Alan Alda’s early symptoms of Parkinson’s disease weren’t the typical tremors, stiffness or slowness of movement.
He threw a pillow at his wife while she slept.
“I had a symptom that wasn’t widely known at the time: following your dreams,” the 90-year-old Emmy winner told CBS Sunday Morning.
The “M*A*S*H” star recently revealed that her first indicator of neurodegenerative disease was a rare one: REM sleep behavior disorder, or RBD.
RBD occurs during rapid eye movement sleep, which is the stage where our most vivid dreams occur. While the body is typically paralyzed during REM sleep, certain conditions, such as Parkinson’s disease, turn off the switch that controls muscles, leading to involuntary actions.
“I dreamed that someone was attacking me,” he explained. “And I picked up a sack of potatoes and threw it at them. What I was really doing was throwing a pillow at Arlene, my wife.”
People with RBD may have very active dreams, but because their brain signals do not block movement during sleep, they can physically act out these dreams by punching, kicking, or screaming while they sleep.
This sleep symptom is often linked to Parkinson’s disease and other neurological diseases due to the buildup in the brain of a protein called alpha-synuclein, which damages the area of the brainstem responsible for muscle control.
Although not everyone with RBD is diagnosed with Parkinson’s disease, this unusual symptom is a risk factor that can occur years before a diagnosis.
The “West Wing” alum was first diagnosed in 2015 and shared last year that he also suffered from prosopagnosia, or facial blindness. Alda is one of more than 1.1 million people in the United States affected by Parkinson’s disease, whose risk increases with age.
There are two types of RBD: symptomatic (secondary), which occurs due to an underlying cause, and isolated (idiopathic).
Isolated disease occurs when the disease develops without a cause, and in most cases it will eventually lead to a neurodegenerative disease, such as dementia with Lewy bodies, multiple system atrophy, or Parkinson’s disease.
The risk of developing a neurodegenerative disease increases with time from an RBD diagnosis, with one study finding that 33% of patients developed a disease after five years, 76% after 10 years, and 91% at 14 years.
Other risk factors for RBD include being a man over the age of 50, having narcolepsy, and taking certain medications, such as newer antidepressants.
Although it affects about 2% of the U.S. population over age 50, rates may be higher because the disease is more difficult to diagnose.
To diagnose RBD, a healthcare professional may ask you or your sleep partner about your sleep behavior and order a polysomnogram (an overnight sleep study) to track your heart rate, brain waves, eye movements, and muscle activity.
An official diagnosis requires repeated vocalizations or complex movements during REM sleep, absence of seizures, and no other medical, mental health, or medication-related causes.
Safety measures generally include keeping sharp or heavy objects away from the bed, placing pillows between you and surrounding structures, placing a mattress on the floor, and using a sleeping bag.
Although there are no FDA-approved medications for RBD, studies have shown that melatonin, clonazepam, and pramipexole can reduce symptoms.
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