Twin Cities doctor specializes in bizarre sleep behaviors

With its bank of oversized computer screens, the Minneapolis sleep clinic's control room looks like a military command center. Dr. Michael Howell stands in the glare of the monitors analyzing video of a sleeping patient.

At first, the patient lies perfectly still on one side. Then suddenly his arm jerks. He raises it high above his head and spins it around in circles.

"He's in REM sleep," Howell says, studying the wavelengths on the screen that track eye movement and brain activity. REM sleep is when most dreaming occurs, he explains, and in this case, the patient is acting out his dream because his brain has lost its ability to paralyze the body while sleeping.

Howell works in the world of parasomnia — a bizarre and potentially dangerous category of sleep behaviors that range from sleepwalking to sleep fighting to sleep smoking and sleep driving. These are the hard-to-crack sleep disorder cases that Howell, a sleep doctor and neuroscientist, specializes in.

"I've met Batman, Spider-Man — lots of people who have superhero powers in their sleep," he said.

With millions of Americans suffering from sleeping woes, such as insomnia and sleep apnea, the field of sleep medicine is exploding. In just five years, the number of sleep centers accredited by the American Academy of Sleep Medicine has doubled to 2,500. Thirty percent of American adults say they have trouble sleeping, Howell said.

That's why specialists such as Howell are in high demand — he treats patients at three sleep clinics in the Twin Cities area. An assistant professor of neurology at the University of Minnesota, he's at the forefront of the evolving science around the brain and sleep.

His interest in sleep science came in a sudden awakening.

"I was out exploring other lands of neurologies before I walked into a sleep lab," he said. He instantly became hooked. "I started learning about sleep disorders and I thought, 'This is so cool!' "

Howell was drawn into parasomnia while under the wing of Dr. Carlos Schenck, a pioneer in sleep medicine, who calls this science "the world of the strange and beautiful."

"He really was a shining light," Schenck said, remembering the young Howell as enthusiastic and full of ideas.

Schenck was part of a team of doctors at Hennepin County Medical Center who documented the first case of "RBD" (REM behavior disorder), a condition in which the brain stem changes, causing patients to come out of sleep paralysis and start acting out their dreams. Today, many of Howell's patients fall under this category, a disorder that affects 35 million people worldwide. Recent research by Schenck and others has found that RBD can be a predictor of Parkinson's disease and dementia.

"The state of REM sleep is absolutely fascinating because it's when we're consolidating memory," Howell said. "When we experience something that has a strong emotional tag with it — something that was frightening or joyful — we are far more likely to remember that because the brain circuit that holds onto memory is also very closely linked to our emotional brain.

"And what happens during REM sleep, those memories that have the strong emotional content are replayed. That's why our dreams are so emotionally intense."

Dangerous dreams

When the dream state becomes too intense for people, they visit Howell at Fairview sleep center.

The center has several "sleep rooms," each one resembling a Spartan hotel room furnished with a bed, a nightstand and a lamp. There are no windows. But these unassuming rooms are actually overnight laboratories where the center conducts tests on patients, attaching electrodes to record brain activity. Howell sees patients every day, but he reserves Fridays for those with the most extreme behaviors.

Some stand apart from the others.

Take the Spider-Man case, named for the college student who, after a night of drinking, lack of sleep and watching a Spider-Man movie, dreamed that he was the webbed superhero. He stood in front of a second-floor window — naked — and leapt from it. Fortunately, he broke only his wrist, Howell said.

There was also the patient who dreamed that she was smoking and lit a cigarette, burning holes in her clothes.

Cases of dream enactment are as varied as the dreams themselves. "There have been lots of people who were playing baseball or playing football," Howell said. "I had one individual who was trying to tackle Osama bin Laden."

Ronald Wilkens, 67, of Woodbury, has struggled with sleep issues since he suffered a head injury in a car crash as a child. He occasionally acts out his dreams. "My wife kept telling me that I talked in my sleep and I screamed once in awhile. Then I would kick. One time I remember waking up pounding on her stomach," he said. "But I don't remember what I was dreaming about."

He's been seeing Howell lately. "I'm hoping he can come up with an answer for this," Wilkens said.

Secrets to a restful night

So how well does a sleep expert sleep?

"I'm a good sleeper," Howell said, "but I work on it."

At night, he has a clear evening regimen: He avoids drinking alcohol and looking at his smartphone. Instead of watching TV before his 10 p.m. bedtime, he reads. "The trick is to kind of get your brain going on something," he said.

His nighttime ritual includes something else that may surprise some: melatonin.

"I don't take it as a sleeping pill," Howell said of the over-the-counter herbal supplement. "I take it to help keep my circadian rhythm aligned for when I'm trying to sleep."

Even then, he is not immune to waking up in the middle of the night occasionally. When that happens, he said, he gets up for a glass of water and goes back to sleep.

Also surprising: You may think a sleep guru would have a palatial resting room, but his sleeping quarters err on the humble side.

For the past few years, Howell and his wife have slept in a small room that used to be the nursery. The room is outfitted with a queen-size bed and a nightstand. The curtains are drawn just a bit, so Howell can see the early-morning sunlight — another trick to waking up well-rested.

The couple forfeited the master bedroom to their three young daughters — "all good sleepers, by the way," Howell said proudly.

Allie Shah • 612-673-4488