Sleep Disorders: When Sleepwalking Turns Violent

Sleepwalking and hitting?

Hello Doctor: I am inquiring on behalf of my family.
My father hears sounds at night that resemble something being swiped by a hand while he is sleeping.
A few days later, I heard my mother say that he has been hitting people in his sleep.
Could you please advise what kind of symptoms these are? If we go to the hospital for an examination, should we see a neurologist?

Shuì shuì, 20~29 year old female. Ask Date: 2018/07/07

Dr. Hong Weibin reply Neurology

Based on your description, it is highly likely that you are experiencing "REM Sleep Behavior Disorder." Sleep can be divided into light sleep, deep sleep, and rapid eye movement (REM) sleep.
During REM sleep, dreaming occurs, and under normal circumstances, the brain inhibits movements of the limbs.
In REM Sleep Behavior Disorder, this inhibitory mechanism is lost, allowing the limbs to act out the dreams.
For example, if you dream of having a confrontation or fighting with someone, your limbs may mimic the actions of fighting.
Current clinical neurology suggests that this may be a sign of neurodegeneration, with the accumulation of "Lewy bodies" in the brain's nerve cells.
Research from Western countries indicates that within a few years, 30-40% of individuals may develop symptoms of Parkinson's disease (such as bradykinesia, rigidity, and gait instability), while the rate of progression to Parkinson's disease is lower in Eastern populations.
In addition to REM Sleep Behavior Disorder, other conditions that need to be differentiated include sleep myoclonus and periodic limb movement disorder.
It is recommended to seek assistance and evaluation from a neurologist or a sleep specialist at a medical facility with a sleep center.

Reply Date: 2018/07/07

More Info

Sleep disorders can manifest in various ways, and the symptoms you're describing regarding your father suggest he may be experiencing a form of sleep disorder known as "REM Sleep Behavior Disorder" (RBD). This condition is characterized by the acting out of dreams during the REM (Rapid Eye Movement) stage of sleep, which is when most dreaming occurs. In RBD, individuals may physically respond to their dreams, which can sometimes lead to violent movements or behaviors, such as hitting or kicking, as they act out their dreams.
Your father's experience of hearing sounds, such as something being swiped, could be related to auditory hallucinations that sometimes accompany sleep disorders. These hallucinations can occur during the transition between sleep and wakefulness, or during sleep itself, and may be perceived as real by the individual.
In your father's case, if he is indeed hitting or striking out while asleep, it is essential to seek medical advice. This behavior can pose a risk not only to himself but also to others around him. It is advisable to consult a neurologist or a sleep specialist, as they are trained to diagnose and treat sleep disorders. A thorough evaluation may include a sleep study (polysomnography), which can monitor brain activity, eye movements, heart rate, and muscle activity during sleep to provide a clearer picture of what is happening during these episodes.

Additionally, it is important to consider any underlying factors that may contribute to sleep disturbances. Stress, anxiety, certain medications, and other medical conditions can exacerbate sleep disorders. If your father has a history of neurological issues or other health concerns, these should also be discussed with the healthcare provider.

In terms of treatment, options may include lifestyle changes, such as improving sleep hygiene, creating a safer sleep environment, and possibly medication to help manage symptoms. Medications such as melatonin or certain antidepressants may be prescribed to help regulate sleep patterns and reduce the frequency of violent behaviors during sleep.

It is also worth noting that sleepwalking and RBD are different conditions. While sleepwalking typically occurs during non-REM sleep and involves complex behaviors without conscious awareness, RBD occurs during REM sleep and involves acting out dreams. Both conditions can be disruptive and may require intervention, but the management strategies may differ.

In conclusion, if your father is exhibiting violent behaviors during sleep, it is crucial to seek professional medical advice. A neurologist or sleep specialist can provide a comprehensive evaluation and recommend appropriate treatment options. Addressing sleep disorders early can help improve sleep quality and overall well-being, reducing the risk of injury to both the individual and those around them.

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