Unexplained Bruises? The Danger of "Active" Sleeping

If you're dealing with sleep disruption and waking up with bruises you don't remember getting, it can feel confusing—and even a little scary. Many people brush it off as "just tossing and turning," but repeated unexplained bruising deserves attention.

While minor bruises can happen from everyday bumps you don't recall, frequent or patterned bruising during the night may point to something more specific—especially if your sleep is restless, active, or violent.

Let's break down what may be happening, when to be concerned, and what steps you should take.

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Why Am I Waking Up With Bruises I Don't Remember Getting?

Bruises form when small blood vessels under the skin break due to impact. Usually, you remember hitting something. But if you're waking up with bruises you don't remember getting, a few possibilities exist:

Common, Less Serious Causes

• Bumping into furniture during the day without noticing
• Minor nighttime movements against a bed frame or nightstand
• Sleeping in a tight space
• Thinner skin as you age
• Certain medications (like aspirin or blood thinners)
• Vitamin deficiencies (such as vitamin C or K)

These causes are fairly common and often harmless. However, if the bruising is frequent, worsening, or paired with sleep disruption, it's worth digging deeper.

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The Link Between Sleep Disruption and Bruising

Most people move during sleep. But some people experience "active sleeping", where movements become forceful, dramatic, or even violent.

If your body is physically acting out dreams, you might:

• Punch or kick
• Flail your arms
• Fall out of bed
• Hit a nightstand or headboard
• Accidentally strike a bed partner

In these cases, bruises are not random—they're the result of real physical activity happening while you're unconscious.

One of the most important medical conditions linked to this pattern is Rapid Eye Movement (REM) Sleep Behavior Disorder, often shortened to RBD.

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What Is REM Sleep Behavior Disorder?

During normal REM sleep (the stage when most dreaming happens), your body is temporarily paralyzed. This natural paralysis prevents you from physically acting out your dreams.

In REM Sleep Behavior Disorder, that protective paralysis doesn't work properly. As a result, you may physically act out vivid, intense dreams.

Common signs of RBD include:

• Shouting, yelling, or talking during sleep
• Punching, kicking, or flailing
• Falling out of bed
• Dream-enacting behaviors (like defending yourself or running)
• Injuring yourself or a bed partner
• Waking up with bruises you don't remember getting

Importantly, people with RBD often recall vivid dreams that match their movements.

If these symptoms sound familiar and you're concerned about whether your nighttime bruising could be linked to RBD, you can quickly assess your risk using a free Rapid Eye Movement (REM) Sleep Behavior Disorder symptom checker to help determine if you should speak with a doctor.

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Who Is at Higher Risk?

REM Sleep Behavior Disorder is more common in:

• Adults over age 50
• Men (though women can develop it too)
• People with neurological conditions
• Individuals taking certain antidepressants

Research has shown that RBD can sometimes be an early sign of neurological diseases such as Parkinson's disease or Lewy body dementia. That does not mean everyone with RBD will develop these conditions—but it does mean persistent symptoms should be taken seriously.

There's no need to panic. But there is good reason to speak with a doctor if symptoms continue.

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Other Medical Causes of Unexplained Bruising

If you're experiencing sleep disruption and waking up with bruises you don't remember getting, your doctor may also consider:

Blood or Clotting Disorders

• Low platelet counts
• Von Willebrand disease
• Leukemia (rare, but serious)

Medication Effects

• Blood thinners (warfarin, apixaban, etc.)
• Aspirin
• Steroids
• Certain antidepressants

Nutritional Deficiencies

• Vitamin C deficiency
• Vitamin K deficiency
• Severe protein deficiency

Alcohol Use

Alcohol can both disrupt sleep and increase bruising risk by affecting coordination and clotting.

If bruises are large, painful, frequent, or appear without any impact at all, medical evaluation is essential.

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When Is This an Emergency?

Seek urgent medical attention if bruising is accompanied by:

• Severe headache
• Confusion
• Weakness on one side of the body
• Unusual bleeding (gums, nose, urine, stool)
• Very large or rapidly spreading bruises
• Fever and fatigue
• Unexplained weight loss

These could signal a more serious underlying issue.

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Signs Your Sleep May Be the Main Problem

Clues that your bruising is likely due to active sleeping include:

• Bed sheets in disarray most mornings
• Objects knocked off nightstands
• Reports from a partner that you move violently
• Falling out of bed
• Dream recall that matches physical movement
• Repeated injuries occurring overnight

If this pattern sounds familiar, sleep evaluation is a smart next step.

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How Doctors Evaluate "Active" Sleeping

A physician may recommend:

• A detailed sleep history
• Medication review
• Blood tests to rule out clotting issues
• A sleep study (polysomnography)

A sleep study can confirm whether your muscles are failing to relax properly during REM sleep.

This test is painless and provides clear answers.

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Treatment Options

The good news: REM Sleep Behavior Disorder and other sleep-related movement issues are treatable.

Treatment may include:

• Medication adjustments (if antidepressants are contributing)
• Melatonin supplementation (commonly used and often effective)
• Prescription medications like clonazepam
• Bedroom safety modifications, such as:
  • Removing sharp furniture
  • Padding corners
  • Placing cushions beside the bed
  • Lowering the bed height

If a neurological condition is identified, early diagnosis can improve long-term management.

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Don't Ignore Repeated Sleep Disruption

Occasional restless nights are normal. But ongoing sleep disruption with waking up with bruises you don't remember getting is not something to ignore.

Your body should be resting—not fighting imaginary battles.

Even if the cause turns out to be mild, identifying it can:

• Improve sleep quality
• Prevent injuries
• Protect your bed partner
• Reduce anxiety about unexplained symptoms

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Practical Next Steps

If this is happening to you:

1. Keep a sleep journal for 1–2 weeks.
2. Ask a bed partner what they observe.
3. Take photos of bruises to track patterns.
4. Review your medications with a pharmacist or doctor.
5. Use a free online Rapid Eye Movement (REM) Sleep Behavior Disorder symptom checker to evaluate your symptoms in just minutes.
6. Schedule an appointment with your primary care provider.

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The Bottom Line

Waking up with bruises you don't remember getting can have harmless explanations—but when it happens alongside sleep disruption, it may signal "active sleeping" such as REM Sleep Behavior Disorder.

This condition is real. It is diagnosable. And it is treatable.

Do not panic—but do not ignore repeated symptoms either.

If bruising is frequent, worsening, or paired with violent movements during sleep, speak to a doctor. If you notice signs that could be life-threatening—such as unusual bleeding, neurological symptoms, or severe fatigue—seek medical attention immediately.

Your sleep should restore you, not injure you. Getting answers is the first step toward safer, healthier rest.