I wake up to the first punch hitting me square in the side, right below the ribs. My hands flail out, instinctively grabbing at his fists and holding them tight in my own. "Stop! No!"
His fists release. He rolls right on his back, his hand at his sides, snoring. The attack is over.
He won't remember it in the morning, when I'll lift the side of the ratty t-shirt I wear to bed to show him a spot just above my left hip that's already turned an ugly black and blue. His face will be stricken when I do this. "I'm sorry," he'll tell me, wrapping his arms around me and kissing my forehead. "I'm so, so sorry. I don't remember it."
I know he doesn't. He's not a guy who uses "sorry" to hang a yoke of guilt around my neck nor can he control it. The attacks are born out of nightmares—an uncommon but all-too-real side effect of taking antidepressants.
Doctors call this sort of frequent lashing out violently in your sleep REM sleep behavior disorder or RBD. While most of us dream mentally, those with RBD dream physically. They move their arms and their legs. They punch. They kick. They may leap out of bed or scream in the night.
Normally, the body is put into a state of "atonia" during sleep, in which the muscles are essentially told by the brain to shut down, explains Cynthia Bodkin, a neurologist at Indiana University Health and associate professor of neurology at the IU School of Medicine. "Only the eyes and diaphragm still move," she says.
But for the 2 percent of the population afflicted by RBD, that state of atonia doesn't occur, causing the major muscles of the body to remain active during sleep. Exactly why that happens is still being studied, but for some it means even more trouble than roughing up your bed partner. "Often it may be one of the very early signs of a neurodegenerative disease," Bodkin notes. In other words, an RBD diagnosis could signal a diagnosis of Parkinson's or similar condition down the road for some people.
Watch this on Tonic:
But 6 percent of the estimated 60 percent of Americans who take antidepressants also have RBD, and in those cases, their bodies are generally not facing neurological disease. Their medicine is likely to blame. Antidepressants typically regulate serotonin and/or norepinephrine, two of the body's stress hormones. That helps fight depression by day, but during sleep, the body makes use of neurogenic and serotonergic pathways to help us achieve a normal REM sleep cycle, Bodkin says.
"Medications that block serotonin or norepinephrine absorption are blocking the body's natural way of producing muscle atonia," she explains. Going off your medications can often solve the issue completely, and reducing the dose may also do the trick.
That's not an option in my house. My husband has taken antidepressants for half of his life. He needs them to function, and we both notice if he's forgotten to take them. By the light of day, ours is a fairly standard American marriage. We have a child, bills, jobs, a house, and too many pets. My husband's generally gentle nature is part of what attracted me to him in the first place. We're not perfect, but we're perfectly good during the daytime.
But day always turns into night, and with night comes uncertainty. By some estimates more than 50 percent of RBD sufferers report injury to themselves or to their bedmate at some point. Often that's what sufferers mention when they're talking to their doctor, Bodkin says.
"Most patients don't have a lot of memory of what happens," she notes. Instead they may say their partner has complained about being hurt by them in bed, or they might report falling out of bed. My husband has yet to hurt himself. So far it's just been me.
I make it a point to always go to bed first now, hoping I'll fall asleep before he finishes his shower. If I don't, I know I won't make it through the night without decamping to the couch. Something about falling asleep without him in the bed makes it easier, and so I slip a torn piece of paper into my book and turn off the light, close my eyes and will myself to darkness.
It's been like this for two years now, since the night when I woke to a fist square in the mouth. I screamed so loudly it woke the entire house, our then nine-year-old rolling out of her bed and running to our room to see what had happened.
My top lip was already puffy, my husband mumbling "What's wrong? What happened?" He was half in his dreams and half out, unaware that his hand had connected with my face moments before. I walked around with a fat lip for a solid week, but because of my work-at-home job, I never had to explain it to anyone aside from our child. "Oh, Daddy and I knocked heads in our sleep," I told her. At nine, it made perfect sense, and she stumbled back to cuddling with her stuffed animals while I tried—unsuccessfully—to settle back to sleep.
I ended up moving to the couch that night, and when he came downstairs the next morning, he was surprised to find me on the couch and even more surprised to see me sporting a fat lip. He had no recall of the night before: Not of my scream, not of our nocturnal visitor from the next bedroom, certainly not of the part he played in the night's activities. His apologies that morning have become achingly familiar.
"Oh my god! I'm so sorry! I didn't know!" He hugs. He asks what I need. He promises it will never happen again. And then he moves on. What else can he do? He has no pain to nurse, no bruises to ice. There's no sting in his lips as he talks to co-workers or ache in his side as he strains to reach for something on a high shelf to remind him of what went down the night before.
Doctors like Bodkin recommend the sleep partners of RBD sufferers move to another bed if possible, or at least remove any sharp objects in the sleeping space (including the bedside table). At times I do opt for the couch, and we've cleared the bedroom of anything that could become a weapon in the night. He's opted against seeking clonazepam, the most commonly prescribed treatment for RBD, but he's trying melatonin, a more natural treatment option that Bodkin says can also help him sleep more restfully.
I'm hopeful that it will all go away, that we can just sleep side by side like a regular couple, but we're not there—at least not yet.
If I can't beat him to dreamland, I struggle to fall asleep, my head off the pillow at the slightest noise. I've always been a night owl, a "can't sleep because there's too much to think about right this second" kind of person. But now what I think about is his hands and what they might do to me tonight.
The incidents, for him, aren't real. They never happen because he can't remember them. If he hit me in the daylight, when he could remember it, he would have the horror of memory on his side. But there's nothing, save for the occasional bruise revealed in the morning as he readies for work, his mind already on a separate track.
There's only so much evidence I can produce anyway. There are the fat lips and the bruises, sure, but not every night's attack ends with marks on my body. More than a few times it's been a hand clamped over my mouth that I've woken to, my own arms shooting out instinctively as I struggle beneath him. Last week I somehow woke in time to catch both fists in my own before he could land either punch. Was it some stealth awareness of an attack I picked up during my teenage years when I studied karate? Or was it a self-preservation that's slowly built up in the past two years, a means to make sleeping in my own bed less fearful? I'm not sure.
I know only that I know nothing about what tonight will bring.
Read This Next: How to Sleep at Night When Trump is President