The importance of a good night’s sleep can’t be overstated. Interestingly, humans are the only mammals that willingly delay sleep despite the critical role that adequate sleep plays in keeping us healthy and happy. However, not everybody gets to enjoy a full night of uninterrupted sleep – sometimes for reasons beyond their control.
Falling out of bed while sleeping often indicates an underlying sleep disorder. It can happen to anybody at any age, but it’s more common in men over 50. Finding a permanent solution to the problem involves addressing the underlying sleep condition.
If you accidentally roll out of bed when sleeping, it can be challenging to get some good shut-eye, especially if it happens frequently. The rest of this article will go into more detail about why this happens to some people and what you can do to treat the underlying sleep disorder that it often represents.
What Causes Falling Out of Bed When Sleeping?
Falling out of bed when sleeping is caused by a sleep disorder that occurs during the REM (rapid eye movement) stage of sleep. Falling out of bed is more a symptom of a sleep disorder rather than a disorder in itself.
“Parasomnias” is a collective medical term for a variety of sleep disorders – “para” meaning unusual, and “somnia” meaning sleep. Individuals with parasomnias feel sensations or perform actions that are unusual for a person to feel or do while they are asleep.
Throughout the night, we go back and forth between two types of sleep: non-REM (non-rapid eye movement) sleep and REM (rapid eye movement) sleep. Parasomnias can occur during any of these two categories of sleep. As such, experts group parasomnias into:
- Non-REM parasomnias
- REM parasomnias.
Non-REM Parasomnias
Non-REM parasomnias occur during non-REM sleep, the phase we go into when we first fall asleep.
Examples of non-REM parasomnias are:
- Sleepwalking. This activity occurs when an individual gets up from bed and walks around in their sleep.
- Confusional arousals. This problem manifests when a sleeping person appears to have woken up but is disoriented, unresponsive, or says things that don’t make sense.
- Sleep-related eating disorder. This disorder causes an individual to eat or drink while asleep and sometimes consume uncooked or inedible foods.
- Sleep terrors. This issue manifests when a person suddenly wakes up screaming or appears to experience feelings of terror in their sleep.
REM Parasomnias
REM parasomnias occur during the REM stage of sleep, which comes after non-REM sleep.
Examples of REM parasomnias are:
- Sleep paralysis. This problem occurs when a person cannot move their body or limbs for a brief period upon waking up or falling asleep.
- Nightmare disorder. Many people have nightmares now and then, but this condition causes them to happen more frequently.
- REM sleep behavior disorder. This disorder occurs when a person’s dreams cause them to make aggressive movements or sounds in their sleep. This sleep disorder is the most common cause of falling out of bed while asleep.
Why REM Sleep Behavior Disorder Happens
As we transition from non-REM to REM sleep, we experience increased brain activity that usually indicates that vivid dreaming has begun. As we dream, the brain briefly induces a muscle paralysis – a phenomenon called “REM atonia” – that keeps our body subdued and prevents us from actually doing the actions in our dreams while we’re asleep.
Say you’re in slumberland, and you’re dreaming that you’re reaching for a tasty candy: REM atonia is what keeps you from actually stretching out your hand in real life to hold the “candy.”
Without this sleep-induced paralysis, we would kick, punch and scream as we act out our dreams. This abnormal sleep activity happens to individuals with REM sleep behavior disorder.
Because their brains don’t induce atonia during REM sleep, they often carry out the physical actions they’re dreaming about – all while asleep. Sometimes, their actions can become so aggressive that they cause them to fall out of bed.
Toppling out of bed is just one symptom of REM sleep behavior disorder. Other actions that can accompany this condition include:
- Punching
- Kicking
- Sitting up or jumping out of bed suddenly
- Talking, yelling, or screaming
- Other minor or less aggressive movements of the limbs.
Dangers of REM Sleep Behavior Disorder
Like other parasomnias, an individual with REM sleep behavior disorder (or RBD) often doesn’t know that they do these things in their sleep – until their bed partner or somebody that they live with tells them about it. Their movements and vocalizations might make it seem awake, but they’re deep in slumber and can’t control their actions.
RBD can be dangerous for an individual in the following ways:
- It can cause self-injury. Aggressive movements can cause individuals to harm themselves accidentally. Moreover, falling out of bed puts a person at risk of minor injuries, such as bumps and bruises, to more severe concussions and even fractures.
