I have recently had to contact my doctor as I have been abruptly waking up in the night to find I am thrashing about which has resulted in me knocking things off my bedside table (such as my lamp and radio), screaming out, shouting, and even falling out of bed (or some combination of these). Often, I seem to be acting out my dreams/nightmares (sometimes known as ‘dream-enactment’) and this is a form of REM sleep behaviour disorder, and the ‘shouting out’ part of the disorder is known as somniloquy (it should be noted, however, that somniloquy’, or talking in one’s sleep, when it occurs by itself and does not cause distress, is very common and about two-thirds of people do it). Healthy individuals do not act out their dreams/nightmares as, during REM sleep, the body usually becomes temporarily paralyzed. In the case of REM sleep behaviour disorder, though, this self-protective temporary paralysis fails to function.

Several studies have shown that sleep behaviour disorder and other parasomnias are often early signs of PTSD and occur more frequently in those who have been diagnosed with PTSD or have experienced significant trauma, including, of course, childhood trauma (e.g. Bader et al., 2007).

Research carried out by Insana et al.(2012)   found that traumatic experiences during early life were associated with REM sleep fragmentation and that such fragmentation, in turn, was associated with later-life disruptive nocturnal behaviours. REM sleep fragmentation occurs because brief bursts of high arousal during REM sleep wake the individual up, thus making sleep discontinuous and potentially leading to frequent waking by the sufferer and greatly diminishing his/her quality of sleep. This poor quality of sleep, in turn, as very frequently associated with extreme daytime fatigue (i myself can often need to spend several hours a day resting/trying to sleep and, if I’m lucky, getting some fitful sleep on top of the ten or so hours of extremely poor quality, fragmented, disordered, so-called ‘sleep’ I am forced to endureevery night.

Kajeepeta et al. (2015 involved) undertook a systematic review in order to summarize the findings of 30 studies that investigated the relationship between ADVERSE CHILDHOOD EXPERIENCES  (ACEs) and sleep disorders and found that the vast majority of studies found a significant correlation between adults who had experienced ACEs and their likelihood of suffering from a sleep disorder. Furthermore, many of the studies suggested that the more ACEs a person has experienced, the greater his/her risk of suffering from a sleep disorder during adulthood. The authors of this study concluded that their findings highlighted a need for trauma-informed care for survivors of childhood trauma who were experiencing an adult sleep disorder. Research by Sullivan et al. (2019) suggests that, without effective treatment, the damaging effects that ACEs can have on sleep can last up to 50 years.

It is known that the experience of adverse childhood experiences (ACEs) increases the risk of various diseases in adulthood it has been theorized that the adverse effect of ACEs on quality of sleep may significantly contribute to this link.

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When Sleep Disorders Lead To Dangerous Behaviour

Sometimes sleep disorders, including REM sleep behaviour disorder, can lead to violent and dangerous behaviour. In extremely rare cases, such dangerous and violent behaviour can lead to fatalities. One well-known example of this is the case of Brian Thomas (60 years old at the time of the incident) who, whilst on holiday in Wales and sleeping in a camper van, experienced a nightmare that involved him trying to fight off an attacker (i.e. the ‘attacker’ who featured in his nightmare) only to wake and find he had strangled his wife (Christine, age 57) to death. An expert in forensic sleep medicine investigated the case and explained to the court that Brian had been suffering from night terrors at the time of the incident which exempted him from responsibility for his wife’s death. As a result, the court found him not guilty.

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REM sleep disorder may also be associated with Lewy body dementia, Parkinson’s disease, and multiple system atrophy. I hope this is not the case with my own condition but will be certain to ensure I make my GP is aware of this link when I next see him.

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REFERENCES:

Bader, Klaus PhD*; Schäfer, Valérie MSc*; Schenkel, Maya MSc*; Nissen, Lukas MSc*; Kuhl, Hans-Christian MSc*; Schwander, Jürg MD† Increased Nocturnal Activity Associated With Adverse Childhood Experiences in Patients With Primary Insomnia, The Journal of Nervous and Mental Disease: July 2007 – Volume 195 – Issue 7 – p 588-595
doi: 10.1097/NMD.0b013e318093ed00

Insana S P, Kolko DJ, Germain A. Early-life trauma is associated with rapid eye movement sleep fragmentation among military veterans. Biol Psychol. 2012;89(3):570-579. doi:10.1016/j.biopsycho.2012.01.001

Kajeepeta S, Gelaye B, Jackson CL, Williams MA. Adverse childhood experiences are associated with adult sleep disorders: a systematic review. Sleep Med. 2015;16(3):320-330. doi:10.1016/j.sleep.2014.12.013

Sullivan K, Rochani H, Huang LT, Donley DK, Zhang J. Adverse childhood experiences affect sleep duration for up to 50 years later. Sleep. 2019 Jul 8;42(7):zsz087. doi: 10.1093/sleep/zsz087. PMID: 31281929.