Adults don’t usually fall out of bed while sleeping. This is because certain sensory systems in our bodies continue operating. Because people are not completely unconscious during sleep, they can stay safely in bed throughout the entire night. However, this doesn’t apply to everybody.
REM behavior disorder is a sleep disorder that causes people to act out their dreams physically. The condition is most common in men and may cause the sleeper to kick, scream, punch, and fall out of bed, potentially hurting himself or his partner. Restless sleep, old age, dementia, issues with bed space, and certain medications are other causes.
It is critical that you take precautionary steps by safe-proofing your room, sleeping on a mattress on the floor, or using bed rails for added protection. For seniors, it’s advisable to keep the sleep environment as consistent as possible.
What Prevents People from Falling Out Of Bed?
To understand why people fall out of bed, it is important to know about the proprioceptive system of the body. This carries out of a process called proprioception, where the body varies its muscle contraction in response to external stimuli.
The body uses the stretch receptors found in the muscles to keep track of each minor twitch and change in body position and sends this information to the brain.
The proprioceptive system functions while a person is awake and asleep and helps the body stand upright with no conscious effort.
Since it does not function optimally in small children, they are more likely to fall out of bed. The function improves with practice over the years in growing children.
What is REM Behavior Disorder?
REM behavior disorder is a condition that causes the sleeper to act out their dreams physically. The sleeper may scream, kick, punch or fall out of bed, potentially injuring themselves and their partner.
REM behavior disorder is most common in men, particularly after the age of 60. The disorder can be managed with medication and safe-proofing the bedroom.
REM behavior disorders, sleepwalking, and eating while sleeping are examples of sleep disorders called parasomnias.
In many cases, the frequency or aggressiveness of falls can keep patients awake. This prevents them from entering normal sleep cycles, thereby increasing their risk of sleep-related anxiety. In the long-term, falling out of the bed regularly can lead to a form of sleep-onset insomnia.
What Are the Causes?
During sleep, the body naturally progresses through its sleep stages, which includes REM (rapid eye movement) sleep. REM is characterized by dreaming and rigorous brain activity – along with the body’s inability to use its muscles, excluding the diaphragm and eye muscles.
Each REM cycle occurs at around 90-minute intervals throughout the night and is most intense in the last third of your sleep, where the periods become lengthier before waking up.
Usually, our muscles are paralyzed during REM sleep and dreaming. However, this temporary paralysis does not take place in people with a REM behavior disorder, causing them to act out vivid dreams physically.
This causes people to fall out of bed when they’re running, fighting, kicking, or defending themselves from attackers in their dreams.
Signs And Symptoms
Most people with REM behavior disorder report experiencing vivid and unpleasant dreams. Often, these dreams involve animal or human attackers and intruders.
The disorder typically causes sleepers to act out their dreams in a violent or exaggerated manner. During sleep, common signs of this behavior include:
- Screaming or talking
- Falling out of bed
- Striking furniture
- Dropping objects near the bed
The above behaviors often result in injury to the sleeper or their bed partner. Injuries caused by the conditions can be anything from minor cuts, bruises or scratches, to severe injuries, such as bleeding within the brain or fractures.
People with the disorder may also have problems associated with disrupted sleep, such as excessive daytime sleepiness.
People don’t usually exhibit signs of sleepwalking, such as walking, leaving the room, or having the eyes open. Episodes related to the disorder rarely involve eating, drinking, using the bathroom, or sexual activity.
REM behavior disorder affects 4-5 people out of 1000, and 90% of the cases are men in their 50s or 60s. Many patients eventually develop neurodegenerative disorders, such as Parkinson’s disease.
Reporting a history of acting out dream behaviors, along with a sleep study known as a polysomnogram (PSG), is often enough to establish a diagnosis during your doctor’s visit.
In most cases, the PSG shows the unusual presence of muscle tone during REM sleep, indicating that there is activity while the person sleeps. The doctor will also rule out a seizure-like electrical activity using the EEG as seizures can also lead to unwanted movements during sleep.
The patient’s imaging studies will be normal if there is no neurodegenerative disorder associated with a REM behavior disorder.
Your doctor may have to rule out other disorders that lead to symptoms similar to REM behavior disorder. Also sometimes referred to as pseudo-RBD, the following disorders may result in abnormal movements during sleep or increased daytime sleepiness:
- Obstructive sleep apnea
- Nocturnal seizures
- Periodic limb movement disorder
- Post-traumatic stress disorder
- Nocturnal panic attacks
- Other psychiatric conditions
Because the above disorders are not associated with the development of other neurological disorders, treatment for a patient’s dream reenactment is primarily focused on managing the underlying cause.
Managing REM behavior disorder primarily focuses on ensuring that the patient and his or her bed partner are safe.