- It results in reduced quality of sleep. The physical actions the person carries out can jolt them awake throughout the night – not to mention how startling it is to tumble out of bed. This constant waking makes it harder to get a good night’s sleep, which reduces their ability to function normally during the day.
- It affects the people close to them. Living with a person with RDB can occasionally disrupt your sleep, and affect the quality of your sleep, too. An individual with RBD can also unintentionally hit or grab the person they’re sharing a bed with, causing them to sustain injuries.
Risk Factors for Developing RBD
Though the exact cause of RBD is still unknown, certain factors put people at risk of developing the condition. These include:
- Smoking
- Head injury
- Poor sleeping habits or sleep deprivation
- Stress
- Medication for conditions such as high blood pressure, depression, asthma, and allergies
- Alcohol and drug use
- Pregnancy
- Family history of RBD or other parasomnias
- Mental health challenges such as depression, anxiety, and post-traumatic stress disorder
- Other sleep-related disorders such as narcolepsy and sleep apnea.
While RBD can affect anybody of any age or gender, it’s more common in men above 50. In addition, RBD also frequently affects people with Parkinson’s disease or who have suffered a stroke.
How Do I Stop Falling Out of Bed?
You can stop falling out of bed by undertaking various treatment options and preventative measures. As a symptom of REM sleep behavior disorder, falling out of bed can be controlled by using prescription medication while implementing preventive techniques that keep you from falling.
Treatment Options
A qualified sleep physician can diagnose RBD and give you treatment recommendations.
Your physician may suggest an overnight stay at a sleep center to enable them to conduct a polysomnogram – or sleep study – which monitors and records various aspects of your sleep stages while you are asleep. Experts can also perform these sleep studies in the comfort of your home.
The physician may also consult the people close to you to get an idea of the kind of actions you display while you are asleep.
The most common treatment for RBD is sleep aids such as melatonin supplements and clonazepam, which can help improve the quality of REM sleep.
Melatonin Supplements
Melatonin is a hormone produced naturally in the human body and is an integral element of our sleep cycle. Also known as the “sleep hormone,” optimal melatonin production by the body promotes a healthy sleep cycle.
Melatonin supplements are the preferred treatment method for most cases of RBD. The reason is that they have few side effects and are safe to use in elderly patients and people with dementia or sleep apnea.
Clonazepam
Clonazepam is a type of benzodiazepine, a category of drugs used to treat anxiety and insomnia. Clonazepam reduces brain activity, which helps suppress muscle movement and discourages physical activity during sleep.
While clonazepam is effective in treating RBD, physicians will not advise the treatment for individuals who suffer from sleep apnea and dementia.
Preventive Measures to Consider
Regardless of whether or not you’re undergoing treatment for RBD, ensuring that your sleeping environment is as safe as possible to prevent self-injury and injury to others is essential.
Some measures that you can implement to minimize the dangers of falling out of bed include:
- Safety-proof your bedroom. Keep objects that could cause injury – such as sharp or heavy items – away from your bed. You could also place protective padding on the floor around your bed – such as a row of pillows or cushions – to prevent you from injuring yourself should you fall out of bed. Padded bed rails can also keep you safely within the confines of your bed as you sleep.
- Consider sleeping on the floor. You could consider temporarily sleeping on a mattress on the floor as you work on getting treatment. While it might be a slight lifestyle adjustment, it protects you from the potential injuries of falling out of bed as you seek a more permanent solution for the problem.
- Consider sleeping alone. This option may be a considerable adjustment for those with people who share a bed. If the symptoms of RBD are disruptive to your bed partner, sleeping in separate beds is one way to help them get a good night’s sleep.
Summary
Falling out of bed when sleeping is usually a symptom of a sleep disorder called REM sleep behavior disorder (RBD). RBD occurs during REM sleep and causes a person to kick, punch, scream or yell as they act out their dreams while still asleep. These actions can be so aggressive that they cause the individual to tumble out of bed.
Melatonin supplements and clonazepam are the most common and effective treatments for RBD. Moreover, safety measures – such as padded bed rails or sleeping on a mattress on the floor – should be taken to protect an individual with RBD from injury.