Last Updated on September 30, 2023 by Louise Carter
Adults seldom fall out of bed while sleeping because the proprioceptive system continues operating.
Although people aren’t entirely unconscious during sleep, they can usually remain safely in bed. Unfortunately, this doesn’t apply to everyone.
REM behavior disorder is a sleep disorder that causes people to act out their dreams physically.
It’s more common in men than women, causing the sleeper to kick, scream, punch, and fall out of bed, potentially hurting himself or a partner.
Restless sleep, old age, dementia, and bed space are other causes.
Take precautionary steps by safe-proofing your room, sleeping on a mattress on the floor, or using bed rails for added protection.
For seniors, keep the sleep environment consistent and predictable.
What Prevents People from Falling Out Of Bed?
The body’s proprioceptive system carries out ‘proprioception,’ which varies muscle contractions in response to external stimuli.
The body uses stretch receptors in the muscles to keep track of each minor twitch and change in body position, sending this information to the brain.
The proprioceptive system functions while a person is awake and asleep, helping the body remain upright with no conscious effort.
Since it doesn’t function optimally in small children, they’re more likely to fall out of bed. The function improves with practice in growing children.
What Is REM Behavior Disorder?
REM behavior disorder is a condition that causes sleepers to act out their dreams physically. The sleeper may scream, kick, punch, or fall out of bed, potentially harming themselves and their partner.
REM behavior disorder is most common in men, particularly those over 60. The condition can be managed with medication and bedroom safe-proofing.
REM behavior disorders, sleepwalking, and eating while sleeping are parasomnias.
In many cases, the frequency or aggressiveness of falls can keep patients awake, preventing them from entering regular sleep cycles and increasing their risk of sleep-related anxiety.
In the long term, regularly falling out of bed can lead to sleep-onset insomnia.
What Are the Causes?
During sleep, the body naturally progresses through its sleep stages, including REM (Rapid Eye Movement) sleep.
REM is characterized by dreaming, rigorous brain activity, and 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 our sleep, where the periods become lengthier before waking up.
Usually, our muscles are paralyzed during REM sleep and dreaming. However, this temporary paralysis doesn’t occur in people with a REM behavior disorder, causing them to act out vivid dreams.
This causes people to fall out of bed when running, fighting, kicking, or defending themselves in 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, causing sleepers to act out their dreams violently or exaggeratedly. During sleep, common signs of this behavior include:
- Screaming or talking.
- Falling out of bed.
- Striking furniture.
- Dropping objects near the bed.
These behaviors often injure the sleeper or their bed partner. Injuries can range from minor cuts, bruises, or scratches to severe injuries, like bleeding within the brain or fractures.
People may have issues associated with disrupted sleep, like excessive daytime sleepiness.
People don’t usually exhibit signs of sleepwalking, like walking, leaving the room, or having their eyes open. Episodes related to the disorder rarely involve eating, drinking, bathroom use, or sexual activity.
REM behavior disorder affects 4-5 people out of 1000, and 90% of cases are men in their 50s and 60s. Many patients eventually develop neurodegenerative disorders like Parkinson’s disease.
Reporting a history of acting out dream behaviors and a sleep study known as a polysomnogram (PSG) is often enough to make a medical diagnosis.
In most cases, the PSG shows the unusual presence of muscle tone during REM sleep, indicating activity while the person sleeps. The doctor will also rule out a seizure-like electrical activity using the EEG, as seizures can lead to unwanted sleep movements.
The patient’s imaging studies will be normal if no neurodegenerative disorder is associated with a REM behavior disorder. Your doctor may need 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 aren’t associated with developing other neurological disorders, treatment for a patient’s dream reenactment primarily focuses on managing the underlying cause.
Managing REM behavior disorder ensures the patient and their bed partner are safe.
Safe-proofing a bedroom in case of violent dream reenactments involves removing sharp objects and objects that can be tipped over, such as nightstand lamps. 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 recommended. If possible, consider sleeping on a mattress on the floor or sleeping alone. Once movements are sufficiently suppressed with medication, the patient must take fewer safety precautions before bed.
A doctor may prescribe clonazepam to control 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.
Melatonin is a safer alternative that can regulate the normal sleep-wake cycle.
Conditions Associated With REM Behavior Disorder
More than 50% of patients with REM behavior disorders have other neurological disorders, including 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.
Structural brain lesions, like tumors, stroke, or demyelination, can sometimes lead to an acute REM behavior disorder. However, this is uncommon.
Drug intoxication, certain medications (such as antidepressants), or withdrawal from sedatives or alcohol may contribute to REM behavior disorder in some patients.
Seniors Falling Out Of Bed
According to the Canadian Journal of Nursing Research, the risk of falling out of bed 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.
Falls are the leading cause of non-fatal and fatal injuries among seniors. Many elderly individuals experience severe injuries from falls.
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 injuries and dementia.
This prevents them from getting quality sleep, affecting their energy levels, mood, and lifestyle.
