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Dear Dr. Roach: I’m a 67-year-old female who has been talking in my sleep while dreaming. Usually the dream is about me being chased or struggling to get away from someone. I am shouting out loudly, but my son tells me that I am making muffled noises, as if someone has a hand over my mouth. I wake myself up making noise. This really is scaring me.

Is this common?

I started noticing this about a year ago, and it’s becoming more frequent. I’m not stressed to the point where my sleep is affected; I also have noted a loss of sense of smell and constipation. I feel stiff in the morning but am back to normal after I get out of bed and move around a bit.

Please tell me what, if anything, I should do.

R.J.

Dear R.J.: There are several related sleep disorders that cause nightmares and sleep talking, but what you are experiencing sounds most like REM sleep behavior disorder.

“REM” stands for “rapid eye movement,” the part of sleep that is associated with dreaming.

This condition is far more common than you might think: About 2 percent of older adults describe it, and it is reported more frequently in men. It usually comes on between ages 60 and 70, and seems to be caused by changes in the nerve cells of the brain relating to REM sleep.

It is often is associated with other neurologic conditions, especially Parkinson’s disease and Lewy body disease. The loss of sense of smell and constipation you’ve noticed makes developing one of these conditions more likely. Often, the disorder precedes the development of other neurologic issues.

The stiffness you note upon awakening might be just a bit of arthritis, but I would be concerned about your developing Parkinson’s, perhaps in the next few years, but it could be 10 or more years away.

If needed, the initial treatment for REM sleep behavior disorder is melatonin; however, I would strongly recommend that you see a neurologist, ideally one with experience in sleep and movement disorders.

Definitive diagnosis may require an overnight sleep study.

Dear Dr. Roach: Everyone seems to believe that in order to lose weight, you have to drink 64 ounces of water a day. Why can’t tea be considered water? That is what it is, especially if it is unsweetened. What happens in the brewing process? I can add Crystal Light to water. I don’t understand.

Y.

Dear Y.: Tea certainly can be considered water from the standpoint of getting enough fluids for the day. Some people do find it easier to lose weight by drinking more fluids. Sometimes, we feel hungry when we actually are thirsty.

The debate goes on as to whether diet sweeteners make weight loss easier or harder, and there is evidence on both sides. Since they contain no calories, diet sodas are thought to affect hunger and satiety, possibly through effects on the gut bacteria. In my opinion, artificially sweetened drinks are better than those sweetened with sugar, but I still would recommend unsweetened tea or water.

Email questions to ToYourGoodHealth @med.cornell.edu.

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