I hit my girlfriend. This isn’t the kind of thing one brags about though I suppose some people do. Girlfriend hitting is bad under any circumstances, but context is important, especially here. Becca was asleep when I popped her one. I know that doesn’t make what I did excusable, but here’s the thing: So was I.
Someone was attacking me from behind in a dream I was having. It wasn’t Becca, just some guy I didn’t recognize who was upset with me for some reason or another. Awake Dave can be a real dick. Maybe Dream Dave can be as well. At any rate, I decided to fend off my assailant by punching behind me. I don’t know if dream fist connected, but reality fist landed on the top of Becca’s head.
“That hurt, you asshole!” she said before relocating to the couch.
I felt terrible about that and also worried. This was the third time this kind of thing had happened. On a previous occasion, I pulled her hair. Before that, I shoved her. They all happened while fending off an attack that didn’t exist in the waking world.
While waiting at the bus stop, I googled “thrashing in your sleep” and the first result to come up was REM Behavior Disorder, or RBD. It occurs in roughly 0.5% of the population (most often in men over 50) and is at its most lively during violent dreams.
People normally have muscle paralysis during REM. Not so if you have RBD. You physically act out whatever it is you’re dreaming. If it’s picking your nose, no big deal. If it’s a pitched Kung Fu battle, it’s a lot more dangerous.
Reading on, I learned that the symptoms can be controlled. Often, this is accomplished by taking either clonazepam or melatonin. When it isn’t, restraints are sometimes required. Fortunately, I live in San Francisco. If required, a quick shopping trip South of Market would get me anything I’d need.
That was the good news. The bad news was that RBD is an indicator of a current or future neurodegenerative disease. Parkinson’s is the most common of these, and also the least frightening. There is also something called Dementia with Lewy Bodies, which is a little like Alzheimer’s, but with half the memory loss and twice the crazy. And then there is Multiple System Atrophy, which is every bit as fucked up as it sounds.
At work, I messaged Becca letting her know I would pick up some melatonin in the hope it keeps me from bopping her on the head. I also told her about the potentially scary long-term prognosis. We both agreed if there were any further episodes, I’d bring it with my doctor during my next appointment. If Parkinson’s kicked in, it probably wouldn’t be for another 12-13 years and there was no point in agonizing over unpleasant maybes.
Unfortunately, agonizing is my default setting. I stepped up my online research and found little to comfort me. For one thing, the 38% conversion to Parkinson’s reported on WebMD was both out of date and grossly underestimated. A more recent study concluded that 80% could look forward to serious brain malfunction. To make matters worse, RBD with Parkinson’s increases the chances of accompanying dementia or psychosis.
Within a week, I was a nervous wreck. Even with melatonin, I spent hours awake each night. I felt shitty about the future and shitty about the present. Call me a radical feminist, but I never want to hit my girlfriend again.
Becca was very sweet when I apologized to her.
“Don’t worry, sweetie. You didn’t hurt me,” she said.
“Oh, but you said I did.”
“I was just mad that you woke me up, my love. I’m fine, really. You can’t punch for shit.”
At least there was that. Still, I had a hard time thinking about much else. This was a problem. I’m a computer geek so I need my mind reasonably clear for whatever undocumented, unintuitive thing that’s being thrown at me that day. Even if I didn’t have any more violent sleep episodes, I knew I’d go nuts if I waited two months before talking to a doctor. Becca agreed. She’s used to my neuroses, but rarely had she seen me as freaked out as this.
I made an appointment to see my PCP the day after my birthday. At this point, a rational person would stand down until I talked with my physician. The reason we see doctors is that they know things we don’t. Even if they’re not experts in a particular field, they are able to parse the information they do have with a medically trained mind. This is why people with an “MD” after their name are less likely to either believe that Parkinson’s is caused by gluten or try to cure it with essential oils.
Alas, I am not always rational, so I redoubled my online research. I read about how RBD is diagnosed. There are a bunch of steps, but the one that counts is a particular sleep study where they record video evidence of how much you spazz out when your REM cycle kicks in. There is apparently some threshold involved as no one is completely immobile. I’m guessing a few twitches are considered normal, but if you’re doing an aerobics routine and shouting “motherfucker” at the top of your lungs, that’s RBD.
