A Guide to REM Sleep Behavior Disorder (& Treatment)

Medically Reviewed

For a majority of those who engage in sleep every night, dreaming is a mental activity; dreams occur in our mind while the body rests. Those who suffer from REM sleep behavior disorder (RBD) act out their dreams. The limbs of the individuals physically move or even get up and engage in activities associated with being awake.

Many of those who go through this will talk in their sleep, shout, scream, hit and even punch others. It’s possible for them to fly out of bed mid-sleep, and it can cause real dangers to the person sleeping, their bed partner, or others they may encounter. There are many times where ill effects such as injury to self or others while asleep can trigger a diagnosis of RBD. Fortunately, this disorder can be treated successfully.

Getting to that point, however, can be a little tricky. The first series of cases of REM sleep behavior disorder was described in 1985 by Mark Mahowald, MD, and Carlos Schneck, MD, of the University of Minnesota. “Past history and current neurological and psychiatric evaluations were unremarkable, apart from the findings reported,” the authors noted.

The doctors found that 90 percent of RBD patients are male and that the disorder usually strikes after the age of 50, although some patients are as young as nine years old. Most of these patients are calm and mild-mannered when awake; however, the studies depict an entirely different display of rhythmic movements in their legs during non-REM and slow-wave sleep.

What we consider sleep involves transitions between three different states – wakefulness, rapid eye movement (REM) sleep, which is associated with dreaming and non-rapid eye movement (N-REM) sleep. Various characteristics define each state, but to understand REM sleep behavior disorders, you must know that it occurs specifically during REM sleep.

During this state, the electrical activity of our brain, as recorded by an electroencephalogram, looks similar to the electrical activity that occurs while walking. Although neurons in the brain during REM sleep function much as they do while awake, REM sleep is characterized by temporary muscle paralysis. For most, even when they have vivid dreams where they imagine they are active, their bodies will not move. For example, if you have ever been in a dream where you got into a fight and could not defend yourself, this is why.

Those who struggle with RBD lack this muscle paralysis, and as a result, they can act out these dramatic or violent dreams during the REM stage of sleep. Sometimes, it will be initiated by talking, twitching, and jerking during dreaming for years before they are able to act out on their REM dreams. Those with RBD move their arms and legs in bed or talk in their sleep, or they can start sleepwalking without realizing they’re dreaming.

Causes of REM Sleep Behavior Disorder

According to the Mayo Clinic, nerve pathways in the brain that prevent muscles from moving are active during ordinary REM or dreaming sleep, resulting in temporary paralysis of your body. In REM sleep behavior disorder, these pathways no longer work, and you may physically act out your dreams. Some factors put you at a higher risk of developing RBD, and these include:

  • Males over 50 years old: More women have been diagnosed with the disorder, especially under 50, and young adults and children can also develop RBD, usually in association with narcolepsy, antidepressant use, or brain tumors
  • Having a specific neurodegenerative disorder: These can include Parkinson’s disease, multiple system atrophy, stroke or dementia with Lewy bodies.
  • Narcolepsy: A chronic sleep disorder characterized by overwhelming daytime drowsiness
  • Certain medications: Newer anti-depressants have been linked to RBD, as well as the use or withdrawal of drugs or alcohol

Newer studies have shown a correlation between environmental or personal risk factors for REM sleep behavior disorder, including occupational pesticide exposure, farming, smoking or a previous head injury.

How to Diagnose REM Sleep Behavior Disorder

Diagnosing REM sleep behavior disorder can only be done by a doctor, and you must schedule an appointment with your primary care physician to make that determination. When you go to the doctor, you can expect them to review your medical history and listen to your symptoms. The evaluation will also include:

Physical and Neurological Exam

Your physician will conduct a physical and neurological exam and evaluate you for REM sleep behavior disorder or other sleep issues. REM sleep disorder shares similar characteristics to other sleep problems, or it may coexist with obstructive sleep apnea or narcolepsy. Extensive testing must take place to ensure you are experiencing RBD.

Talking with Your Sleeping Partner

The doctor will consult with your sleep partner and determine whether they’ve witnessed you act out your dreams while sleeping, such as punching, flailing your arms in the air, shouting or screaming. Your doctor may also ask the partner to fill out a questionnaire about your sleep behaviors.

A Nocturnal Sleep Study (Polysomnogram)

To make an accurate diagnosis, the doctor may suggest an overnight study in a sleep lab. The tests will monitor your heart, lung, and brain activity, breathing patterns, arm and leg movements, vocalizations, and blood oxygen levels while you sleep. Additionally, you may be videotaped to document your behavior during REM sleep cycles.

To diagnose REM sleep behavior disorder, there is a certain criteria sleep doctors use to determine if you have the ailment.

  • You have repeated times of arousal during sleep where you talk, make noise, or perform complex motor behaviors
  • You can recall dreams associated with the movements or sounds
  • If you wake up, you are instantly alert and not disoriented
  • The sleep study shows you have increased muscle activity during REM sleep
  • The sleep disturbance is not caused by other sleep disturbances, mental health, or substance abuse

How to Treat REM Sleep Behavior Disorder

Treatment for REM sleep behavior disorder may include physical safeguards and medications. The doctor may recommend that you make changes in your sleep environment, which will make it safer for yourself and your bed partner. Some of these changes may include:

  • Removing hazardous objects from the bedroom, such as sharp items or weapons
  • Padding the floor near the bed
  • Placing barriers on the side of the bed
  • Protecting bedroom windows
  • Moving furniture and clutter away from the bed
  • Potentially sleeping in a separate bed or room from your bed partner until the symptoms are under control

In addition to some of the safeguards, the doctor may prescribe medications as well. These include:

  • Melatonin
  • Klonopin

It’s crucial to speak with your doctor and find out what’s best for you. If you have been using drugs like Klonopin and have become addicted, you should reach out to the experts at Arete recovery for help.

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