REM Sleep Behavior Disorder and How to Cope with Hallucinations

Today I’ll respond to 2 questions posted in the comments section yesterday.

1. David, Could you post a link or 2 on the REM articles?  I would be very interested in reading some of them. Maybe you could do a post on what you read if that would be easier? Thanks, Inge’

One of the best sites for an overview on REM Sleep Behavior Disorder (RBD) is at this site. RBD is characterized by the acting out of dreams that are vivid, intense, and violent. Dream-enacting behaviors include talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing. An acute form may occur during withdrawal from alcohol or sedative-hypnotic drugs. RBD is usually seen in middle-aged to elderly people (more often in men).

The exact cause of RBD is unknown. It may occur in association with various degenerative neurological conditions such as Parkinson’s disease and Lewy Body Dementia. RBD often precedes the development of these neurodegenerative diseases by several years. Not all people with RBD develop Parkinson’s disease or Lewy Body Dementia.

2. David..I do so enjoy your posts.  My step-father has LBD and life is very difficult for he and my Mom.  One question that I have that puzzles me is “Why can’t I convince my step-dad that his hallucinations are not real?”  His worst ones always involve my 80 year old Mom “being” with other men.  He then calls her horrible names and screams at her for hours.  He also has capgras syndrome and believes that she is an imposter or that he is in the wrong house.  He currently takes Ativan..(has been on this drug for years) and also Rispiradone.

  • First…..remember the old expression, “Perception is reality!”

  • Don’t try to argue or rationalize. Realize that hallucinations and delusions seem very real to the person who is experiencing them and arguing will not build trust.

  • Offer reassurance and validation ‑ “I know this is troubling for you, let me see if I can help.”
  • Check out the reality of the situation. Maybe what they see or think is true. I remember one of my female patients with schizophrenia who complained that she smelled something ‘bad’ in her kitchen. She was committed by her husband several times for this. After further investigation, it turned out that the refrigerator in the kitchen was leaking freon.
  • Sometimes things in the environment may be misinterpreted (i.e., glare or shadow in the window, noisy furnace, etc.) and be frightening. Explain potential or actual misinterpretation, e.g., that the noise is the furnace turning on.
  • Try changing the environment if needed. (A mirror may become distracting or confusing; adding more lights may be helpful at night.)
  • Check to see if the person’s hearing or vision needs are met to reduce excess disabilities that contribute to these problems.
  • Remember that whispering or laughing around the person may be misinterpreted.
  • Do not take accusations personally.
  • Use distraction ‑ activity, conversation, food, music ‑ try to pull the person’s attention from the delusion or hallucination.
  • If the person asks you directly if you see or hear something, be honest but don’t struggle to convince or reason with them about what is real.
  • Try to respond to what the person may be feeling ‑ insecurity, fear, confusion.

I personally remember my own RBD exactly as described above.  The dreams and nightmares were terrible — vivid, intense, and violent. Sometimes I didn’t want to go to sleep because of the  talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing. I remember hurting Pam several times. I can’t say how sorry I was and am for that. At the time, I just thought I was trying to work through unconscious unresolved issues and anger. But I never was that angry in real life! One night I actually hurled myself up out of bed and threw myself over onto the floor….what an awakening experience! It scared the bajeezies out of me. My Dr. brushed off all of these symptoms. What can I say?


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