Recent studies have linked post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) to a rare sleep disorder strongly associated with Parkinson’s Disease and other neurodegenerative conditions. The link between REM sleep behavior disorder (RBD) and Parkinson’s could provide a path for military veterans to receive additional disability benefits before developing symptoms. Because processing disability claims is a lengthy process, veterans are encouraged to learn as much as possible about this new research and apply for benefits as soon as possible.
In this article about PTSD and sleep for veterans:
- What Is RBD?
- What Causes RBD?
- How Is RBD Diagnosed?
- How Do PTSD And TBI Contribute To RBD And Parkinson’s Disease?
- How Can Identifying RBD In Veterans Help With The Potential Of Developing Parkinson’s?
- Can I Receive VA Disability Compensation For Parkinson’s Disease Due To RBD?
- The Links Between PTSD, TBI, and Parkinson’s are Growing
- Don’t Wait to Call and Start Your VA Disability Claim
What Is RBD?
To better define REM sleep Behavior Disorder (RBD), it is helpful first to understand how we experience sleep cycles. The Rapid Eye Movement (REM) cycle of sleep typically occurs about 90 minutes after falling asleep. This is the sleep phase where dreams occur. For most of us, dreams are functions of the mind and have no physical manifestation whatsoever. A person with RBD, however, experiences something entirely different.
Muscle movement does not “turn off” during REM for people with RBD. They become physically agitated, actively and unknowingly moving their body in their sleep. They may even sleepwalk and seem to function as if they were completely awake. However, in some instances, their movements can be very aggressive and sometimes violent, putting others around them at risk of being harmed. In fact, 90 percent of spouses who share a bed with a partner with RBD also report having sleep problems, and more than 60 percent of them have also suffered a physical injury.
A person with RBD may display behavioral symptoms during sleep including kicking, punching, arms flailing, and physically lashing out. They may also make noises, such as laughing, swearing, talking, shouting, or screaming. After waking up, a person with RBD can remember details about what they were dreaming of but have no recollection of their physical movements.
These episodes can happen repeatedly throughout the night. Because they follow our normal REM sleep cycles, they can occur up to four times during a typical night’s sleep. These episodes do not necessarily happen every night, and a person may go as long as a week or month in between occurrences. When they do occur, they tend to happen more during the morning hours when the frequency of REM increases.
What Causes RBD?
There is no clear evidence as to what causes RBD, but RBD has been known to occur as a negative reaction to some medications or during drug withdrawal. Antidepressants, for example, cause RBD in as many as 6 percent of those who use them. For people with severe alcohol dependence, RBD can occur when they stop consuming alcohol. Other evidence suggests a link between PTSD and RBD, often occurring in individuals who recently experienced trauma.
Treatments for RBD include benzodiazepine medications such as clonazepam, which effectively treat about 90 percent of all cases. Other effective treatments include melatonin and antidepressants that can help subdue some of the more violent behaviors that occur while sleeping.
How Is RBD Diagnosed?
The American Academy of Sleep Medicine’s International Classification of Sleep Disorders lists four criteria that must be met in order to receive an RBD diagnosis:
- You’ve had recurring episodes of acting out your dreams with vocalizations or leg and arm gestures during REM sleep.
- Your clinical history or in-laboratory polysomnogram (in-lab sleep study) confirms that the RBD episodes you experience occur during REM sleep.
- Polysomnography confirms that your episodes include sleep with the absence of atonia, an extremely relaxed or paralyzed state of skeletal muscles that occurs during REM sleep.
- The episodes are caused by something else, such as a mental health disorder, side effects from medications, substance abuse, or other sleep disorders.
Doctors will typically diagnose RBD by asking you to undergo a physical and neurological examination to rule out other potential causes, such as medications, alcohol, or narcolepsy. They will also watch for symptoms associated with Parkinson’s Disease including muscle stiffness and hand tremors and will ask your bed partner to describe any behaviors they have noticed while you sleep. If warranted, they may also ask that you participate in a videotaped sleep study so they can monitor your heart and brain activity, eye movement, blood oxygen levels, breathing, and leg and arm movement.
Tips for Veterans Going In for a VA Disability Sleep Study
Has the VA requested a Sleep Study for your rating? Read these tips before you go in for the best experience.
How Do PTSD And TBI Contribute To RBD And Parkinson’s Disease?
Current data reports that PTSD and PTSD + TBI (Traumatic Brain Injury) has been an underappreciated critical risk factor for RBD. Because RBD has previously been identified as a precursor to developing Parkinson’s Disease, this correlation is significant for Veterans. The fact that Veterans already experience PTSD and TBI at such high rates suggests that they may, consequently, be at higher risk for developing Parkinson’s Disease as well.
A recent study published by the Sleep Research Society sought to explain the relationship between PTSD, TBI, and RBD and how their combination might contribute to neurological disorders such as Parkinson’s Disease. Because many veterans have experienced a concussion, which can exacerbate neurodegenerative processes, researchers believe persistent stress on the brain can contribute to sleep disorders in Veterans with PTSD.
Nearly 400 male Veterans from the Oregon Health & Science University and the VA Portland Health Care System participated in the research, which examined the previous diagnosis of PTSD and TBI, diagnostic screening, and an in-lab sleep study. From 2015 to 2017, participants were monitored as they slept. Researchers focused on their REM sleep and watched for signs of dream reenactment and muscle activity.
