By Dr Ian Dunican
As a fan of combat sports, I am also interested in hearing what former professional athletes have to say about their careers, from how they train, how they felt in competition, how they recovered and general stories and funny insights. Last week, I listened to former UFC middleweight champion and Mixed Martial Arts (MMA) legend Michael “The Count” Bisping. Michael is a funny guy with stories for days and is full of energy at age 43. Michael is a pioneer of British MMA and winner of Season 3 of The Ultimate Fighter (TUF) in 2006.
Night terrors: Michael recently appeared on the Joe Rogan Experience (#119) to discuss his career and his upcoming documentary on his life. At around 5 minutes into the podcast, he started to discuss a potential sleep disorder affecting him. He tells a couple of stories that last for 3 minutes. The first story occurred at his home. Michael discusses how relatives were staying with him at his family home, and in the middle of the night, he dreamt that he was being chased and someone was trying to kill him. He fell down the stairs and ran out of the house naked only to awake on the neighbour’s wall. On another occasion, he thought that the ceiling fan in his bedroom would chop him and his wife up, so he grabbed her and threw her out of bed, only for her to wake up in shock. And finally, he discussed how he was staying in a high-rise hotel on holiday in Cancun, Mexico and had to lock the balcony door each night to ensure he did not walk out and jump off whilst asleep. When told by Michael, these incidents are told in a cheerful manner, and I must admit I had a chuckle as I listened. I also understood the seriousness of such a disorder.
REM behaviour disorder: Rapid Eye Movement (REM) behaviour disorder may be happening to Michael. REM behaviour disorder is a parasomnia and is one of >70 recognised sleep disorders from the American Academy of Sleep Medicine (AASM)1. When we sleep, we go through two main phases of sleep. They are non-REM sleep that includes stage one and two (light stages of sleep), stage three sleep (deep sleep) and REM sleep or dreaming sleep. To protect us during REM, sleep our bodies whilst asleep will have muscle atonia or body paralysis, which stops you from moving around during REM or acting your dreams out. REM Behaviour Disorder (RBD) is when this muscle atonia is gone and can be accompanied by shouting, talking, singing, or swearing. As stated by Michael in this interview, “your bed partner is at risk when such an incident occurs”, as is the person to which the episode is occurring, with reports of nearly 20% of people incurring a head injury due to an incident 2.
What causes RBD? The exact cause is not known. The current known risk factors for developing RBD are family history of RBD, prior head injury, farming, exposure to pesticides, low education level, depression, and use of antidepressants3. It is thought that it is due to neural pathways in the brain. It often is related to other neurodegenerative conditions such as Parkinson’s disease, Lewy body dementia, narcolepsy, or stroke. More than >90% of people with idiopathic RBD (relating to or denoting any disease or condition that arises spontaneously or for which the cause is unknown) develop a neurodegenerative disease3. It is prevalent in 0.5–2% of the overall population. It is more common in males, but the typical onset of RBD is in those aged >50 4. Recent research in 2020 also found a relationship between chronic traumatic encephalopathy (CTE) and RBD 5. Surprisingly 32% of contact sport athletes had RBD. This may be due to repetitive head impacts.
How do I know if I have RBD? First, if you have suspected RBD, you should seek medical attention for further diagnostics and treatment. Typically, you will be referred to a sleep and respiratory physician or similar specialist to undergo overnight testing known as polysomnography (PSG) in a laboratory or your home and validated questionnaires such as the “REM sleep behaviour disorder screening questionnaire” 6.
What can you do about RBD? The treatment of RBD includes non-pharmacological treatments such as reducing alcohol or prescription drugs that may cause RBD. In addition, lowering stress, having good sleep hygiene, and having a consistent sleep routine. Check out the Good Sleep Habits from the Australian Sleep Health Foundation and protect your sleep environment not to harm yourself or others. Pharmacological treatments include Clonazepam 0.25–2 mg nightly and Melatonin 3–15 mg nightly or a combination7.
Next steps: As a combat sports enthusiast and martial artist, I believe sleep is considerably underrated and undervalued in combat sports. That is why I am launching the “Combat Sport Sleep Optimisation Program.”
Objective: To quantify, assess and determine your sleep habits and behaviours, identify barriers to sleep, optimise recovery for fight camp and the week of the fight. This will support identification, diagnostic and treatment of RBD as discussed in this article.
Rationale: Athletes rarely achieve the 7-9hrs of sleep duration with 50%–78% of athletes experiencing sleep disturbance with >30% of athletes having a clinical sleep disorder or problem which may be exacerbated by training camps, weight cutting, caffeine, alcohol, and other substances
Our experience: In Formula 1 for the week/s leading up to practice, qualifying and race day to gain a 20% improvement in alertness that required the inclusion of travel, media, team meetings and sponsor obligations. In MMA and BJJ (see YouTube video), we have designed plans incorporating travel, jet lag, weight cutting, media, and training periods. In Super Rugby (see YouTube video here) and Basketball (see YouTube video here) to maximise recovery to enable next-day training and to maximise performance for training and strength and conditioning to achieve maximum alertness and performance.
How do we do this
- One-on-one consultation for 60 mins via ZOOM, recorded and provided to you for your reference.
- Determine your sleep habits and behaviours by connecting your wearable device to our platform.
- Determine the potential prevalence of sleep problems and disorders.
- Identify optimal scheduling, training, and recovery periods based on your data.
- Review your use of alcohol, nicotine, and caffeine.
- Review your lifestyle, work, and social factors.
- Identify supplements and nutrition for sleep.
- Travel and jet lag planning are designed specifically for you to optimise performance.
- Fight week planning for weight cutting, fan events and media.
- Sleep environment optimisation
- Berry RB BR, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL and Vaughn BV. Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications V2.2. Darien, Illinois: American Academy of Sleep Medicine; 2015.
- Postuma RB, Montplaisir JY, Pelletier A, et al. Environmental risk factors for REM sleep behaviour disorder: a multicenter case-control study. Neurology. Jul 31 2012;79(5):428-34. doi:10.1212/WNL.0b013e31825dd383
- Arnaldi D, Antelmi E, St. Louis EK, Postuma RB, Arnulf I. Idiopathic REM sleep behaviour disorder and neurodegenerative risk: To tell or not to tell to the patient? How to minimise the risk? Sleep Medicine Reviews. 2017/12/01/ 2017;36:82-95. doi:https://doi.org/10.1016/j.smrv.2016.11.002
- St Louis EK, Boeve BF. REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions. Mayo Clin Proc. Nov 2017;92(11):1723-1736. doi:10.1016/j.mayocp.2017.09.007
- Alosco ML, Cherry JD, Huber BR, et al. Characterising tau deposition in chronic traumatic encephalopathy (CTE): utility of the McKee CTE staging scheme. Acta Neuropathologica. 2020/10/01 2020;140(4):495-512. doi:10.1007/s00401-020-02197-9
- Stiasny-Kolster K, Mayer G, Schäfer S, Möller JC, Heinzel-Gutenbrunner M, Oertel WH. The REM sleep behavior disorder screening questionnaire–a new diagnostic instrument. Mov Disord. Dec 2007;22(16):2386-93. doi:10.1002/mds.21740
- Aurora RN, Zak RS, Maganti RK, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD). Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. Feb 15 2010;6(1):85-95.