Discovering a completely new disease? That almost never happens anymore. Yet there is a field in which new syndromes regularly emerge: sleep medicine. This is mainly because we have only been able to properly study sleep since we have been able to measure people’s brain activity via an EEG. This technique was developed in the 1920s, but it was not until 1953 that REM sleep was first described. Since then we have learned much more about special sleep phenomena, such as talking in your sleep, sleepwalking and sleep paralysis.
And then there is the so-called REM sleep behavior disorder (RBD). In addition, people scream, hit or kick during their dreams. It is now clear that this sleep disorder has a link with Parkinson’s disease, an incurable brain disease. The ‘shaking hand’ is a classic symptom. What’s up with that?
Yelling, hitting and kicking
REM sleep is the most enjoyable part of the night for many people. In this phase you are dreaming. Your brain shows almost as much activity as when you are awake and your eyes start to move. Your brain stem does paralyze your skeletal muscles, because otherwise you would live out your dreams. This way you can explore completely quiet dreamland.
But REM sleep is not a positive experience for everyone. ‘In the mid-1980s, sleep researchers Schenck and Mahowald discovered for the first time that all the features of REM sleep are present in some people, except for muscle paralysis,’ says sleep physician Sebastiaan Overeem of Kempenhaeghe Center for Sleep Medicine. Their patients were very restless during their dreams and often even violent.
But things got really interesting when Schenk and Mahowald noticed that ten years later, part of their research group was diagnosed with Parkinson’s disease. Sleep researchers dug in and confirmed the link between the two.
Sleep doctors and neurologists work together
That the REM sleep behavior disorder predicts that Parkinson’s is lurking has therefore been known for thirty years. Yet little was done with it by neurologists. ‘That was mainly because we don’t have much to offer people’, says neurologist io Sirwan Darweesh, who researches Parkinson’s disease. ‘We cannot yet prevent or cure the disease.’
That sentiment used to prevail among doctors, says Overeem. ‘Some sleep doctors believed that you should not inform people about the relationship between Parkinson’s and RBD, because we could not predict whether and when they will develop Parkinson’s. But people have a right to information. And research also shows that people with this sleep disorder want to know.’
But that tide has turned. To further unravel the mystery, sleep doctors like Overeem are increasingly collaborating with neurologists like Darweesh. “Of all the signs of early Parkinson’s, sleep disturbance is the strongest indicator,” Overeem says. The disorder thus plays a crucial role in the early detection of the disease. Darweesh: ‘It is really the minority that has not developed Parkinson’s twenty years after the sleep problems were diagnosed.’
Brain stem not working properly
But how is it possible that those dream sleep problems occur so early? What you should know about Parkinson’s is that it can arise in several places in the body. For example in the olfactory nerve, the brain or in the intestines. From there, the disease spreads upward through the body, affecting nerve cells along the way. This makes it difficult for you to produce the chemical dopamine, and you get problems with thinking and moving.
‘If the dream sleep problems develop before people get the classic Parkinson’s symptoms, the disease probably originated in the gut,’ says Darweesh. “From there, it ascends through your spinal cord to the brainstem. That brain area is therefore affected by Parkinson’s quite early.’ And precisely in that brain stem is the area that ensures that your muscles flatten during REM sleep. “It won’t work then.”
tolerate Parkinson’s
According to Darweesh, Parkinson’s is often diagnosed around a person’s 70s, even though symptoms start much earlier. ‘There is at least five years between the first signs and the diagnosis. People often keep going through with complaints.’ The dream disorder often starts even earlier, sometimes as much as twenty years before the onset of the classic symptoms, such as the shaking hand.
It’s a shame that people wait so long to see a doctor. ‘Parkinson’s is a progressive disease’, says the neurologist. ‘The longer you keep walking around with complaints, the more irreparable brain damage will occur.’ It is true that this damage cannot (yet) be repaired with medication, but various trials are already underway. Overeem: ‘If you already know that you run an increased risk of Parkinson’s, you can keep an eye on developments and respond immediately.’
According to Overeem and Darweesh, it is therefore important that people sound the alarm if they notice that they are living their dreams screaming and kicking. If only to rule out that you have REM sleep behavior disorder. “Other sleep disorders also cause restlessness during dream sleep, such as nightmare disorder,” says Overeem. “So it’s important to find out why you move while dreaming.”
Participate in research
Neurologist Darweesh will start one soon new research on Parkinson’s, which specifically people with the sleep disorder can participate in. He hopes to find ways to prevent the still incurable disease.
2023-07-25 08:31:38
#live #dreams #night #higher #risk #Parkinsons
