Wednesday, April 23, 2014

Rapid-eye-movement sleep behavior disorder (REMBD) may be an indicator for Alzheimer's, Parkinson's Disease

Researchers at the University of Toronto say a sleep disorder that causes people to act out their dreams is the best current predictor of brain diseases like Parkinson's and Alzheimer's.
According to an article in Trends in Neurosciences, John Peever, MD, associate professor at the University of Toronto suggests the link occurs because brain degeneration attacks the brain circuits controlling REM sleep before it attacks those areas involved in Parkinson’s, Alzheimer’s, and other neurodegenerative conditions.

Sleep occurs in five distinct phases; the the fifth stage is REM, the the most active sleep phase in which you’re most likely to dream. The REM stage is also when you may find yourself twitching or tossing.
During normal REM sleep your brain temporarily paralyzes your muscles, but in people with REM sleep behavior disorder (REMBD) this paralysis ceases to occur; they may act out their dreams, resulting in injury to themselves and/or their bed partner.

The new research examines the idea that neurodegeneration might first affect areas of the brain that control sleep before attacking brain areas that cause more common brain diseases like Alzheimer’s. REMBD is most common in older men – 90 percent of people who develop it are male, and most are over the age of 50. Scientists already knew REMBD was associated with certain brain disorders including Parkinson’s: previous research has shown that approximately 30 percent of people diagnosed with REMBD will develop Parkinson’s within three years. However, the new study suggests that  80 to 90 percent of people who develop REM sleep behavior disorder will develop degenerative brain disease within the near future.

Medications are available for many of these conditions that can delay or slow progression of the disease when taken early enough, so REMBD could serve as an alert to do so. Once you’re diagnosed with REMBD the usual treatment is a muscle relaxant such as clonazepam (Clomid or Klonopin). However this new research suggests it’s a good idea for anyone diagnosed with REMBD to have a complete workup for Parkinson’s, Alzheimer’s, dementia, and other brain disorders.

Dr. Peever suggests that “...It’s important for clinicians to recognize RBD as a potential indication of brain disease in order to diagnose patients at an earlier stage. This is important because drugs that reduce neurodegeneration could be used in RBD patients to prevent (or protect) them from developing more severe degenerative disorders.”


Breakdown in REM sleep circuitry underlies REM sleep behavior disorder (Abstract; Trends in Neuroscience, 03/04/2014
Specific Sleep Disorder Associated with Brain Diseases: Psyche Central

Monday, April 7, 2014

Engineer in fatal Bronx train derailment had sleep apnea

The commuter train engineer at the center of last year's deadly derailment in the Bronx was found to have obstructive sleep apnea that went undiagnosed before the Dec. 1 derailment, a sleep medicine doctor said in the National Transportation Safety Board's investigation docket. Rockefeller told investigators that he felt fine that day, but experienced something like highway hypnosis as he stared straight ahead at the tracks. "I came up with that hypnotized feeling, dazed, that's what I was in," he said. "The only thing that shook me out of it was the feeling of the train. Something wasn't right with it.
" He activated the emergency brake, but it was too late. The train derailed as it headed around a sharp curve at 82 miles per hour, nearly three times the speed limit.

A report on Rockefeller's medical history revealed he had never been tested for a sleeping disorder by any of his doctors prior to the accident. He had a history of snoring but "not of choking or gasping" awake. His sleep was disrupted as much as 65 times per hour, the report stated.
Sleep apnea occurs when a person involuntarily stops breathing while asleep. Rockefeller's lawyer said that
"...He had absolutely no idea of this condition prior to the diagnosis. It was exacerbated by the change in shifts two weeks earlier."

 Excessive daytime drowsiness is a tendency to sleep at inappropriate times regardless of activity or circumstance. It can manifest itself in mild or severe forms.
Excessive daytime sleepiness is a common problem in today's society. It is so common that in some circles people almost consider it a normal aspect of a productive society. The fact is that daytime sleepiness and fatigue are leading causes of accidents, both on the job and on the road. The cost to society is estimated in billions of dollars per year. There are several common causes for increased daytime sleepiness. The simplest cause of daytime sleepiness that can be corrected results from insufficient sleep.

A common medical problem that can cause increased daytime sleepiness results from having a breathing problem during sleep. Snoring for example, is a form of obstructed breathing. Obstructive breathing can make it difficult to breathe properly during sleep and can even cause a complete blockage in the airway during which breathing stops. Breathing is re-established with a brief disruption of sleep and possibly a brief gasp or choking sound.

Another common medical problem causing frequent disruptions of sleep is called Periodic Limb Movements of Sleep. This occurs when a person has multiple brief leg movements every 20 to 60 seconds for long periods during the night. These leg movements can fragment sleep, resulting in increased daytime sleepiness. Frequently people with this problem also have what is called Restless Legs Syndrome (RLS). RLS occurs when a person is sitting still or lying in bed, which makes it difficult to keep their legs still. This frequently can keep people awake, causing insomnia. People with this problem feel that moving their legs relieves this restless sensation.

These problems are all treatable. Unfortunately, many physicians are not yet familiar with treating these conditions. Ask your doctor about treatment and feel free to have your doctor contact us for questions on diagnosis and treatment for these conditions.
If you have a problem with daytime sleepiness and you have increased your sleep length without improving your daytime sleepiness, then you should be evaluated by a Sleep Disorders Specialist. With proper care most people can obtain the treatment they need to improve this problem. Contact us today at 281-407-6222 or visit  for more information.