Sleep and Alzheimer’s, Sundowning, RBD – Ask Dr. Sleep

Dear Doctor,
When my telephone rings in the middle of the night it wakes me up from sleep and I feel as if I am dying. My heart pounds irregularly, I get scared, dizzy and I start sweating. It takes few minutes before I become “normal” again and can talk. What causes this phenomenon? What should I do?
Stephanie R. Oak Park, IL

Dear Stephanie,
What happens to you is actually a quite common experience. The morning hours are usually occupied by REM sleep. This is a time of dreams and high emotional sensitivity. Your heart rate might also become unstable at that time. When an external stimulus such as a loud ringing, a drop of cold water or a rough touch suddenly
disrupts sleep, your heartbeats become irregular for a minute or two. This is associated with the feelings you described so eloquently.

Usually, it is not dangerous but if this happens frequently or the person has an underlying heart problem such as a heart arrhythmia, the stimuli in the morning might be more troublesome.

It would be a very good idea to tell your doctor and consult a cardiologist to evaluate your individual situation. You also could contact a sleep specialist. A sleep evaluation could rule-out an underlying sleep disorder that can cause sleep arrhythmias.
Good Luck! -Dr. Sleep

Dear Doctor,
My 72-year-old father is frequently agitated, screams and shouts while he is sleeping especially in the morning when someone touches him. He hurt himself, broke some things and hit my mom. He does not remember this later. Is it a sleep disorder or is he developing Alzheimer’s disease?
Larissa W. Morton Grove, IL

Dear Larissa,
The nighttime agitation as you described frequently is seen in patients suffering from Alzheimer’s disease. These patients develop agitation, hallucinations and confusion, which become worse at night. It might be related to another phenomenon: “sundowning”, which is also frequent in older people and characterized by periods of predominantly nighttime confusion associated with partial or complete inversion of sleep biorhythm (agitated at night and sleepy during the day). These patients become extremely fearful and agitated and scream and shout when the lights are turned off at night. In these patients there seem to be an impoverished processing in some areas of the visual systems of the brain and the reduction in activity and sensory input at night can cause hallucinations.

Because his symptoms are more frequent during the morning hours, what you described about your father is probably related to the condition called REM (Rapid Eye Movements) Behavior Disorder. Physicians called it RBD. The patient with RBD might or might not have Alzheimer’s disorder. This condition is characterized by significant behavior agitation in the morning hours while they are sleeping in the REM stage. The person might kick, thrash about in bed, scream loudly, might strike accidentally a bed partner or break things in close proximity as well as hurt himself against the corners of furniture. It is very importantly to consult your doctor and a sleep specialist. RBD might have a progressive course but could be treated effectively.
Dr. Sleep