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Exploring REM Sleep Behavior Disorder and its Neurological Implications!
Delving into the depths of REM sleep behavior disorder (RBD) unveils a complex interplay between the subconscious mind and neurological pathways.
Dreams emerge as expeditions of our central nervous system, unfolding during periods of bodily repose, yet with our minds beholden to the rapid eye movement (REM) phase of slumber. For individuals afflicted by an uncommon malady, their entire physique enacts the dreams, at times leading them to vacate their bedchambers or even their domicile.
REM sleep behavior disorder (RBD) stands apart from noctambulation and, if the movements are sufficiently forceful, can pose peril to the afflicted individual as well as to a slumbering companion.
RBD is an affliction warranting earnest attention, as posited by Jeanne Feuerstein, MD, an adjunct professor of neurology at the University of Colorado School of Medicine, due to its potential link to other neurological disorders, such as dementia with Lewy bodies, multiple system atrophy (MSA), or Parkinson’s disease.
In the ensuing question-and-answer session, Feuerstein elucidates this enigmatic condition, the avenues of treatment, its association with other neurological ailments, and the focal points of her investigation, including an exploration of RBD’s correlation with post-traumatic stress disorder (PTSD), according to medicalxpress.com.
What characterizes REM sleep behavior disorder?
During the REM phase of sleep, which signifies a profoundly entrenched stage of slumber, the brainstem regulates bodily flaccidity. However, individuals afflicted with REM sleep behavior disorder do not experience such flaccidity, resulting in somatic mobility, a phenomenon termed REM sleep without atonia. Consequently, they may exhibit markedly exaggerated dream enactments. Diagnosis is contingent upon a sleep analysis, which captures instances of nocturnal mobility.
Could you elaborate on the diagnostic process for this disorder? What transpires during the sleep assessment?
Typically, diagnosis ensues from an in-clinic sleep analysis. Confirmation necessitates the presence of both REM sleep without atonia and dream enactments, the latter being unobservable via domiciliary sleep assessments. Video documentation in the sleep laboratory is instrumental in documenting dream enactments. Individuals with RBD invariably manifest some degree of REM sleep without atonia nightly, albeit the severity varies.
How do individuals discern their affliction? How does it evolve?
The natural progression remains inadequately explored, although there is speculation that individuals evincing REM sleep without atonia may subsequently develop RBD. Typically, awareness is aroused by a bedmate. Those with RBD are seldom perturbed by their condition unless it culminates in ejection from bed or bodily harm. Generally, it is the bedfellow who discerns the anomaly.
I heard an anecdote about an individual dreaming of being targeted by an incoming missile and, in a bid to evade harm, leaping from a second-story hotel window. He landed unscathed on the verdant turf but narrowly evaded, severing his femoral artery by a mere fraction of a millimetre.
Are such extreme manifestations of RBD commonplace?
Certain individuals sustain injuries from bed falls or inflict harm upon their partners or bedfellows. They may topple lamps or collide with furniture, precipitating potential peril. Anecdotes abound of individuals physically enacting their dreams in myriad ways. In one instance, an individual delivered a political oration, while another was observed smoking. The spectrum of dream enactments is remarkably diverse.
Individuals with RBD must ensure that weaponry is secured, and sharp objects are inaccessible. Some opt for mattresses on the floor or padding on bedposts as safety measures. Oftentimes, affected individuals find themselves sleeping alone, as their significant other refrains from sharing the bed.
How does RBD differ from noctambulation?
Noctambulation occurs during a distinct sleep stage—stage two—which denotes a lighter phase of slumber than REM.
What is the prevalence of REM sleep behavior disorder?
Data remain somewhat equivocal owing to underreporting, yet prevalence is estimated at approximately 0.5%. Of particular interest is the observation that individuals with RBD harbor a considerable likelihood—ranging from 70% to 90%—of developing a synucleinopathy, such as Parkinson’s disease.
Estimates indicate that approximately 30% to 50% of Parkinson’s patients exhibit REM sleep behavior disorder. Incidence rates of RBD are elevated in cases of MSA and dementia with Lewy bodies.
This underscores the imperative for individuals exhibiting dream enactment behavior disorder to undergo a sleep analysis. It is imperative to differentiate their experience from other sleep parasomnias manifesting in alternate sleep stages, as REM sleep behavior disorder may herald a diagnosis of a graver condition.
Are the neural motor pathways implicated in sleep enactment disorder dissimilar from those engaged during wakefulness?
No, the motor mechanisms are largely analogous. During REM sleep, multiple brainstem nuclei interact with spinal cord cells, inhibiting movement. Various brainstem regions contribute to impeding motor pathways in the spinal cord, precluding mobility.
