– SURE, I HAVE HIT ANITA PRETTY
HARD BEFORE.   – AND ONE NIGHT, IT WAS JUST
WHAM, WHAM, ONE AFTER THE   OTHER, RIGHT IN THE TEMPLES.   AND THAT NIGHT, I
DID SEE STARS.   – SOMETIMES I’D CHOKE HER.   SOMETIMES I’D KICK HER.   – WITH MY ARM, HE WAS BENDING
IT BACKWARDS LIKE HE WAS   GONNA SNAP IT.   AND THAT HURTS.   – OF COURSE, YOU WAKE UP
APOLOGETIC AND ALL THAT,   BUT IT’S ALREADY DONE.   IT’S DAMAGE.   YOU’VE HIT YOUR WIFE, AND THEN
YOU HAVE THE MEMORY OF IT.   – WE THINK THAT DREAM ENACTMENT
BEHAVIOR, OR REM SLEEP   BEHAVIOR DISORDER, IS A
LESION CAUSED BY THE PATHOLOGY   OF PARKINSON’S DISEASE
DEEP IN THE BRAIN STEM.   IN THIS AREA, NORMALLY WHEN
YOU DREAM, THIS CENTER WILL   SHUT OFF YOUR SPINAL CORD,
BASICALLY, SO THAT IF YOU DREAM   ABOUT RUNNING AWAY FROM A
TIGER, YOU WON’T ACTUALLY RUN   AWAY FROM A TIGER.   YOU’LL JUST DREAM THAT YOU DO.   WHEREAS IN THESE PATIENTS,
THAT SORT OF OFF SWITCH GETS   KNOCKED OUT BY THE PARKINSON’S
PATHOLOGY, AND SO NOW THEY   WILL QUITE LITERALLY RUN AWAY
FROM A TIGER AND SORT OF RUN   OUT OF BED OR, YOU KNOW,
KICK THEIR BED PARTNER.   – THE PROBLEMS I’VE HAD WITH
MY SLEEP AND THE PARKINSON’S,   AT FIRST, WE THOUGHT IT WAS
PTSD BECAUSE I WOULD ACT OUT   A LOT OF MY DREAMS,
STARTING IN THE LATE EIGHTIES.   I FINALLY WENT TO A VET CLINIC
IN FRESNO FOR THE DREAMS.   – YEARS AGO, WHEN WE THOUGHT IT
WAS JUST THE PTSD, WE DID GO TO   SUPPORT GROUPS, BUT THEY
NEVER TALKED ABOUT IT, LIKE,   WHAT YOU CAN DO TO HELP
WITH THE NIGHTMARES.   – THE DREAMS IMPACTED MY LIFE
IN THE WAY OF THEY WOULDN’T   ALLOW ME TO GET ANY REST,
AND I’D WAKE UP   WITH TREMENDOUS ANXIETY.   THEY WERE SO REAL THAT IT
WOULD JUST LEAVE ME DEVASTATED   THE NEXT DAY.   SO AFTER A COUPLE OF DAYS
OF THAT, YOU’RE PRETTY NUMB   AND PRETTY HARD TO DEAL WITH.   – IN THE VA POPULATION,
IT’S REALLY TRICKY BECAUSE WE   SEE A LOT OF PATIENTS WITH
POSTTRAUMATIC STRESS DISORDER,   AND OBVIOUSLY IN OUR CLINIC,
WE SEE A LOT OF PATIENTS   WITH PARKINSON’S DISEASE.   IT CAN BE REALLY HARD
BECAUSE PATIENTS AND THEIR BED   PARTNERS ARE USED TO A LIFETIME
OF NIGHTMARES FROM PTSD.   BUT MOST OF THE TIME IF WE ASK,
THEY’LL SORT OF DELINEATE   ACTUALLY SOMETHING SORT OF
DIFFERENT ABOUT THE NATURE   OF THEIR NIGHTMARES NOW.   BUT YOU REALLY HAVE TO ASK
THOSE PROBING QUESTIONS TO   SORT OF TEASE THAT OUT.   – I WOULD ACTUALLY EVEN HAVE
FANS IN MY ROOM WHERE I COULD   FEEL THEM WALK IN FRONT OF
THE FANS AND STOP THE AIR,   AND ALMOST LIKE A
HALLUCINATION, YOU KNOW.   YOU’RE AT THE POINT WHERE
YOU’RE AWAKE, OR AT LEAST I   FEEL LIKE I’M AWAKE TO THE
POINT WHERE YOU BELIEVE IT.   YOU WAKE UP MAD.   AND I WOULD FEEL THEM WALK IN
FRONT OF THE FANS AND THEN GET   RIGHT IN MY FACE, AND THAT’S
WHEN I’D COME UP SWINGING.   – WHATEVER CAUSED YOUR PTSD
OR WHATEVER THE THEME   OF THE DREAMS THAT YOU RELIVE
ARE MAY SORT OF INFLUENCE THE   DREAMS IN REM SLEEP BEHAVIOR
DISORDER, WHEREAS IF YOU   DIDN’T HAVE PTSD, YOU MIGHT
BE DREAMING ABOUT SORT   OF THE GARDEN-VARIETY
