REM Sleep Behavior Disorder

What is REM Sleep Behavior Disorder?

REM sleep encompasses approximately 20% of nightly slumber, and it happens most often during the latter half. It is the time when dreaming takes place, but in those with REM Sleep Behavior Disorder (RBD), sleep is far from peaceful. Those with the rare disorder are most often males over the age of 50.

It rarely affects women. Subjects may exhibit unusual movements and behaviors that include striking out and/or thrashing about while loudly vocalizing. Dreams may be highly disturbing and vivid. The disorder is also referred to as dream-enacting behavior since sufferers physically and verbally react to their dreams.

The exact cause of RBD is unclear, but it commonly occurs in those with narcolepsy, diffuse Lewy body dementia, Parkinson’s disease, Shy-Drager syndrome and in subjects with other neurodegenerative and sleep-related disorders. It can also occur as a side-affect of certain medications, sudden abstinence from alcohol or drugs and in those with anxiety or post-traumatic stress disorder (PTSD).

What are the Symptoms of REM Sleep Behavior Disorder?

The symptoms of REM sleep behavior disorder may include:

  • Unusual physical activity during sleep such as:
  •  Punching
  •  Kicking
  •  Jerking
  • Swinging of the arms
  • Thrashing about
  • Jumping from the bed

Symptoms of the disorder may also include vocalizations such as:

  • Screaming
  • Crying
  • Laughing
  • Speaking
  • Cursing

REM Sleep Behavior Disorder Causes

There are many potential causes of REM sleep behavior disorder (RBD). Firstly, it tends to be more common in men aged 50 or more, than it is in women and children. Elderly people tend to be most at risk.

RBD is often seen in people with a neurological disorder such as Parkinson’s disease and multiple system atrophy. However, it is not clear why this is. Some people with RBD go on to develop Parkinson’s disease many years later, which is why it’s very important to look out for symptoms of Parkinson’s such as muscle tremors.

The condition is also linked with other sleep disorders, particularly:
– Narcolepsy
– Periodic limb movement disorder
– Sleep apnea

However, it is not clear whether these disorders are causes of RBD, caused by RBD, or simply occur concurrently, perhaps due to other underlying health conditions.

How is REM Sleep Behavior Disorder Treated?

The treatment of REM sleep behavior disorder may include the treatment of underlying conditions. Solutions may include:

  • Stringent safeguards to avoid injury
  • Medication such as clonazepam, melatonin or an anti-depressant
  • Avoidance of alcohol
  • Changes in sleep habits

It is important to have a physical and neurological exam to rule out an underlying condition or a neurodegenerative disorder. A sleep study may also be necessary to properly diagnosis and treat REM sleep behavior disorder. Treatment of RBD is usually successful.

REM Sleep Behavior Disorder Prevention

There is no scientifically proven method to prevent RBD, but it may be possible to reduce the frequency or severity of episodes with medication. However, it’s also very important to consider injury prevention, both for the person with RBD and their partner.

For one, it can be helpful to place an extra mattress on the floor beside the bed, which will help to break the patient’s fall should they often leap or roll out of bed. Placing padding on the sharp corners of furniture may also be helpful. Some patients may benefit from sleeping inside a sleeping bag, as this may restrain their body movements enough to prevent injury to themselves or their bed partner.

In some cases it may be necessary to remove anything from the bedroom which could be used by the patient as a weapon, such as sharp objects, and which could cause serious harm to their partner. In others, it may be necessary for partners to sleep in separate beds or in separate rooms, particularly until the RBD is under control with the help of professional treatment.

Last Reviewed:
October 09, 2016
Last Updated:
December 07, 2017
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