When these connections are suppressed, activation of said pathways ensues, prompting somnambulation. My research at the VA focuses on individuals with PTSD. Those afflicted with PTSD may evince analogous dream enactment behavior—REM sleeps without atonia. This realm remains relatively unexplored. The question at hand pertains to discerning whether this sleep disorder linked to PTSD similarly portends the onset of a synucleinopathy or merely parallels its manifestations. Accordingly, distinguishing between RBD and PTSD constitutes the crux of my inquiry.
Can RBD be discerned via biomarkers, such as synuclein proteins?
Synuclein aggregates can be detected through a seeding technique utilizing cerebrospinal fluid. However, this applies solely to individuals predisposed to develop Parkinson’s or akin disorders. Synuclein, per se, does not serve as a definitive marker for RBD. For instance, narcoleptic individuals manifest REM sleep without atonia yet do not progress to Parkinson’s. Ergo, diverse pathways may precipitate RBD, prompting endeavors to ascertain which cohorts are predisposed to synucleinopathies.
What treatment modalities are available for RBD? The individual who leaped from the window mentioned being prescribed clonazepam.
Clonazepam features prominently among treatment options, albeit it is not the preferred choice due to its psychotropic properties and potential for addiction. Melatonin is typically the preferred treatment, having exhibited efficacy in clinical trials. Extended-release formulations may be favored by some as they mitigate addiction risk. Infrequently, if melatonin proves ineffective, benzodiazepines like clonazepam may be administered. While effective in ameliorating motor symptoms, clonazepam may compromise sleep quality, necessitating a delicate balance.
It appears that RBD remains inadequately understood.
Indeed, that appears to be the case. Sleep disorders, in general, remain enigmatic. Initially embarking on this research endeavor, I anticipated a wealth of clinical knowledge, only to encounter a paucity thereof.
It behooves individuals to recognize that, despite the seemingly eccentric or anomalous nature of nocturnal dream enactments, seeking evaluation is imperative. Equally crucial is discerning whether RBD bears any connection to synucleinopathies, which may herald graver conditions.
Numerous studies are underway for individuals with RBD devoid of Parkinson’s, affording them insights into their condition and potentially informing treatments.
News
Bridging the Gap: Police Training for Black Autistic Youth
Improved police training and awareness are essential to ensure safer, more understanding interactions with Black autistic youth.
United States: Black parents with teenagers with autism have concerns about their children’s vulnerability when they encounter police officers.
Key Findings from the Study
A study published on Dec. 16 in the Autism Journal has revealed that aspects like reduced eye contact observed in children with autism may make police consider them to be guilty, as reported by HealthDay.
Sadly, police officers do not learn that these actions are typical among children with autism, families informed scholars.
Voices of the Researchers
“It’s important for everyone to understand that the parents in this study said they were hopeful, which we interpreted as Black caregivers’ faith that interactions between officers and Black autistic youth could be better,” said lead researcher Ashlee Yates Flanagan, a clinical psychologist at the Children’s Hospital of Philadelphia Center (CHOP) for Autism Research.
Researchers reveal important themes to improve interactions between police and Black autistic youth https://t.co/4KaqLTKU8M
— Continental Clinical (@Conti_Clinical) December 16, 2024
“This demonstrates that there’s space for improvement in training, and we can take what we know from this study and explore it further,” Flanagan added in a CHOP news release.
During the interviews, four distinct themes surfaced:
- The caliber of police officer education
- Inappropriate police enforcement of typical autistic behaviors
- The overt threat of injury and death
- Families believe that police officers may become aggressive towards gestures and responses that are normal for AS children but not for other children, as the study indicated.
Some families said that training might make police see these differences in conduct, which should bring about tolerance and perseverance that could enhance the relations between children and the police.
CHOP Researchers Identify Key Ways to Improve Police Interactions with Black Autistic Youthhttps://t.co/8wlvNa0HUu pic.twitter.com/RhpNeYSc0f
— Autism and Friends (@autismtalknd) December 17, 2024
“In this study, we captured rich narratives from stakeholders who have not been represented well in prior research, but whose thoughts and perspectives are critical for knowing how to improve outcomes for Black autistic youth and police,” said senior researcher Julia Parish-Morris, a scientist in the CHOP Center for Autism Research, as reported by HealthDay.
“Our findings suggest that there is a lot of room for growth in training for police officers and that Black parents of Black autistic youth carry hope that outcomes can be improved,” Parish-Morris added.
News
AI Breakthrough Simplifies Lung Disease Testing
This AI breakthrough promises faster, more accessible, and cost-effective COPD diagnosis with a single CT scan.
United States: Research says that people with breathing problems can know whether they are suffering from COPD with the help of a new lung AI test.
AI Offers a One-Scan Solution for COPD
The newly developed AI can accurately diagnose COPD using data from a single chest CT scan performed as a person inhales, researchers reported Dec. 12 in the journal Radiology: Cardiothoracic Imaging, as reported by HealthDay.
