During the day, Lawrence Neumann was a mild mannered man, considerate, kind and loving to his wife of many years, Bonnie.
In the middle of the night, as they tried to sleep, he became someone else -- screaming obscenities, grunting, kicking, punching Bonnie in the arm, violently hurling himself out of bed.
For 16 years, the couple from Streator, Ill., had no idea what was happening or why night after night. The doctors they consulted were at a loss to explain the strange symptoms.
"Nobody seemed to know anything about it," said Lawrence, 73.
Relief came at long last in the form of a diagnosis from a neurologist at Northwestern University's Feinberg School of Medicine. Lawrence had a little known condition, REM sleep behavior disorder, in which people act out their dreams, unconsciously, during sleep. That diagnosis was a turning point, since the condition is easily treatable.
Nine out of 10 people who suffer the disorder are men. Most are 50 or older, although new research is finding a higher prevalence of the disorder in younger adults as sleep problems gain more attention, according to Dr. Bradley Boeve, a professor of neurology at the Mayo Clinic in Rochester, and a leading expert on the condition.
"Several patients we've seen, their spouse will describe first encountering this on their wedding night," he said.
Estimates suggest one in every 200 adults has the strange affliction, caused by a dysfunction in a part of the brain that suppresses muscle activity while people are in REM sleep, a dream-filled phase of slumber.
The prevalence of REM sleep behavior disorder might be much higher in seniors. Notably, 9 percent of 2,300 adults 70 to 90 surveyed in Minnesota's Olmsted County reported symptoms consistent with the diagnosis.
"Even if only half actually have it, that's still 4 to 5 percent -- and that makes it pretty common," Boeve said.
A growing body of research suggests the condition is a precursor to Parkinson's disease and Lewy body dementia in up to 25 to 50 percent of patients. Why this is so is not yet clear, but neurons in adjacent areas of the lower brainstem appear to be implicated, according to Minnesota's Dr. Carlos Schenck, one of the physicians who first described REM sleep behavior disorder.
Circle Pines man struggles
Asked about patients, Schenck described men who have jumped through windows while asleep, strangled their bed partners, smashed into dressers, knocked themselves unconscious, and given their wives black eyes. Typically, their experiences are eerily similar: Men dream they're being chased or hounded by large insects, animals or threatening people and have to defend themselves, Schenck said. Almost inevitably, the dreams are colored by violence and aggression.
One of Schenck's patients is Cal Pope, 85, of Circle Pines, who had seen 400 men go down on a ship in the South Pacific in World War II.
"I was sure he was reliving that," said his wife, Rowena, 81, who would watch Cal kick the wall fiercely and threaten to crush people's heads in the middle of the night.
It took nine years for Pope to get a proper diagnosis and treatment.
Sleep study is a start
To be evaluated, patients need an expert sleep study, with electrodes placed on their arms and legs to track movements during slumber, said Dr. Alon Avidan, an associate professor of neurology at Ronald Reagan UCLA Medical Center. A videotape will capture the patient's activities and other conditions, such as sleep apnea, that can cause similar symptoms. Also, alcohol, coffee and certain antidepressants can serve as triggers for REM sleep behavior episodes.
Symptoms are relieved 90 percent of the time by clonazepam (also known as Klonopin), a medication commonly used to treat anxiety, panic attacks and seizure disorders. It helps patients sleep more soundly, wake up less often and have fewer episodes when they do. Many patients also are helped by melatonin, which is being studied at Northwestern as a treatment for REM sleep behavior disorder.
For Lawrence and Bonnie Neumann, night became a time of danger, suffused with the potential for injury. Once, after leaping out of bed in the midst of an episode, Lawrence hit his head on a nightstand, opening a large gash. Another time, he threw himself out of bed head first, smashing his forehead on the floorboards and causing a concussion. It was routine for him to start kicking his wife, dreaming a bear was sneaking up on him.
"The mood was one of defense against attack," he remembered. "If she tried to touch me, I'd come after her."
Bonnie put pads around the bedroom furniture so Lawrence couldn't hurt himself. Other couples take sharp objects away, put mattresses on the floor, arrange foam barriers between them, or move their bedrooms to the ground floor so they don't leap out of second-story windows.
After extensive neuropsychiatric tests and three sleep studies, Lawrence was finally diagnosed with REM sleep behavior disorder in 2008. Doctors gave him clonazepam, which worked like a charm, while also treating a mild case of sleep apnea, which can contribute to episodes.
"It was the first time in more than 16 years that I could say I got a good night's sleep," Lawrence said. "I sleep really well now."