So where did leave me? Was my dream violence frequent or intense enough? More to the point, what about the nonviolent stuff that determines the diagnosis when no battle royale occurs during the sleep study? Lastly, what about the sleep apnea I may or may not have?
I used to have some serious sleep apnea years ago when I was seriously misbehaving every chance I had. I would dream I was drowning and wake up gasping for air, feeling like I narrowly escaped dying. Perhaps I did.
My current situation is less scary, at least as far as breathing goes. I’ve been snoring loudly, loud enough to wake me, or so I thought at first. Now I’m noticing that when this happens, I awaken feeling out of breath. Maybe that’s just wishful thinking. There is something called pseudo-RBD that is caused by…you guessed it, sleep apnea.
After all the googling and conjecturing, I still had no clue about the likelihood of my having RBD. I couldn’t dismiss the possibility of being diagnosed so I tried to paint that eventuality as something less of a downer.
Using a timeline estimate more or less pulled out of my ass, I figured I had 20 tolerable years ahead of me. There would be 10 until I contracted Parkinson’s and another 10 before it seriously fucked me over. During that time, there might be some serious progress in stem-cell research or some other medical advancement. I enjoyed that glimmer of hope.
Then I remembered that idiopathic (a word I recently learned) RBD only accounts for 55% of diagnoses. The other 45% had a known underlying cause, which could include the aforementioned neurodegenerative buzzkills or perhaps brain lesions.
Surely, I’d notice if something that heavy duty were wrong with me. Well, maybe and maybe not. I felt like shit, but that was perhaps caused by several days of sleep deprivation and nonstop worry. I remember on the way to dinner on my birthday, I felt disconnected and ill at ease with my surroundings. I felt either too hot or too cold and had severe eyestrain. In the restaurant, I googled anxiety symptoms and was relieved to find out that they matched what I was experiencing. It was nice to know the culprit was not aggressive brain rot.
The next day, I went to the doctor. The MA weighed me and took my vitals. I had gained a few pounds (sedentary weekends and pizza delivery will do that) and my resting pulse rate had increased from the mid-60s to the mid-70s. Neither of those was alarming. My blood pressure was another matter, at an impressive 183/110.
“I’ve been a little stressed lately,” I said.
The doctor met with me shortly after. Almost immediately, I startled rattling off about hitting Becca on the head, the other episodes, what I learned online about RBD and its grim long-term prognosis, and sleep apnea as my unlikely savior.
The doctor sighed. I’m sure I was not the first WebMD asshole he had come across spouting symptoms real or imagined, but he kept his cool. He neither confirmed nor denied that I might have RBD, but was quick to point out that dreading something far in the future was no way to live. As for apnea, he ordered a sleep study to find out for sure.
What concerned him mostly was my blood pressure. It dropped to 170/107 when retook it, but that was still way too high. He prescribed a beta blocker in addition to my existing BP meds. One of its side effects is drowsiness. I could use some of that.
He also asked me about my drinking. I told him that I averaged four drinks per weekend night, which was sort of true. In practice this often meant I would have eight drinks on Friday then spend Saturday night lying on the couch still hung over from the night before.
He then told me that in addition to raising blood pressure, alcohol was a type-1 carcinogen.
“What’s a type-1 carcinogen?” I asked.
“Maybe you can google that,” he said.
Point taken, good doctor. Point taken.
It’s been two weeks since I’ve lashed out in my sleep. I don’t know if the melatonin is keeping that in check or if it wasn’t going to happen anyway. The sleep study my doctor ordered is a pulmonary one and will only determine if I have apnea and need to wear a CPAP fatty mask. My RBD status will remain a mystery.
I may be OK with that. My doctor was right. Parkinson’s will suck if I get it, but there is nothing I can do about it now. If I do have RBD, the melatonin may prevent me from ever having another episode. If it doesn’t, I’ll get a prescription for clonazepam. If that doesn’t work, I’ll have to get to get creative with bed bondage.
I don’t know why I’m more stoic about it now. Maybe the panic has run its course or maybe I’m just tired. I just hope I lash out at Becca in my sleep and if I do, there’s no harm done. On this, I think the odds are in my favor. After all, I can’t punch for shit.