REM Sleep Behavior Disorder

Table of Contents

    What is REM Sleep Behavior Disorder?

    REM (rapid eye movement) Sleep Behavior Disorder (RBD) is a chronic, non-familial sleep-related movement disorder characterized by dream enactment and the patient’s loss of inherent muscle atonia (the usual, temporary paralysis of the arms and legs) during REM sleep. This condition is often referred to as REM Sleep without Atonia, or RSWA. The episodes of dream reenactment tend to get worse over time.

    The actual prevalence of RBD in the general population is difficult to determine. Since it occurs during sleep, many patients with RBD are unaware of their behaviors.

    REM Sleep Behavior Disorder Facts

    • RBD patients have a high risk of developing other neurodegenerative diseases — over 70% of RBD patients will develop parkinsonism or dementia within 12 years of their RBD diagnosis.
    • Other neurological conditions associated with RBD include Lewy body dementia and multiple system atrophy.
    • Conversely, RBD occurs more frequently in some movement disorder patients — specifically Parkinson’s and atypical parkinsonism patients
    • The onset of RBD is often gradual and may worsen over time.
    • RBD is non-familial.
    • RBD most often occurs in men and can happen at any age, though it most often occurs in men after they turn 50.

    What Are the Symptoms of REM Sleep Behavior Disorder?

    The primary RBD symptoms include acting out vivid dreams while asleep — these dreams are often filled with action and may be violent. The actual acting out may include some or all of the following actions:

    • Shouting
    • Swearing
    • Flailing
    • Grabbing
    • Punching
    • Kicking
    • Jumping
    • Leaping

    You Are More Than Your Symptoms

    Movement disorders are incredibly complex diseases affecting multiple systems in the body. At Neurology Solutions, we believe that these challenging diseases require a comprehensive approach that treats the whole patient— not a list of symptoms. 

    Are There Complications With RBD?

    RBD is a unique condition, and as such, it can cause a variety of complications in the lives of its patients. For starters, many RBD patients end up injuring themselves or their bed partners. RBD by itself does not cause daytime sleepiness, but it is often found to co-exist with other sleep disorders including:

    • Sleep apnea
    • Periodic limb movement disorder
    • Narcolepsy

    However, RBD can be very disruptive to the patient’s bed partner and can greatly affect their ability to get a good night’s sleep.

    One of the most serious aspects of REM Sleep Behavior Disorder is the fact that RBD patients have a very high risk of developing atypical parkinsonism, dementia, and/or Parkinson’s disease. Over 70% of RBD patients will develop either atypical parkinsonism or dementia within 12 years of receiving their RBD diagnosis. And about 50% of PD patients also have RBD. 

    Also, atypical parkinsonism and dementia tend to progress more rapidly in patients with RBD.

    How Is REM Sleep Behavior Disorder Different From Sleepwalking or Other Parasomnias?

    REM Sleep Behavior Disorder (along with Restless Leg Syndrome and Bruxism) is considered parasomnia, a category of disruptive sleep disorder involving undesirable or abnormal physical movements, talk, emotions, and actions that happen while you are sleeping. 

    There are many different types of parasomnias, but each class can be categorized by when it occurs — specifically, during which stage of sleep — either during REM sleep or non-REM sleep.

    Generally speaking, non-REM sleep occurs during the first half of a full night’s sleep — from first falling asleep through about the first half of the night. REM sleep typically occurs after the non-REM sleep part of the night, but it’s not a constant state, as your body tends to cycle through and repeat non-REM and REM sleep about every 90 minutes to 2 hours or so.

    Typically, people experiencing non-REM parasomnias, such as sleepwalking, have no memory of the episode when they awake. Furthermore, if awakened during a non-REM parasomniac episode, they will typically be disoriented or confused. By contrast, people with REM-sleep parasomnias often recall their parasomniac episodes in great detail the next day. Also, if awakened, they typically do not feel confused or disoriented.

    REM Sleep Parasomnias

    • REM Sleep Behavior Disorder
    • Sleep Paralysis
    • Nightmare Disorder

    Non-REM Sleep Parasomnias

    Our Approach to Treating REM Sleep Behavior Disorder

    The most important step in treating RBD is making an accurate diagnosis. This is done by taking a thorough history and examination and then determining what tests are required. Typically a sleep study will be ordered to evaluate sleep patterns, which will help diagnose RBD. 

    Once a diagnosis is made then we discuss treatment options tailored to each patient. Not all patients are treated the same and each requires a specific treatment plan. 

    Common treatment strategies may include:

    • Modifying the sleep environment, to reduce sleep-related injuries
    • Magnesium and melatonin are supplements that are typically helpful in reducing RBD severity
    • Clonazepam is a prescription medication commonly used in RBD
    • Baclofen and pramipexole have also been shown to be helpful in some patients

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