnias, visit http://www.parasomnias-rbd.com).
Bizarre Behavior
Schenck has catalogued a range of parasomnias in the documentary "Sleep Runners," including those who eat in their sleep.
"A woman with sleep eating, every time she eats a bit of her brownie, she extends the pinky of her hand and nibbles on it and that's no way that she would ever do that in the daytime," said Schenck. "The sleep-eaters generally have partial awareness of what they're doing, but they don't know the full extent until the next morning when with horror they see all that they consume and also they are really very disgusted with how they ate, such as spaghetti and meatballs with their bare hands or they make a tuna fish sandwich loaded with salt and pepper or they'll even make a cat food sandwich."
A cat food sandwich? It turns out that's the least of it.
"They butter cigarettes. They put coffee grounds, Coca-Cola, egg shells in a blender and they blend it all together and drink it," he said. "It's bizarre."
Sometimes the behavior can be quite violent.
"You'll see a Japanese man acting out a Samurai warrior dream," said Schenck.
Another man in the documentary is seen suffering from a sleep terror, and responds by punching his pillow and growling.
"I think it's the fight or flight response that suddenly out of deepest sleep you encounter a major threat and you have to respond by either running away or fighting against the threat," said Schenck.
REM Disorders
The parasomnias are considered a brain dysfunction, not a mental illness. Schenck said that "most parasomnias can be diagnosed and effectively treated, and most parasomnias are not a function of a daytime psychiatric disorder."
Some people with the condition are reluctant to seek treatment because they fear the stigma, he added.
The more violent episodes -- occurring during the dream stage of sleep known as rapid eye movement or REM -- can be a precursor to brain diseases including Parkinson's.
"We identified a disorder, what is the rapid eye movement sleep behavior disorder, or RBD, mainly affecting men 50 or older who were acting out violent dreams involving unfamiliar people or animals," said Schenck. "After we followed these men along for a decade or longer, we realized that at least two thirds of these men developed Parkinson's disease, which is a traditional neurologic disorder involving tremor and rigidity."
Such potential complications are among the reasons Doyle finally signed up for a sleep study at the Minnesota Regional Sleep Disorders Center. He was wired up so that researchers could monitor his brain and body.
Doyle's wife, Cheryl, said that her husband has been walking, talking and occasionally raging at her in his sleep throughout their eight-year marriage.
"He'd bolt up right out of bed, would scream, yell, like a night terror," said Cheryl. "Sometimes he would scream that the house was on fire. Sometimes it was just nonsense -- there were dogs in the house and we needed to get the dogs out. The only time I would probably run after him is if I'd hear the front door open or the garage door open."
Doyle said the episodes were happening "three, four, sometimes five, six times a night."
'A Totally Different Person'
One of his recent night episodes involved the movie "Cape Fear." In the film, Robert De Niro stars as an ex-con who stalks the family of a lawyer played by Nick Nolte.
"There's a scene where the family is on the boat in the river and the family is trying to escape Robert De Niro and all jumped into the river, and I dreamt that I was on that boat and I got up out of bed, I got a running start and dove into our living room," said Doyle. "Basically just got up and went back to bed and wasn't until a couple hours later wondering why the bed was wet and I realized when I turned on the light that my knees were bleeding from having scraped my knees."
"He's not himself at night when he has these episodes," said Cheryl. "He's a totally different person. "
In his night personality, Doyle has hurt himself and acted belligerently -- though never violently -- with his wife. But sleep disorders have played prominent roles in crime.
Ten years ago Scott Falater, a devout and devoted family man with no criminal past, stabbed his wife and held her under their pool. He claimed he was sleepwalking. A jury convicted him of murder.
But in 1987, Canadian Kenneth Parks was found not guilty of killing his mother-in-law, because experts testified he was asleep.
"Someone with a parasomnia can commit an act of murder and have no idea what he or she is doing in the process, so on that basis, yes they should be considered innocent," Schenck said.
Dreaming of Sleep
During his sleep study, Doyle was monitored overnight and through a series of naps totaling nearly 24 hours. In the morning, Dr. Schenk and Dr. Mark Mahowald -- a neurologist -- went over the results.
"His REM sleep did appear normal," said Mahowald.
Doyle and Cheryl got some good news: The sleepwalking did not appear to be the more serious REM behavioral disorder, (RBD) the red flag for Parkinson's disease.
"The bottom line is that you have sleep apnea that is superimposed on your sleep walking," explained Schenck. "You did have one episode of confusional arousal with mumbling out of slow wave sleep which is very consistent with the sleep walking history. But you had mild to moderate obstructive sleep apnea, 25 episodes an hour."
The prescribed treatment included a breathing device to prevent sleep apnea and perhaps a common sedative. Doyle hopes that will help him achieve "what I would consider a normal night's sleep."
Cheryl also said she's looking forward to "getting a good night's sleep myself. Uninterrupted sleep would be nice."
For the Doyles, that is the ultimate dream: a sound sleep unburdened by the terror of the night.
The following Web sites offer more information about parasomnias and sleep disorders:
