REM sleep behavior disorder involves unusual actions or behaviors during the rapid eye movement sleep phase.
The condition is a type of sleep disorder known as a parasomnia. These are sleep disorders in which strange or dangerous events occur that disrupt sleep.
While it can occur at any age, men over the age of 50 years most commonly have Rapid eye movement (REM) sleep behavior disorder (RBD).
This article explores the nature of RBD, the symptoms of the condition, and how to diagnose and treat it, as well as the possible causes.
REM sleep is a phase of the sleep cycle that starts 90 minutes after falling asleep during a normal cycle.
Dreams occur in REM sleep.
During the REM phase of sleep, the muscles in the body usually enter a state of temporary paralysis. In a person with RBD, this paralysis is incomplete or even completely absent, so the person “acts out” their dreams, sometimes in dramatic or violent ways.
The lack of temporary muscle paralysis causes sleepers with RBD to become physically agitated, actively move their limbs, leave the bed, and engage in other actions linked to being awake.
In some cases, people with RBD might injure themselves or whomever else shares their bed.
The risk of violent movement is higher if the person is having an aggressive or frightening dream.
If the person wakes up, they may remember their dream but have no idea that they engaged in any movement.
An episode can occur with each REM phase, making around four per night. They may only occur once a week or even once a month in rarer cases.
The episodes tend to occur towards the morning hours when REM sleep is more frequent.
A person with RBD may demonstrate the following behaviors while asleep:
- lashing out physically
- punching and kicking
- a clear ability to recall dreams on waking
Their partner or other people sharing the bed may raise concern about these behaviors on waking.
About 38 percent of people with RBD might develop other neurological diseases such as Parkinson’s disease, Lewy body dementia or multiple systems atrophy. Sometimes the RBD can occur 50 years prior to symptoms of other neurological diseases.
People who experience it may later develop more serious cognitive, emotional, and neurological problems, including:
- lower scores in attention
- cognitive issues
- problems with executive functioning
The exact cause of RBD is unclear.
On occasion, RBD may be an adverse reaction to certain medications and may occur during drug withdrawal. People with severe alcohol dependence who suddenly stop consuming alcohol may experience RBD.
Studies suggest that antidepressant medications trigger RBD in up to
Evidence has linked RBD with post-traumatic stress disorder (PTSD), and this sleep issue can occur in people who have
For an accurate diagnosis, doctors at a dedicated sleep center with experience in dealing with parasomnias should examine a person who has symptoms of RBD.
The doctor may order a sleep study to test for RBD or other sleep disorders, such as sleep apnea. During a sleep study, the person will stay in a specialized facility throughout the night.
The medical team will monitor sleep and breathing activity, brain action, and muscle movement. A specialized facility will be able to identify the absence of muscle paralysis during REM sleep.
The assessment will also rule out other possible causes or parasomnia.
Treatment for RBD is usually successful. Managing the condition often involves prescribed medication and by adapting sleep habits.
A number of medications have proven effective in cases of RBD depending on which symptoms present.
Low doses of clonazepam, from the benzodiazepine class of drugs, can help in about 90 percent of people with RBD. These drugs suppress muscle activity and relax the body during sleep.
If clonazepam is not effective, certain antidepressants or melatonin may help to calm violent behavior during sleep.
People with dementia, gait disorders, and obstructive sleep apnea should use caution when using clonazepam. Always follow the instructions of a healthcare professional.
There are a few measures for improving sleep habits in people with RBD, including adopting a predictable sleep-wake cycle to avoid sleep deprivation and avoiding alcohol.
The following strategies can help keep an individual with the condition and their sleeping partner safe:
- Use a mattress on the floor, place cushions around the bed, or place the bed against a wall.
- Consider installing padded bedrails.
- If the person with RBD gets up at night, they should sleep on the ground floor if possible.
- Keep furniture and sharp objects away from the bed.
- Remove potentially dangerous objects from the room.
- Move the bed far from the window.
- Bed partners should sleep in a separate room or bed until RBD symptoms are under control.
The person with RBD should also have regular follow-up checks for Parkinson’s disease.
The movements involved in RBD may grow more violent over time. Treatment for this condition is important, as it can prevent injuries during the night-time.
If examination does not highlight an underlying cause, medication can help to control symptoms, and there are usually no complications.
If an underlying neurological disease is causing symptoms, the outlook will depend on the severity of the disease.
RBD is a condition in which REM sleep does not fully switch off muscle movement, and a person will begin to “act out” the events of their dreams.
This often takes a violent turn and can involve punching and shouting. The person with RBD may leap out of bed or walk around while asleep.
A dedicated sleep center should be able to diagnose the condition. Treatment includes medication and lifestyle adjustments to reduce the risk of injury during sleep hours.
The individual with the condition might find it alarming, but symptoms are manageable depending on the nature of any underlying conditions.
Are the physical reactions involved in RBD always violent?
No. The physical reactions involved in RBD can be nonviolent or even pleasant. Doctors have reported smiling, laughing, and singing during episodes of RBD.