ouch! I hit my head!

Hi Mary Ann—

No, I don’t think your hitting your head was “dumb luck.” Rather, it actually is a classic instance of REM Behavior Disorder—a disorder which we have seen appear in this column more than once. In your case, though, you hurt yourself in the process of “acting out your dream,” and this is what we always fear with this disorder.

REM Behavior Disorder is a failure of the body to completely intercept the commands for movement that are routinely generated by our brains during Dreaming, or REM sleep. In a famous experiment performed on cats by the French researcher Michael Jouvet in 1963, Jouvet lesioned the location in the brainstem that is responsible for intercepting these signals. When the cats recovered from surgery, remarkably enough, they all demonstrated REM Behavior Disorder. Which is to say that, instead of sleeping peacefully through their dreams, the cats actually got up and began acting them out. Most of the activity observed was what one normally sees in developing kittens—play fighting, pouncing and leaping—but this time the play was all performed with imaginary objects.

REM sleep is remarkably uniform across all warm-blooded creatures. Cats, dogs, wolves, horses, bears—we all dream. And we all experience the concurrent loss of muscle tone that, coupled with the activation of the dreaming brain, is so defining of REM sleep. But the dampening of motor response to the commands for movement is imperfect. Cats twitch their whiskers; dogs “run” in their sleep. Surely horses and bears experience the same twitches and jerks. In humans, REM Behavior Disorder commonly manifests itself as sleep-talking. The mouth and vocal cords are not “turned off,” and so we vocalize our dreams. In more severe cases, people actually get out of bed and run around the room. When this happens, the disorder—as you well know—can become dangerous.

If this is a one time event—that is, you don’t have a history of getting up and acting out your dreams—then most doctors would refrain from prescribing you any
medication to treat the disorder. If it has happened before, or if it happens again, then you definitely want to consult with a sleep physician. A sleep specialist will take a detailed history of your experiences (be sure to bring your bed-partner with you to get an accurate accounting), and may want to perform a test in a sleep lab. Once your level of disturbance is determined, together you can assess your treatment options. Good luck!

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