The following are the leading causes of seniors falling out of bed:
A recent stroke or surgery may increase the risk of an elderly person falling out of bed. The majority of these falls occur while getting in and out of bed.
Conditions like 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, susceptibility to falls, and getting injured when tired.
A significant percentage of falls occur when a person is dreaming. Many older people report jumping from bed as a part of their dreams 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. Stress and exhaustion cause their brain to enter sleep cycles more vigorously, even though the body hasn’t caught up.
Certain medications may tamper with your natural brain chemistry, worsening your sleep quality and contributing to unusual dreams.
The prescription Ambien (a sleep medicine) has been associated with parasomnias, including sleepwalking and REM behavior disorder.
Issues with Balance
Something as simple as reaching 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 result from 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.
The otoconia may shift and send false signals to the brain when the head moves. This often results in vertigo and dizziness that may contribute to falls.
When elderly individuals are unfamiliar with their surroundings and the objects around them, they’re more likely to bump into things and fall out of bed. Therefore, patients must be consistent with their bedroom arrangement. Avoid 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’re considering safe-proofing an elderly person’s room, consider removing 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, place 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, like not sleeping or tossing and frequently turning at night.
Sleeping too close to the edge of the bed can also increase that person’s risk of falling. They may be rolling around in bed at night, resulting in a fall.
Bed rails can help the elderly sleep safely without 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 getting out of bed, but aren’t fully conscious of doing it.
Confusion and disorientation in the dark are common causes of falls among seniors. In many cases, this may be associated with certain medications.
Talking to a doctor may determine the underlying cause and switch to a different prescription if medication is responsible for the disorientation.
Confusion and disorientation may also signify dementia.
Using the Bathroom
As a person ages, bladder control during the night becomes more problematic, causing them to rush immediately to the bathroom. Being in a hurry to prevent a toilet accident can cause a person to trip and fall while getting out of bed.
Talk to your doctor about better managing toilet requirements and hydration levels. One effective way to prevent nighttime falls among an elderly loved one is to have a bedside toilet.
This means they’ll have to move a shorter distance, which can benefit urgent nighttime bathroom trips.
Complications Associated with Falling Out Of Bed
In addition to causing physical injury, falls can lead to mental stress in a senior’s life. Their anxiety may be associated with fear of sleeping due to their risk of falling.
Stress, anxiety, and fear of sleeping can affect a senior’s sleep quality. 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 compound them. Therefore, prevention is recommended to ensure your loved one’s health and wellness.
The severity of a fall depends on specific circumstances, like the fall’s speed, the bed’s height, items around the bed, and the individual’s condition.
Although falls are common among seniors, their impact can be reduced at night by taking specific preventive methods, like those mentioned below.
If you notice poor sleep patterns or mobility issues in a senior, preventing falls should be your priority to avoid severe 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 possible causes.
Eyesight problems, like cataracts, are common causes of nighttime falls associated with poor vision. Addressing untreated cataracts can help seniors navigate better at night and increase their confidence.
If a senior takes medications, the doctor should determine if nighttime falls are associated with certain drugs and whether changing the prescription or dosage can help.
Physical therapy is another recommended way to prevent falls among the elderly, as it can help improve mobility, increase strength, and develop muscle memory.
Why You Must Take Falls Seriously In Seniors
A fall can signify a severe underlying medical condition that requires treatment.
For example, a senior may be weak and have fallen due to dehydration or a urinary tract infection (UTI). Moreover, seniors who have fallen have a higher risk of falling over again.
Many cases that involve falling out of bed occur in nursing homes and hospitals due to the change of environment and unfamiliarity with the physical surroundings.
If a senior sleeps in an unfamiliar space or away from home, take precautionary measures to prevent them from falling or getting injured. Preventative measures include:
Lower The Bed
Keeping the bed close to the floor will allow the person to adequately touch the ground when seated while getting into or out of bed.
If the bed is too high, there’s a higher risk of an elderly person falling due to not correctly placing their foot on the ground. If lowering the bed isn’t feasible, consider using a mattress only.
Determine the side of the bed your loved one is most likely to roll out and put bed rails on that side.
Installing bed rails on one side will prevent rolling out of bed and falling while ensuring that the person can get up in the middle of the night to use the bathroom using the rail as a handhold.
If a senior rolls out of bed often, place one large body pillow on either side of their body, as this will keep them secure at night and prevent them from rolling around the bed.
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.
Consult A Doctor
If incontinence or a frequent urge to use the bathroom is causing an elder to get up multiple times a night, talk to their physician or nurse to explore ways to reduce nighttime bathroom trips.
The lighting should be bright enough to allow a senior to see without it being harsh on their eyes.
If a senior is away from home, like a hospital or a nursing home, ensure the staff takes precautionary measures to prevent falls.
This includes sleep monitoring, helping the individual to get in and out of bed, using bed rails, and having low-sitting beds. Ask the staff about bedtime routines.
Also, check for unusual signs, like bed sores, that may indicate a lack of care.