The violent sleep disorder that could cure Parkinson’s disease

by | Sep 22, 2016

Sue Geagan dreads going to bed.

Her husband, Patrick Geagan, is a gentle giant during the day, she said. But at night, he dives into the wall, jabs his arms in the air and screams obscenities.

“He doesn’t know it’s happening and I can’t wake him up,” Sue said. “His dream just keeps going on and on.”

Patrick even talks to Sue, throwing out cuss words and smutty ideas he would never say during the day. He’s been caught on camera yelling, “Hey a**hole” and “peckerwood.”

Speaking candidly in the sunroom of their home in Eagan, Minnesota, Sue told Patrick: “I have, in the past, even locked the door because I’m afraid you’ll come barging in on me. You’re being so mean and that isn’t you at all.”

“I had one the other night,” Patrick said. “I can’t remember exactly what I was doing — but I woke myself up when I threw my iPad into the wall. Put a dent in the iPad and a hole in the wall.”

Remarkably, the iPad still works, though the wall needs paint.

Patrick has rapid eye movement sleep behavior disorder, or RBD. People with RBD act out vivid and often violent dreams, sometimes hurting themselves and those around them. It’s similar to what dogs do when they “chase squirrels in their sleep.”

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It’s different than sleepwalking, said Dr. Michael Howell, a sleep neurologist and an associate professor at the University of Minnesota. Dream enactment happens during REM sleep, a stage when we all have lifelike and action-packed dreams. This is the time during sleep when the brain consolidates memories. Normally, we just lie there. The brainstem paralyzes our muscles so we don’t act out our dreams.

For people with RBD, though, the signal for paralysis short circuits.

“If you are not paralyzed you will act out these dreams,” Howell said. “This can include punching, kicking, jumping… and sometimes this can involve bed partners and it can be absolutely terrifying.”

Sue started fearing sleep nearly 20 years ago, when Patrick began showing symptoms for RBD. It was just a few years after he was diagnosed with Parkinson’s disease.

“I think it was in Florida one time, I think in my sleep [he] must have hit me because I had a bruise,” she said.

Patrick Geagan acts out a dream where he’s tossing an explosive over a hedge. Video courtesy of Dr. Michael Howell, University of Minnesota Medical Center. (Photo credit: Michael Howell/University of Minnesota Medical Center)

“… he had grabbed his wife’s head and started to turn…”

Michael Howell, M.D.

Sleep Neurologist, University of Minnesota Medical Center

"It can involve bed partners, and it can be absolutely terrifying..."

by Dr. Michael Howell

Since then, she’s found Patrick wandering around the house or crashing into walls. Patrick, a retired 30-year veteran of Eagan’s police force, said he’s often trying to save people in his dreams, which sometimes replay real events from his past.

Once, Sue woke up to Patrick attacking her. In an attempt to defend herself, she pushed him off the bed so forcefully he broke his back.

That’s when they decided to undergo an overnight sleep study with Howell at the University of Minnesota Medical Center.

“Stories such as Patrick’s are not unusual,” Howell said. “One example was of a gentleman who was in his dream deer hunting. He had shot the deer and the deer wasn’t dead yet. He thought the kind thing to do was to was to grab the deer by the antlers and break its neck. The problem was he had grabbed his wife’s head before she screamed and woke him up.”

About 1.5 million people in the United States have RBD — the global estimate is 35 million — but there are likely many more who are not diagnosed. “A lot of people leap out of bed, and a lot of surgeons do a wonderful job of fixing the broken bones, but nobody asks the question: Why did an otherwise normal adult jump out of bed? An adult should never fall out of bed. That shouldn’t happen.”

Since it was first described by Dr. Carlos Schenck in 1982, researchers estimate roughly 90 percent of people diagnosed with RBD later develop brain degenerative diseases, like Parkinson’s and certain forms of dementia. But at night, all the debilitating symptoms seem to go away.

“People who have Parkinson’s disease and have horrendous tremors are still capable of making extremely dramatic lunging, jumping, punching and kicking movements they would not be able to do during the day, which is really fascinating,” Howell said.

This has led some researchers to hope that a cure for Parkinson’s may be hidden somewhere in its connection to RBD.

“One of the new exciting things in neuroscience is the development of protective therapies, kind of an aspirin for the brain,” said Howell.

Researchers are years away from developing a treatment from this line of study. For Patrick Geagan it will likely come too late. For now, Patrick hopes he doesn’t stray too far from the bedroom and relies on Sue to wake him.

In the face of this disease they both fear, they often turn to humor.

“You know you could say nice things to me but you don’t, you swear bloody murder. It’s awful,” she chidingly told him. “You are a soft touch. It’s too bad to see you like that because you’re a real nice guy.”

“You’re ruining my reputation,” he shot back with a laugh.

Source: Carlos H. Schenck, M.D., Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, University of Minnesota Medical School

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