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“I used to laugh about it and call it ‘The Wes Show,’” said Eileen Mills, 49, of Taos, New Mexico.
But he doesn’t find it funny anymore.
Wes Mills, a contemporary artist working in The Whitney and MoMA, hasn’t been able to hold a pencil for more than a year. Her tremor started on one side of her body and now affects both sides. In January, at age 63, she was diagnosed with Parkinson’s disease.
Researchers say dream depictions can indicate health problems, with one of the most common and serious being the future onset of Parkinson’s disease. Wes Mills began acting out his dreams more than 10 years before his first tremor appeared. Other common conditions that can lead to dream enactment are obstructive sleep apnea and post-traumatic stress disorder (PTSD).
Those who regularly act out their dreams should consult a doctor and undergo a sleep study to discover the underlying reason for their behavior, experts say.
Why do people act out their dreams?
When changing to rapid eye movement (REM) sleepWhen dreams occur, the body normally goes into a state of almost total paralysis to prevent the dream from coming true. But some people (approximately 1 percent of those over 50 years of age lose this paralysis.
This chronic sleep condition, known as REM sleep behavior disorderor RBD, appears most frequently in middle-aged men, researchers have found.
“The brain stem has two joined nuclei that generate the protective paralysis of REM sleep, and when one of them, or its connecting pathway, is damaged, muscle tone is released,” he said. Carlos Schenck, psychiatrist at the Minnesota Regional Sleep Disorders Center. “People can then represent their dreams.“
In 1986, Schenck and his colleagues RBD described for the first time in four men and one woman, aged 60 or older. Most had a long history of injuring themselves or their bed partners with aggressive behaviors while they slept. One patient had tried to strangle his wife while she dreamed of fighting a bear, while another knocked down furniture while dreaming of being a soccer player. The researchers noted that RBD is distinct from sleepwalking, which originates in non-REM sleep.
Dream representation behavior has also been documented in severe obstructive sleep apnea, as it causes people to abruptly stop breathing for brief periods during sleep and partially wake up. Since these breathing interruptions are most common and severe during REM sleep, they may represent your dreams, mimicking the symptoms of RBD, Schenck said.
About 39 million American adults have Obstructive sleep apneaaccording to the National Council on Aging, but it is unknown how many of these adults make their dreams come true.
Similarly, those with PTSD may show signs of reliving their trauma through representation of dreams. About 70 percent of patients with PTSD report sleep disturbances and up to 70 percent have recurrent nightmares. However, there is no data on the prevalence of dream enactment behavior in post-traumatic stress disorder, Schenck said.
The link between RBD and Parkinson’s
For those with RBD, the risk of Parkinson’s is astonishingly high. People age 50 and older with idiopathic RBD (occurring spontaneously without other health problems or recent changes in medication) have a 130 times greater probability of developing Parkinson’s disease compared to someone without the sleeping condition.
“There is nothing like this. …80 percent of people with this condition develop Parkinson’s disease 15 to 20 years later,” he said Ronald Postumadirector of neurology at the McGill University Health Center.
RBD is 10 times better than any other clinical marker (for example, an abnormal motor exam or loss of the sense of smell) in predicting the eventual onset of Parkinson’s. RBD is strongly associated with other synucleinopathiesAlso, a group of diseases that includes dementia with Lewy bodies and multiple system atrophy.
bad folding alpha-synuclein, a protein, is considered to play a role in both idiopathic RBD and Parkinson’s and other synucleinopathies. When misfolded protein builds up in large toxic clumps in the brain, it can disrupt nerve cell function and cause Parkinson’s symptoms such as tremors and stiffness.
The brains of people with idiopathic RBD have enough misfolded alpha-synuclein to affect their REM sleep, but the harmful protein has not spread further in the brain, experts say.
Very rarely, RBD It can be caused by a stroke, a tumor, or medications such as certain antidepressants.
What to do after an RBD diagnosis
RBD presents a unique opportunity for researchers to study early Parkinson’s disease, its progression, and preventative therapies. For example, Michele Huprofessor of clinical neuroscience at the University of Oxford, co-directs a randomized placebo controlled trial in patients with RBD testing whether a drug can reduce brain inflammation, an early feature of Parkinson’s.
“We know that lifestyle modifications, such as exercise, also slow the progression of Parkinson’s, so there is even more reason to think it is likely effective in RBD,” Hu said. “And that’s what I tell all the patients we diagnose with RBD.”
People with RBD, diagnosed through a sleep study, can enroll in the RBD record established by the North American Prodromal Synucleinopathy Consortium (NAPS), whose goal is to develop treatments that prevent or delay the onset of neurodegenerative disorders associated with RBD. The Michael J. Fox Foundation also seeks people who represent your dreams participate in the Parkinson’s Progression Markers Initiative (PPMI) to identify biological markers of the risk, onset, and progression of Parkinson’s disease.
“You have to plan your life accordingly: retirement planning, financial planning, taking those trips with your family that you’ve been putting off,” Schenck said. “I think knowledge is actually very useful in terms of life planning, and not just pessimism.”
Eileen Mills has been trying to strike a balance between living in the moment, such as hiking with her husband and dog, and making necessary preparations based on her recent diagnosis, such as long-term insurance. And Wes Mills still loves creating art. He has focused on things he can do, like sculpting and woodworking.
“When it became apparent that he couldn’t hold a pencil still, he didn’t even miss a beat. She immediately started working in a new medium,” Eileen said. “Wes is honestly the most extraordinary human being I know.”
Do you have a question about human behavior or neuroscience? Email BrainMatters@washpost.com and we may answer it in a future column.