Compared to non-Veterans and the general population, the study found that RBD is significantly more prevalent in Veterans. Specifically, it was double in Veterans with PTSD or who had been diagnosed with both PTSD and TBI. Additional research is focused on whether Veterans with RBD might also be at risk of developing Parkinson’s Disease.
Approximately 38 percent of individuals with RBD in the general population develop Parkinson’s and other neurological diseases, such as multiple systems atrophy or Lewy body dementia. It is also known that some people will experience RBD as many as 50 years before developing other neurological disease symptoms. The symptoms from these neurological problems become more severe over time. They may include an increase in anxiety and apathy, cognitive issues, lower scores in attention, and problems with executive functioning.
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How Can Identifying RBD In Veterans Help With The Potential Of Developing Parkinson’s?
Symptoms of Parkinson’s Disease, such as fatigue and tremors, can be helped with certain therapies. However, there is no known prevention or cure for Parkinson’s to date. Most people with Parkinson’s are diagnosed long after it might be possible to reverse symptoms or participate in clinical trials for new therapies. That’s why identifying patients with RBD is critical and could be an opportunity to gauge the possibility of developing Parkinson’s Disease. With early intervention, it may also be possible to test promising interventions to prevent some Parkinson’s symptoms.
Can I Receive VA Disability Compensation For Parkinson’s Disease Due To RBD?
Service connection for Parkinson’s Disease is available to Veterans who qualify, but presumptive conditions currently only include those who served in Vietnam between January 9, 1962, and May 7, 1975. Parkinson’s Disease is also listed as a presumptive condition for Veterans who served in the Korean Demilitarized Zone between April 1, 1968, and August 31, 1971, or for those who served at Camp Lejeune for a minimum of 30 days between August 1953 and December 1967. Veterans who meet any of these conditions only need to provide documentation of where they served and proof that they have been diagnosed with Parkinson’s Disease.
These locations of service, however, are based on exposure to toxins such as Agent Orange. Veterans who did not serve at any of the three locations listed above may still be eligible for a service connection, but they must submit documentation proving that their Parkinson’s is linked to another service-related cause. And to be clear, this connection is provided for Veterans who have already been diagnosed with Parkinson’s.
A veteran who, for example, submitted medical records showing that their Parkinson’s was caused by a traumatic brain injury while in service may be eligible for benefits. It has been established that veterans who suffer from TBI are at increased risk for developing Parkinson’s. A similar medical correlation has also been found for Veterans who have PTSD.
But what about Veterans who have yet to be diagnosed with Parkinson’s Disease but who have RBD as a result of PTSD or PTSD + TBI? Because research on the association between RBD and Parkinson’s is somewhat new and, in some cases, inconclusive, the issue remains largely untested. However, having a disability claim approved can take a significant amount of time and sometimes requires multiple attempts. Even if your claim is initially denied, it may be possible to receive retroactive benefits when your claim is eventually approved.
Veterans who have reason to believe their PTSD or PTSD and TBI is a contributing cause of their RBD should now consider applying for benefits. The process begins by completing one of two forms: VA form 21-526 (Veteran’s Application for Compensation or Pension) or VA form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits). Either of these forms may be submitted by mail or online at the eBenefits area of the VA’s website.
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For a claim to be considered, you must present evidence that includes details about your time in service and any medical opinions or documentation supporting your claim. Specifically, you will need to submit a DD214 (or other separation documents), service treatment records, and any medical evidence relating to the correlation of diagnosis of Parkinson’s Disease.
The VA is in charge of assisting you in obtaining related documents from any federal agency. This includes military or Department of Defense (DoD) documents and records from VA Medical Centers (or private facilities where the VA has approved treatment) and the Social Security Administration. Therefore, the VA is responsible for arranging for a medical test or obtaining a doctor’s opinion, but only if they believe it is necessary to determine your claim.
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You are in charge of obtaining all documents that are not from a government agency. Records from private (non-VA) physicians, hospitals, current or former employees, and state or local governments may be included. In some instances, the VA may be able to assist you in obtaining records from these locations, but it is ultimately your duty.
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In addition to service personnel and medical records, current non-service medical records, and job records, Veterans may want to gather and submit lay statements, written statements from friends, relatives, colleagues, or employers that do not require expertise. Lay statements are especially beneficial for determining how much Parkinson’s Disease affects your ability to function or perform everyday tasks. A lay statement by a fellow service member, a “buddy statement,” may also be helpful.
The Links Between PTSD, TBI, and Parkinson’s are Growing
Veterans are disproportionately affected by PTSD and TBI, both of which have been found to cause a greater risk of developing RBD. Because recent research has shown a link between RBD and the development of Parkinson’s Disease, Veterans should consider reevaluating their current medical condition with their doctor. Although there may be no current signs of Parkinson’s, research relating to PTSD/TBI as a trigger for RBD has raised new questions about whether veterans are at greater risk of the disease. To maximize benefits that may be available to you and to ensure you receive them while you are still able, Veterans are encouraged to submit a disability claim as soon as possible.
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Not if you haven’t had your C&P Exam yet. We can make sure you get everything covered in your initial application, but if you need to add something, we can do that too. New evidence also comes in handy if you are denied benefits by the VA. We’ll use new and relevant evidence (that’s the technical term) to make a strong appeal.
Yes. Some VA ratings follow the symptoms and not the diagnosed disease. If you have service-connected symptoms that affect your daily life, you should try to get a VA rating for your symptoms, whether they are tied to a specific illness or not. This is especially true as more veterans are getting disability for MUCMI disabilities.