STUFF THAT YOU AND I MIGHT   DREAM ABOUT.   – EVEN THOUGH PARKINSON’S IS A
HIDEOUS DISEASE, KNOWING THAT   YOU HAD IT WAS KIND OF A RELIEF.   THEN I KNEW WHAT I HAD
TO DEAL WITH.   – CONSERVATIVE THERAPIES FOR
REM SLEEP BEHAVIOR DISORDER   INCLUDE MAKING SURE YOUR
NIGHTSTAND IS NOT RIGHT NEXT   TO YOUR BED, YOU DON’T HAVE
SHARP CORNERS, YOU DON’T HAVE   LAMPS WHERE YOU’RE GONNA BASH
THE LAMP WITH YOUR HANDS.   A LOT OF TIMES, WE’LL ACTUALLY
RECOMMEND THAT PEOPLE PUT   THEIR MATTRESS ON THE FLOOR.   – OUR BED IS ABOUT 3 FEET
UP OFF THE FLOOR, SO NOT   PROTECTING YOURSELF, NOT
BEING AWAKE ENOUGH TO PROTECT   YOURSELF, THAT HURTS PRETTY
GOOD HITTING THE FLOOR.   – THE SECOND STEP IS OFTEN TO
INSTITUTE SOME MEDICATIONS TO   TREAT REM SLEEP
BEHAVIOR DISORDER.   IN THE CASE OF MR. WIENER,
WE USE CLONAZEPAM, WHICH IS   THE MOST COMMONLY ADVOCATED
MEDICINE FOR USE OF TREATMENT   OF REM SLEEP BEHAVIOR
DISORDER, AND WE STARTED   AT A VERY LOW DOSE.   – THE DRUG FOR THE NIGHTMARES,
I TAKE ON A REGULAR BASIS.   THAT’S HOW IT WORKS, IS YOU
TAKE IT ON A–YOU DON’T KNOW   WHEN YOU’RE GONNA HAVE THE
DREAMS, AND IF YOU WAIT UNTIL   AFTER YOU’VE HAD DREAM,
WELL, IT’S TOO LATE.   I TAKE IT EVERY NIGHT,
AND I TAKE IT ABOUT AN HOUR   BEFORE I GO TO BED.   I FEEL THAT IT HELPS ME GO TO
SLEEP A LITTLE EASIER, AND IT   GETS ME ALL THE WAY
THROUGH THE NIGHT WITHOUT   HAVING A DREAM.   – I’M ABLE TO RELAX MORE.   HE RELAXES MORE, OBVIOUSLY,
AND THERE’S LESS NIGHTMARES,   LESS MOVEMENT.   – LIKE A LOT OF PATIENTS,
HE NOTICED A DRAMATIC   DIFFERENCE ON THE
VERY FIRST NIGHT.   AND ONE OF THE NICE THINGS
ABOUT TREATING DREAM ENACTMENT   BEHAVIOR OR REM SLEEP BEHAVIOR
DISORDER IS THAT THE EFFECTS   OF THE MEDICATION ARE
IMMEDIATE, AND SO PATIENTS   WILL LITERALLY TELL YOU
THEY WENT FROM HAVING DREAM   ENACTMENT ACTIVITY EVERY NIGHT
TO NOT AT ALL IF YOU HAVE HIT   A THERAPEUTIC DOSE.   – IT WAS KIND OF
A MIRACLE DRUG.   I DIDN’T THINK SOMETHING
LIKE THAT WOULD EXIST.   AND I TOLD DR. GLASS, WHICH IS
KIND OF FUNNY, I TOLD DR. GLASS   ABOUT THE REVELATION OF
NO MORE DREAMS, AND HE SAID,   “OF COURSE.
THAT’S WHAT THE DRUG IS FOR.”   – IF YOU OR SOMEONE YOU
LOVE HAS PARKINSON’S DISEASE   AND HAS SLEEP PROBLEMS,
IT’S IMPORTANT TO BRING THOSE   TO THE ATTENTION OF YOUR DOCTOR
BECAUSE IN MANY CASES, WE CAN   MAKE THOSE SLEEP PROBLEMS
SIGNIFICANTLY BETTER AND THUS   IMPROVE THE QUALITY OF YOUR
LIFE AND YOUR PARTNER’S LIFE.   – THE STAFF AT THE
CLINIC IS FANTASTIC.   I’LL HAVE TO SAY, YOU NEVER
WALK OUT OF HERE   WITH A BAD FEELING.   JUST EVERY TIME WE SEE THEM,
IT’S A LITTLE MORE OF A HELP   AND AN ANSWER OR HELPING US
GETTING THROUGH THIS, BUT YOU   LEAVE WITH A BETTER FEELING.   – MY SLEEP NOW IS
ALMOST NIGHTMARE FREE.   AND IT ISN’T THAT THE DRUGS
DRUG YOU UP TO THE POINT THAT   YOU HAVE TO GO TO SLEEP.   IT’S AMAZING.   IT JUST KIND OF
ELIMINATED THE DREAMS.   AND THE NEXT DAY, I WAKE UP
AND I’M REFRESHED AND REALLY   HAVEN’T HAD THOSE ANXIETY
ATTACKS SINCE I STARTED TO   TAKE THE MEDICATION.   IT’S MADE LIFE WORTH LIVING.