Huh? REM Sleep Behavior Disorder?
“Rob, I just want to know why my daughter kicks her sister in her sleep!” Until this mother brought me the unusual case of Julia (all names have been changed), age 9, I had never heard of REM sleep behavior disorder either. I referred Julia and her mom to an internationally-recognized sleep center in Boston to make the diagnosis. But I’m getting ahead of the story. Here’s what happened:
When Julio and Maria, Julia’s parents, bought a new king-size for themselves, they decided to keep their old queen-size mattress and give it to their daughters Julia and Junissa. This would save the couple space and laundry. And the girls were enthusiastic about sharing a bed.
That is until the middle of the night in August when Junissa ran to her parents bedroom crying.
“Julia hit me! Julia hit me!”, she kept sobbing.
Maria and Julio didn’t quite know what to think. The girls loved each other. They got along well, even unusually well. They had never so much as pushed one another in the 7 years since Junissa was born.
Junissa was telling the truth. She had a bruise coming up on her leg in the shape of Julia’s foot. Her parents rushed to the girls’ bedroom and found Julia asleep.
Maria shook her and raised her voice, demanding that Julia explain what happened. Julia woke with a jolt. The poor girl was confused and scared. She swore she didn’t do anything to her sister.
“But I had a dream…”
The next morning, Julia explained to her parents and her sister that she had been dreaming about playing soccer, as she had been earlier the previous day. In the dream her friend passed her the ball and she wound up and made a huge kick toward the goal. This must have been when she kicked her sister.
Julia’s parents believed her, and left things as they were. But a week later, again after a soccer day, Julia began kicking wildly in her sleep, this time narrowly missing her sister each time.
That’s how the family came to me. I took a detailed history and asked all the questions I usually do, but I was stumped. Then I remembered ages ago learning about REM Sleep Behavior Disorder (RBD). I had never seen it before. Was I seeing it for the first time?
What is REM Sleep Behavior Disorder?
Rapid Eye Movement (REM) is that stage of sleep when people dream vividly. It’s also a stage of sleep when people tend to have very low muscle activity, except for their eyes (hence the name). In REM Sleep Behavior Disorder, by contrast, people retain muscle control, and tend to move as though they are acting out their dreams. If the dreams are especially exciting or violent, the dreamer could hurt herself or bedmates, as in our girl’s case, or damage property.
Originally thought to occur only in middle-aged and older men, RBD is now recognized to occur in children as young as 7. RBD has been associated with parasomnias like Restless Legs Syndrome, as well as developmental problems such as autism, or brain diseases. Certain medications also give RBD as a side-effect. Julia had been sleepwalking since she was 5. On deeper questioning, her parents revealed that both of them had been sleepwalkers, unbeknownst to each other!
Treatment of REM Sleep Behavior Disorder
According to the literature, and to the sleep center in Boston, the only known therapies for RBD involved taking medication. Maria brought this issue up with Julia’s pediatrician, and they had a frank discussion. Julia’s parents and the pediatrician decided that the possible side-effects of the medications were more serious than Julia acting out her dreams.
Instead, the family decided to sell the queen-size bed that the girls shared, and to buy them matching twin beds. This would reduce the immediate risk of Julia kicking her sister after game day. They also installed a video monitor in the girl’s room. If Julia began to thrash or kick, one of her parents would stand guard to make sure she did not get out of bed and harm herself. I thought it was a terrific decision.
I suggested to the parents that Julia adopt a sleep schedule. She would go to bed at the same time every night, and keep her daytime as regular and predictable as possible. She cut back on one of her extra-curricular activities that might have been adding to her stress. And she began eating less junk food, especially before bed.
In about 6 months, Julia stopped having RBD events. When Junissa turned 9, she began doing the same as her sister! Again, with modification of her sleep schedule and diet changes, or maybe because of some other mysterious reason, Junissa began to sleep peacefully as well.
Do you or your kids act out their dreams? If so, I’m here to help.