Safe-proofing a bedroom for any violent dream reenactments includes, removing any sharp objects and objects that can be tipped over, such as lamps on nightstands. Placing some additional padding around the bed can also be beneficial in reducing damages caused by any falls.
If needed, locking the windows and doors is also recommended. If possible, consider sleeping on a mattress on the floor, and even sleeping alone. Once movements are sufficiently suppressed with medication, the patient will have to take fewer safety precautions before going to bed.
Your doctor may prescribe the medication, clonazepam, which can be highly effective in controlling abnormal electrical activity in the brain.
However, it can be intolerable to some patients as it can lead to nighttime confusion among the elderly and daytime sleepiness. The drug can also lead to dependence in some patients. Melatonin is a safer alternative that helps regulate the normal sleep-wake cycle.
Conditions Associated With REM Behavior Disorder
More than 50% of patients with REM behavior disorder will have other neurological disorders. These include Parkinson’s disease, multiple system atrophy, and dementia with Lewy bodies.
65% of patients with the disorder will develop dementia or Parkinson’s many years later, if they don’t show signs of neurological disorders right now.
Sometimes, structural brain lesions, such as a tumor, stroke, or demyelination may lead to an acute form of REM behavior disorder. However, this isn’t very common.
Drug intoxication, certain medications (such as antidepressants), or withdrawal from sedative medications or alcohol may contribute to REM behavior disorder in some patients.
Seniors Falling Out Of Bed
According to the Canadian Journal of Nursing Research, a person’s risk of falling increases with age.
Many people associate falling from bed with small children as their ability to understand their surroundings during sleep hasn’t fully developed yet.
However, according to the CDC, falls are the leading cause of non-fatal and fatal injuries among seniors. Many elderly individuals suffer from severe injuries from falling out of bed.
As the body ages, its muscles and bones become more fragile and less supportive, increasing the chances of fall-related injuries among the elderly.
In many cases, falling out of bed among the elderly is associated with other medical conditions and causes, such as existing injuries and dementia.
This also prevents sufferers from getting quality sleep, thereby affecting their energy levels, mood, and overall lifestyle. The following are some of the main causes of seniors falling out of bed.
A recent stroke or surgery may increase the risk of an elderly person falling out of their bed. The majority of these falls occur while getting in and out of bed.
Conditions such as incontinence cause elderly individuals to leave the bed in the middle of the night, increasing their risk of falling due to the dark.
According to the Journal of Family and Community Medicine, 74.4% of seniors with incontinence reported a history of falling due to their need to use the bathroom frequently during the night.
It’s vital to understand that deteriorating eyesight significantly increases an older person’s risk of falling as well. They are also particularly susceptible to falling and getting injured when they’re tired.
A significant percentage of falls occur when a person is dreaming. Many older people report jumping from the bed as a part of their dream and find themselves waking up on the ground.
If a person is stressed, sleep-deprived or exhausted, they may experience dreams that cause them to fall out of bed. This is because stress and exhaustion cause their brain to enter into sleep cycles more vigorously, even though the body hasn’t caught up yet.
Certain medications may tamper with your natural brain chemistry, worsening your sleep quality, and contributing to unusual dreams.
The prescription sleep medicine Ambien, has been associated with parasomnias, including sleepwalking and REM behavior disorder.
If you experience any unusual behavior in the night and take sleep medication often, talk to your doctor about trying an alternate prescription.
Issues with Balance
Balance issues or problems with mobility are frequent causes of falls among adults. Something as simple as trying to reach for a glass of water placed next to the bed may cause an elderly individual to lose their balance and fall from their bed.
In some cases, balance issues may be a result of a condition called benign paroxysmal positional vertigo (BPPV).
BPPV is a common issue among seniors, and may cause symptoms such as dizziness and vertigo, along with problems associated with fragments (otoconia) that have built up in the inner ear.
When the head moves, the otoconia may shift and send false signals to the brain. This often results in vertigo and dizziness that may contribute to falls.
When an elderly individual is unfamiliar with their surroundings and the objects placed around them, they’re more likely to bump into objects and fall out of bed.
Therefore, it is critical that patients are consistent with their bedroom arrangement, avoiding changing the height and position of the bed.
Even a change in bedding can result in falls among the elderly. New bed linens that slide off sheets or stick to them can cause a person to fall while getting into or out of bed.
If you are considering safe-proofing an elderly person’s room, consider removing any unwanted objects that increase the risk of falls, such as lamps and vases.
Instead of moving the bed to a different spot in the room, try placing some padding next to the bed to reduce injuries associated with falling out of bed.
Rolling Out Of Bed
Rolling out of bed is a common problem among seniors that may result from many causes, such as not being able to sleep and tossing and frequently turning in the night.
Sleeping too close to the edge of the bed can also increase an elderly person’s risk of falling. The person may be rolling around in bed during the night, resulting in a fall.
