Please welcome Dr. Anthony DiMarco, MD, Medical Director and Professor of Physiology at Case Western Reserve University
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What is REM Sleep Behavior Disorder?

What is REM Sleep Behavior Disorder?

While some people toss and turn at night, those with REM sleep behavior disorder (RBD) experience a whole different level of sleep activity. Some have dreams at night that feel realistic, yet those with RBD regularly act out vivid dreams. Many people with this curious sleep disorder do not even know that there is a name for it.

To help understand if you are affected by RBD, we have provided answers to some of the most common questions surrounding the disorder. Find out what it is, what symptoms and behaviors are associated with RBD, how it is diagnosed and who is more at risk for developing it.

REM Sleep Behavior Disorder: What is it?

RBD is another type of sleep disorder in which the division between sleep and wakefulness is blurry. Narcolepsy and parasomnias also have this issue where the brain does not effectively separate the two states.

Normal sleep involves sending brain chemicals that induce muscle paralysis, called atonia. This makes our bodies lie still while we dream during the rapid eye movement phase. REM begins about 90 minutes after falling asleep and occurs multiple times throughout the night. This sleep phase includes high levels of brain activity and dreaming. People with RBD, however, do not have this type of muscle paralysis. Instead of lying still, they regularly get out of bed and act out their most vivid dreams.

Activity is most often associated with generally unpleasant dreams, those that may be emotionally charged, dramatic or violent. The person sleeping feels what happens during the dream and, to some extent, acts it out. Violent or scary dreams can be distressing and, in some cases, cause serious injury to a bed partner. Episodes can reoccur as many as four times throughout the night, though most people with REM sleep behavior disorder experience active dreams less frequently – on a weekly or monthly basis.

What Behavior is Commonly Associated with RBD?

Because people with RBD do not remember their nocturnal activity, REM sleep behavior disorder is often identified only with the help of a roommate or bed partner. They report seeing the following types of behavior:

  • Talking, shouting or cursing while asleep,
  • Laughing or crying,
  • Sleepwalking,
  • Sudden limb movement, including kicking and punching,
  • Jumping,
  • Emotional or violent outbursts,

Diagnosis of RBD can be challenging. It should not be confused with somnambulism, sleep-related eating disorder, or sexsomnia. Unlike these other disorders, RBD does not usually involve leaving the bedroom, opening their eyes, eating, drinking or engaging in sexual activity while asleep.

How Does REM Sleep Behavior Disorder Develop?

The onset of REM sleep behavior disorder is usually a gradual process and symptoms tend to get more pronounced over time. Things such as talking, twitching and jerking may be a common occurrence for years before someone experiences the more intense dream activity.

REM sleep behavior disorder can be associated with serious neurodegenerative conditions including Parkinson’s disease and Lewy Body Dementia. It may also occur in combination with other sleep disorders, such as sleep apnea and narcolepsy.

What are the Symptoms of RBD?

Patients seeking a diagnosis for REM sleep behavior disorder have often experienced the following symptoms:

  • Recall of dreams if they are awakened.
  • Disturbing bed partners while they sleep.
  • Acting out dreams, as described above.

What is the Process for Diagnosing RBD?

RBD is a sleep disorder, not a psychiatric problem. Because RBD can be easily confused with other parasomnias, a clinical sleep evaluation is needed to diagnose. Sleep test technicians should have experience identifying RBD and other, less common, parasomnias. This type of testing includes monitoring brain activity and muscle movements. Usually, a single overnight evaluation can determine if someone lacks normal muscle paralysis during the REM stage.

Are There Any Risk Factors for RBD?

Some patients are more prone to developing REM sleep behavior disorder. The more common risk factors include:

  • Having a neurological disorder, like Lewy Body Dementia. It can also be a precursor for Parkinson’s disease, another neurodegenerative disorder.
  • Having other sleep disorders, such as narcolepsy.
  • Being male over the age of 50. Although women, young adults and children may also suffer from this disorder.
  • Using certain prescription medications, including antidepressants.
  • Withdrawing from drugs or alcohol.
  • A history of concussions or head injuries.

Can REM Sleep Behavior be Treated?

The good news is that people with RBD do have some effective treatment options. Melatonin can naturally help relieve some of the symptoms of this sleep disorder. Additionally, many patients are successfully treated with antiepileptic, antidepressant or psychoactive medications.

Find Out What is Bothering You at Night

The first step to getting better rest is accurately diagnosing the sleep disorder that is affecting you. A sleep evaluation can even be a pleasant experience. Ask to take a tour at Sleep Health Solutions. Our sleep center was designed to make everyone feel comfortable and relaxed. Call (330) 923-0228 to schedule a consultation today.

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