Friday the 13th. REM Sleep Behavior Disorder and Sudoku Answer

I’ve been dealing with some strange symptoms this week. The REM sleep behavior disorder came back with a roar. I awakened last night and ended up staying up for about 1/2 hour. The nightmare was so strong that I couldn’t get it out of my mind. I actually was afraid to go back to sleep but did give in. The rest of the night was OK. This week has been weird. I’ve felt sleepy, apathetic, amotivated and just dull. But I haven’t felt depressed. At first I thought maybe SAD was catching up with me. But today I feel just fine. So Pam and I are going out to get some staples. (Oops, that’s the word we used growing up which means buying the necessary groceries to tie you over.)

Yes, it’s a good idea. I’m going to show Pam how to write a post to the blog. I never gave it much thought that anyone would be worrying. But since I usually blog everyday, it probably makes sense to do it.

The main symptom of REM sleep behavior disorder is dream-enacting behaviors, sometimes violent, causing self-injury or injury to the bed partner.

The dream-enacting behaviors are usually nondirected and may include punching, kicking, leaping, or jumping from bed while still asleep.

The person may be awakened or may wake spontaneously during the attack and vividly recall the dream that corresponds to the physical activity.

Here is the answer to the sudoku puzzle which I posted the other day. 

4

3

6

7

5

2

1

9

8

2

1

9

4

3

8

7

6

5

8

7

5

6

1

9

4

3

2

7

5

4

2

8

3

6

1

9

6

2

3

9

7

1

8

5

4

1

9

8

5

6

4

3

2

7

9

8

1

3

3

7

5

4

6

5

4

7

1

9

6

2

8

3

3

6

2

8

4

5

9

7

1

Thanks to all who have expressed concerned. Have a great weekend!

Warmly………David

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Up from the grave he arose

Wow! What an experience I’ve just had. Thing only thing I barely remember last Sunday was that the Steelers won the Super Bowl. The last couple of days had me wondering. I do think it’s the worst I have ever been with the LBD.

I’ve underlined the worst symptoms I had in the following review of LBD which I posted last week.


Lewy Body Dementia Symptoms as explained by the Lewy Body Dementia Association

Dementia is a process whereby the person becomes progressively confused. The earliest signs are usually memory problems, changes in their way of speaking, such as forgetting words, and personality problems. Cognitive symptoms of dementia include poor problem solving, difficulty with learning new skills and impaired decision making.

Other causes of dementia should be ruled out first, such as alcoholism, overuse of medication, thyroid or metabolic problems. Strokes can also cause dementia. If these reasons are ruled out then the person is said to have a degenerative dementia. Lewy Body Dementia is second only to Alzheimer’s disease as the most common form of dementia.

Fluctuations in cognition will be noticeable to those who are close to the person with LBD, such as their partner. At times the person will be alert and then suddenly have acute episodes of confusion. These may last hours or days. Because of these fluctuations, it is not uncommon for it to be thought that the person is “faking”. This fluctuation is not related to the well-known “sundowning” of Alzheimer’s. In other words, there is no specific time of day when confusion can be seen to occur.

Hallucinations are usually, but not always, visual and often are more pronounced when the person is most confused. They are not necessarily frightening to the person. Other modalities of hallucinations include sound, taste, smell, and touch.

Parkinsonism or Parkinson’s Disease symptoms, take the form of changes in gait; the person may shuffle or walk stiffly. There may also be frequent falls. Body stiffness in the arms or legs, or tremors may also occur. Parkinson’s mask (blank stare, emotionless look on face), stooped posture, drooling and runny nose may be present.

REM Sleep Behavior Disorder (RBD) is often noted in persons with Lewy Body Dementia. During periods of REM sleep, the person will move, gesture and/or speak. There may be more pronounced confusion between the dream and waking reality when the person awakens. RBD may actually be the earliest symptom of LBD in some patients, and is now considered a significant risk factor for developing LBD. (One recent study found that nearly two-thirds of patients diagnosed with RBD developed degenerative brain diseases, including Lewy body dementia, Parkinson’s disease, and multiple system atrophy, after an average of 11 years of receiving an RBD diagnosis. All three diseases are called synucleinopathies, due to the presence of a mis-folded protein in the brain called alpha-synuclein.)

Sensitivity to neuroleptic (anti-psychotic) drugs is another significant symptom that may occur. These medications can worsen the Parkinsonism and/or decrease the cognition and/or increase the hallucinations. Neuroleptic Malignancy Syndrome, a life-threatening illness, has been reported in persons with Lewy Body Dementia. For this reason, it is very important that the proper diagnosis is made and that healthcare providers are educated about the disease.

Other Symptoms

Visuospatial difficulties, including depth perception, object orientation, directional sense and illusions may occur.

Autonomic dysfunction, including blood pressure fluctuations (e.g. postural/orthostatic hypotension) heart rate variability (HRV), sexual disturbances/impotence, constipation, urinary problems, hyperhidrosis (excessive sweating), decreased sweating/heat intolerance, syncope (fainting), dry eyes/mouth, and difficulty swallowing which may lead to aspiration pneumonia.