Using bed rails can help the elderly sleep safely in their bed, without being prone to falling and getting injured.
Confusion and Disorientation
Some elderly individuals may feel disoriented or confused in the middle of the night, causing them to fall when they’re trying to get out of bed but aren’t fully conscious of doing it.
Confusion and disorientation in the dark is a common cause of falls among the elderly. In many cases, this may be associated with certain medications.
Talking to your doctor may help you determine the underlying cause and switch to a different prescription if medication is responsible for the disorientation.
Confusion and disorientation may also be a sign of dementia.
Using the Bathroom
As a person ages, bladder control in the night becomes increasingly problematic, causing them to rush immediately to the bathroom. Being in a hurry in an attempt to prevent an accident can cause a person to trip and fall while getting out of bed.
Talk to your doctor about better ways to manage toileting requirements and hydration levels. One excellent way to prevent nighttime falls among an elderly loved one is to have a bedside toilet.
This means that they will have to move a shorter distance in the night, which can be especially beneficial for urgent nighttime bathroom trips.
Complications Associated with Falling Out Of Bed
As with any fall, falling out of bed can lead to zero to minor injuries or severe injuries that require medical attention. In addition to causing physical injury, falls can lead to mental stress in an elderly person’s life. Their anxiety may be associated with fear of sleeping due to their risk of falling.
Stress and anxiety, and being afraid of sleeping can be detrimental to a senior’s quality of sleep. Getting quality sleep is crucial for an aging mind and body.
If a person falls multiple times, the physical and mental effects of the fall can have a compounding effect on them. Therefore, prevention is better than the cure to ensure your loved one’s health and overall wellness.
The severity of any fall depends on specific circumstances, such as the speed of the fall, the height of the bed, items around the bed, and the physical condition of the sufferer.
Although falls are common among seniors, their impact can be reduced in the night by taking specific precautionary methods, such as the ones mentioned below.
If you notice poor sleep patterns or any mobility issues in a senior, preventing falls should be your top priority to avoid serious injuries and mental anxiety.
How To Prevent Falls In The Elderly
If an elderly person falls, or is at risk of falling, talk to your doctor about any possible causes.
Eyesight problems, such as cataracts are common causes for nighttime falls associated with poor vision. Addressing untreated cataracts can help a senior navigate better in the night and increase their overall confidence.
If a senior is taking medications, the doctor should find out if nighttime falls are associated with certain drugs and whether changing the prescription or dosage can help.
Physical therapy is another excellent way to prevent falls among the elderly as it can help improve mobility, increase strength, and develop muscle memory. This can help seniors get in and out of bed without having an accident.
Why You Must Take Falls Seriously In Seniors
There are many reasons falls are a serious cause for concern among the elderly. One major reason is that a fall can be a sign of a severe underlying medical condition that requires treatment.
For example, a senior may be weak and may have fallen due to dehydration or urinary tract infection. Moreover, seniors who have fallen have a higher risk of falling in the future.
Improving Physical Space
Many cases that involve falling out of bed occur in nursing homes and hospitals. This is because of the change of environment and unfamiliarity with physical surroundings.
If a senior is sleeping in an unfamiliar space or away from their home, it is critical to take precautionary measures that will prevent them from falling or getting injured. These include:
- Lowering the bed. Keeping the bed as close to the floor as possible will allow the person to adequately touch the ground from a seated position while getting into or out of bed. If the bed is too high, there is a higher risk of an elderly person falling because of not being able to place the foot on the ground correctly. If lowering the bed is not a feasible option, consider using a mattress only.
- Bed rails. Determine the side of the bed your loved one is most vulnerable to roll out of and place bed rails that block that side only. Installing bed rails on one half of the bed will prevent rolling out of bed and falling, while ensuring the person can get up in the middle of the night to use the bathroom using the rail as a handhold.
- Body pillows. If a senior rolls out of bed often, try placing one large body pillow on either side of their body. This will keep them secure in the night and prevent them from rolling around in the night. You can also use a pool noodle on one side of the bed to remind your loved one where the edge of the bed is, thus preventing them from rolling over.
- Talk to your doctor. If incontinence or a frequent urge to use the bathroom is causing an elder to get up multiple times a night, consider talking to their physician to determine whether there are ways to reduce nighttime bathroom trips.
- Pay Attention To Lighting. The lighting in the room should be bright enough to allow a senior to see in the night, without it being too harsh on their eyes.
Taking Preventive Measures Away from Home
If a senior is away from the home, such as in a hospital or a nursing home, you must ensure that the staff is taking precautionary measures to prevent any falls.
This includes sleep monitoring, helping the elder get into and out of bed, using bed rails, and having low-sitting beds. Ask the staff about bed routines and look out for any unusual signs, such as bedsores, that might indicate that your loved one isn’t taken care of properly.