The researchers said it can also inform from that scan how severe a person’s COPD is.
So far, doctors have required two CT scans to diagnose and assess COPD — one when the person has taken a deep breath and one when he or she has exhaled.
“Our study shows that COPD diagnosis and staging is feasible with a single CT acquisition and relevant clinical data,” said researcher Kyle Hasenstab, an assistant statistics and data science professor at San Diego State University.
A Growing Global Health Concern
COPD is defined as a systemic group of lung diseases that become worse over time and make it difficult for individuals in the community to breathe. COPD is chronic, and there is no known treatment for the disease, although it ranks third in deaths globally, according to the researchers’ background information.
The researchers added that spirometry, a lung function test that tests the amount of air, including vital capacity, that a patient can inhale and exhale, has been the primary approach toward identifying COPD.
Some hospitals already use CT images of the lungs to help diagnose COPD because the images can point out lung tissue that might be limiting breath, Hasenstab said.
“However, this type of protocol is not clinically standard across institutions,” Hasenstab said; this is due to the fact that it requires additional training for the staff to be able to take good CT images as well as to be able to interpret them.
Scientists believed that if the AI could read CT scans for COPD, more people could be provided with CT scans, despite a lack of training.
How the AI Works
To provide answers for this study, the researchers captured the inhaled and expelled lung CT scans of nearly 8,900 patients who were tested from November 2007 to April 2011 and their spirometry results.
The average age of patients was 59, and all patients were smokers.
Benefits of the AI Tool
The team then utilized the CT scans and the clinical data to teach the AI to forecast spirometry outcomes.
Study findings indicated that the AI could identify COPD by relying on one of the CT scans and could reasonably express how severe the COPD had become.
Researchers pointed out that when they introduced clinical data, the accuracy of the AI was enhanced.
Researchers also discovered that the AI’s performance was similar when the patients had to hold their breath during the CT scan or when they were breathing normally, as reported by HealthDay.
“Reduction to a single inspiratory CT acquisition can increase accessibility to this diagnostic approach while reducing patient cost, discomfort, and exposure to ionizing radiation,” Hasenstab said in a journal news release.
News
Screen Time Wrecks Preschoolers’ Sleep and Behavior
Excessive screen time disrupts preschoolers’ sleep and behavior, underscoring the need for controlled device usage and better sleep habits.
United States: Excessive use of electronic devices threatens preschoolers’ sleep and urges the child to become a terror of the house, new research shows.
Screen Time and Sleep: A Vicious Cycle
Researchers said poor sleep worsens children’s ability to focus and be less hyperactive and moody, as published in Early Child Development and Care on 12th December.
Worse still, cylinders can occur where kids spend a lot of time in front of screens, leading to poor sleeping habits and consequently increased screen time, as reported hy HealthDay.
“Our results suggest the presence of a positive feedback loop, wherein increased screen time and sleep disturbances exacerbate each other through cyclic reinforcement, heightening the risk of hyperactive attention problems, anxiety, and depression,” said researcher Dr. Bowen Xiao, an expert in children’s socio-emotional functioning and developmental psychopathology with Carleton University in Canada.
The Research: Insights from Parents
To gather data, the authors administered questionnaires to the 571 mothers of preschool children aged between 3 and 6 years attending seven public kindergartens in Shanghai.
Moms recorded the number of daily hours their children spent with a TV, smartphone, computer, or any other screen-based device. They also asked them questions to determine any possible behavioral issues that their kids may have, as well as the quality and duration of sleep their children get.
“Our results indicate that excessive screen time can leave the brains of preschool children in an excited state, leading to poor sleep quality and duration,” said researcher Yan Li, an expert in preschool education from Shanghai Normal University.
Researchers also pointed out that other studies have shown that children’s screen use can cause emotional issues and hyperactivity.
According to this study, screen time may be the cause, according to the experts.
Screen Time’s Impact on Sleep
“This poor sleep may be due to postponed bedtimes caused by screen viewing and the disruption of sleep patterns due to overstimulation and blue-light exposure,” added lead author Shujin Zhou, a doctor of psychology at Shanghai Normal University.
“Screen use might also displace time that could have been spent sleeping and increase levels of physiological and psychological arousal, leading to difficulties in falling asleep,” Zhou said in a journal news release.
Therapeutic Implications
According to Zhou, these findings may help guide future therapies for young children’s mood and hyperactivity issues.
“The implications of our study are two-fold: first, controlling screen use in preschool-age children can help alleviate behavioral problems and poor sleep quality, and second, sleep interventions and treatments can be effective in mitigating the adverse effects of screen time on behavioral issues,” Zhou noted, as reported hy HealthDay.
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