Being beaten in a dream and waking up with a black eye? Revealing the terrifying interpretation of dreams!

Author: Zhou Fenli, deputy chief physician, Peking University Shenzhen Hospital

Reviewer: Fan Dongsheng, Chief Physician, Peking University Third Hospital

A special elderly couple came to the sleep clinic of the Department of Neurology. The husband had his arm hanging and the wife had a bruised face and a swollen nose. The two elderly people looked like they had been beaten. What on earth had they experienced?

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After careful questioning, it turned out that the husband often had nightmares in which he was chased and beaten by others, and then he showed corresponding resistance behaviors in his sleep, such as beating his wife next to him or falling off the bed to escape from the chase. Such nightmares happened from time to time, and the two elderly people had been injured many times. In fact, this is not just a nightmare. Acting out the content of dreams during sleep is a sleep-related disease - rapid eye movement sleep behavior disorder (RBD).

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During the sleep cycle, there is a period of rapid eye movement, which is called rapid eye movement sleep. During this period, people will have vivid dreams, but their self-protection function will relax their muscles and keep their bodies still. RBD patients lose this self-protection function, and their muscles are not relaxed, which causes them to express the content of their dreams through physical movements, which can bring dangers. For example, in a dream, they may fall off the bed or even fall from the balcony to avoid being chased, or hurt their bedmates in resistance to beatings.

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The incidence of RBD is about 0.5% in the general population and about 2% in people over 60 years old. Its core characteristics are nightmares and abnormal sleep behaviors. Common abnormal sleep behaviors include punching, kicking, falling from the bed, as well as talking, screaming, groaning, etc. The causes of RBD are divided into primary and secondary: the primary cause is currently unclear and may be inherited from the family; the secondary causes include drug-induced, alcohol withdrawal, and neurodegenerative diseases such as Parkinson's disease. In addition to clinical manifestations, RBD can also be diagnosed by polysomnography. The first priority in the treatment of RBD is safety protection, especially for patients with violent dream behavior. The safety of the sleeping environment should be ensured, dangerous items should be removed, the corners of furniture should be wrapped with soft objects, the balcony should be closed, the glass windows should be protected for safety, and the doors and windows should be closed; the bed should not be too high, and it is best to place the mattress on the floor; live in separate rooms from your partner. There are currently only two first-line drugs for drug treatment, namely melatonin and chlordiazepoxide, both of which are recommended to start at low doses. For the elderly, melatonin is safer than chlordiazepoxide.

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You can quickly screen your risk of RBD by asking yourself this question: Has anyone ever told you, or do you suspect that you act out your dreams during sleep, such as punching, waving your arms in the air, or running? If the answer is yes, then it is recommended that you visit the sleep clinic of the Department of Neurology in a timely manner.