MEN ASLEEP: VIOLENT SLEEPING SYNDROME
Sharing a bed with a violent sleeper is no joke. Not only can violent sleepers injure themselves, but they are a menace to their partners. In the middle of the night they may unknowingly lash out at the sleeping body next to them, begin shouting uncontrollably or urinate in a pair of shoes. They can do the craziest things while remaining fast asleep. Over a prolonged period, this kind of sleeping disorder can cause considerable marital discord.
Take the case of an ex-footballer who repeatedly mistook his wife’s head for a football. While still asleep himself, he would lunge across the bed, grab her head under his arm and try and make off with it. She found this deeply disturbing, and it was only after she moved into another room that he decided to seek treatment.
He was embarrassed and ashamed. She was confused and feared that after 30 years of marriage his true feelings were finally coming out – that deep down he hated her.
The husband, who was in his 60s, had been a rugby player for many years and had then been a referee. The assaults on his wife’s head seemed to follow a pattern and would usually occur on Sunday nights during the football season. Typically, he would spend a large part of Sunday watching football on television and then go to sleep, only to incorporate the game in his dreams.
But because he suffered from a particular sleep disorder, he would attempt to act out his dreams. Dreaming usually occurs during REM sleep, when most people are in a state similar to paralysis. Even if their dreams are hectic, their bodies remain still. If, however, they have a REM sleep disorder, they can move freely and often try to act out the dream. This disorder occurs almost exclusively in men and usually begins around the age of 50.
If woken during these episodes, men become rapidly alert and orientated. Once awake, they have vivid dream recall and often describe having to fight off attackers, or similar scenarios. More than 80 per cent of them eventually suffer some injury from the episodes.
While this disorder is more common in men who have had strokes, it also occurs with alcohol-related brain damage. Those who are perfectly well may suffer from it too, and if they are followed up, about 30 per cent will ultimately develop Parkinson’s disease. This disorder may be an early marker for Parkinson’s.
Fortunately REM sleep disorder can be controlled with anticonvulsant medication: the ex-footballer and his wife are now peacefully back in the same bed.
Men who sleepwalk or experience night terrors can also be violent sleepers. These episodes usually occur during the first third of the night’s sleep, during slow-wave sleep, when they are in a kind of limbo – not quite awake but not fully asleep either.
Typically, an episode of night terrors begins with the man sitting up in bed screaming. He will be terrified, his heart will be racing and he will be sweating and trembling. He may leave his bed and injure himself or someone else. In panic, he may jump on his partner or run through a window.
During the episode he will seem disorientated and unresponsive and will usually not achieve full consciousness. The episode may last from a few seconds to 20 minutes, after which he will go back to sleep. This ability to return to sleep after such extreme panic is striking. Unless he becomes fully awake during the episode, he is unlikely to remember it in the morning.
Night terrors are quite distinct from nightmares. Nightmares arise during REM sleep and tend to occur later in the night. A man suffering nightmares is less anxious and more easily woken. He can usually recall the narrative of the nightmare.
In the case of night terrors there is no story – just a terrifying image from which the man feels compelled to escape. Family members who witness this are impressed by the man’s sheer panic and their inability to console him.
Men who experience night terrors as children can have them reactivated in adulthood by traumatic or stressful events. One man began having night terrors again after a difficult divorce that involved separation from a child.
Sleepwalkers have the same confusion and lack of responsiveness but not the intense panic. They too can’t remember what happened during the night when they wake the next morning. In Sydney a student who had been knocked over by a car at midnight could not explain what he was doing in pyjamas on the main road.
After a night’s drinking, another student went to bed, only to get up a short while later and walk right off the second-floor balcony of his college. He broke both legs and couldn’t recall the incident. The range of treatments for men suffering these disorders includes psychotherapy, drugs and behavioural modifications such as avoiding sleep deprivation, excessive alcohol consumption and going to sleep with a full bladder. Sometimes it is necessary to remove dangerous objects from the room and fit special latches to doors and windows.
Wives complain that men who suffer nocturnal epilepsy are violent sleepers too. These men may be fine during the day but occasionally have a seizure while asleep. Some have classic grand mal seizures with fitting, shaking, stiffness and incontinence.
Others have frontal seizures that manifest themselves in bizarre behaviour. These men may begin chewing, banging their head or smacking their lips. This epilepsy can be controlled with medication.
In Canada, violent sleeping was recently used as a defence in a murder trial. A jury acquitted a man who drove kilometres and then murdered his mother-in-law and attacked his father-in-law, all while asleep.
While there is an understandable reluctance to admit to violence during sleep and a widespread perception that it is a sign of mental illness, violent sleepers can draw comfort from the fact that their condition is treatable. They shouldn’t worry that they are going crazy or that they have hidden secrets. They should just seek help.
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