Other psychiatric disturbances may include systematized delusions, aggression and depression. The onset of aggression in LBD may have a variety of causes, including infections (e.g., UTI), medications, misinterpretation of the environment or personal interactions, and the natural progression of the disease.

I’m coming back to myself once again–

Now to start catching up with 1009 emails. I’ll just do it little by little.

Warmly………David

Boys and Sports

First of all, I’d like to thank those of you who’ve already voted for the blog, for all those who’ve made comments and to those of you who like the new blog look. I keep experimenting with different themes………I think I’ll stick with this one. It gives me a few more options which I can use over time. Plus it just seems easier to read.

I thought I’d post a little review on the symptoms of Lewy Body Dementia.

Lewy Body Dementia Symptoms as explained by the Lewy Body Dementia Association

In this section we’ll discuss each of the symptoms, starting with the key word: dementia. Dementia is a process whereby the person becomes progressively confused. The earliest signs are usually memory problems, changes in their way of speaking, such as forgetting words, and personality problems. Cognitive symptoms of dementia include poor problem solving, difficulty with learning new skills and impaired decision making.

Other causes of dementia should be ruled out first, such as alcoholism, overuse of medication, thyroid or metabolic problems. Strokes can also cause dementia. If these reasons are ruled out then the person is said to have a degenerative dementia. Lewy Body Dementia is second only to Alzheimer’s disease as the most common form of dementia.

Fluctuations in cognition will be noticeable to those who are close to the person with LBD, such as their partner. At times the person will be alert and then suddenly have acute episodes of confusion. These may last hours or days. Because of these fluctuations, it is not uncommon for it to be thought that the person is “faking”. This fluctuation is not related to the well-known “sundowning” of Alzheimer’s. In other words, there is no specific time of day when confusion can be seen to occur.

Hallucinations are usually, but not always, visual and often are more pronounced when the person is most confused. They are not necessarily frightening to the person. Other modalities of hallucinations include sound, taste, smell, and touch.

Parkinsonism or Parkinson’s Disease symptoms, take the form of changes in gait; the person may shuffle or walk stiffly. There may also be frequent falls. Body stiffness in the arms or legs, or tremors may also occur. Parkinson’s mask (blank stare, emotionless look on face), stooped posture, drooling and runny nose may be present.

REM Sleep Behavior Disorder (RBD) is often noted in persons with Lewy Body Dementia. During periods of REM sleep, the person will move, gesture and/or speak. There may be more pronounced confusion between the dream and waking reality when the person awakens. RBD may actually be the earliest symptom of LBD in some patients, and is now considered a significant risk factor for developing LBD. (One recent study found that nearly two-thirds of patients diagnosed with RBD developed degenerative brain diseases, including Lewy body dementia, Parkinson’s disease, and multiple system atrophy, after an average of 11 years of receiving an RBD diagnosis. All three diseases are called synucleinopathies, due to the presence of a mis-folded protein in the brain called alpha-synuclein.)

Sensitivity to neuroleptic (anti-psychotic) drugs is another significant symptom that may occur. These medications can worsen the Parkinsonism and/or decrease the cognition and/or increase the hallucinations. Neuroleptic Malignancy Syndrome, a life-threatening illness, has been reported in persons with Lewy Body Dementia. For this reason, it is very important that the proper diagnosis is made and that healthcare providers are educated about the disease.

Other Symptoms

Visuospatial difficulties, including depth perception, object orientation, directional sense and illusions may occur.

Autonomic dysfunction, including blood pressure fluctuations (e.g. postural/orthostatic hypotension) heart rate variability (HRV), sexual disturbances/impotence, constipation, urinary problems, hyperhidrosis (excessive sweating), decreased sweating/heat intolerance, syncope (fainting), dry eyes/mouth, and difficulty swallowing which may lead to aspiration pneumonia.

Other psychiatric disturbances may include systematized delusions, aggression and depression. The onset of aggression in LBD may have a variety of causes, including infections (e.g., UTI), medications, misinterpretation of the environment or personal interactions, and the natural progression of the disease.

All right now. Enough of some serious material. Now it’s time to play. These are the kind of puzzles which make me feel really smart. The more I do, the smarter I feel. I hope they help you just as much.

Boys and Sports
by Shelly Hazard

Wilma and three other women were comparing notes about the achievements of their sons. Each son had a favorite sport and each was a star player. The boys ranged in age from 10 years old to 13 years old. Determine the full name of each mother, the name of her son, the sport each son played, and how old each son was.

1. Sara Copper’s son, who wasn’t Brian, didn’t play soccer.

2. The boy who played basketball was the youngest. Mrs. Green’s son was a year younger than the boy who played baseball but a year older than Sara’s son.

3. The oldest boy, who wasn’t Mark, was Sharon’s son but he didn’t play hockey.

4. The boy who played baseball was a year older than the boy who played hockey.

5. From youngest to oldest, the boys were Mark, Teresa’s son, Mrs. Silver’s son, and Eric.

6. Mrs. Wild’s son was two years older than Chris.

boyandsports1

boysandsports2

Click here for the Solution

Warmly………David

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?

Warmly………….David

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