Alan Alda’s first symptoms of Parkinson’s disease weren’t the typical tremors, stiffness or slow movement.
It was throwing a pillow at his wife in his sleep.
“I had a symptom, which at the time was not that well-known: acting out your dreams,” the 90-year-old Emmy winner told CBS Sunday Morning.
The “M*A*S*H” star recently revealed his early indicator of the neurodegenerative disease was an uncommon one — REM Sleep Behavior Disorder, or RBD.
RBD occurs during rapid eye movement sleep, which is the stage where our most vivid dreams happen. While the body is typically paralyzed during REM sleep, certain conditions — like Parkinson’s — turn off the switch that controls muscles, resulting in involuntary actions.
“I had a dream that somebody was attacking me,” he explained. “And I picked up a sack of potatoes and threw it at ’em. What I was really doing was throwing a pillow at Arlene, my wife.”
Those with RBD can have very active dreams, but because their brain signals don’t block movement during sleeping, they can physically act out these dreams by punching, kicking or yelling in their sleep.
This sleep symptom is often linked to Parkinson’s and other neurological conditions because of the buildup of a protein in the brain known as alpha-synuclein, which damages the area of the brainstem responsible for controlling muscles.
While not everyone with RBD is diagnosed with Parkinson’s, this unusual symptom is a risk factor that can occur years before a diagnosis.
The “West Wing” alum was first diagnosed back in 2015 and shared last year that he was also experiencing prosopagnosia, or face blindness. Alda is one of more than 1.1 million people in the US who are affected by Parkinson’s, the risk of which increases with age.
There are two types of RBD: symptomatic (secondary), which happens because of an underlying cause, and isolated (idiopathic).
Isolated occurs when the condition develops without a cause, and in most cases will eventually lead to a neurodegenerative condition, like Lewy body dementia, multiple system atrophy or Parkinson’s.
The risk of developing a neurodegenerative condition increases over time from an RBD diagnosis, with one study finding that 33% of patients developed a condition 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, like newer antidepressants.
While it affects about 2% of the US population over 50, rates may be higher as the condition is more difficult to diagnose.
To diagnose RBD, a healthcare provider may ask you or your sleep partner about your sleeping 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, the absence of seizures and no other medical, mental health or medication-related causes.
Safety measures generally include moving 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.
While there aren’t any FDA-approved medications for RBD, studies have shown that melatonin, clonazepam and pramipexole can reduce symptoms.
