What Is REM Sleep Behavior Disorder?
Rapid eye movement (REM) sleep behavior disorder (RBD) is a
condition in which you act out your dreams while you sleep. These dreams are
often very vivid and can involve a wide range of movements. Unlike sleepwalking
or night terrors, you can recall your dreams upon waking.
RBD occurs in less than one percent of the population, according
to the National
Sleep Foundation. It was once believed that this disorder mostly affected
men, but new data suggests that it occurs in both men and women with similar
frequency. RBD can be treated with medication. However, it often occurs with
other sleep problems or conditions, which may require additional treatment. If
diagnosed, you should be monitored by your doctor. REM sleep behavior disorder
may indicate a neurodegenerative disease or may be induced by some medications.
What Are the Symptoms of REM Sleep Behavior Disorder?
During an episode of RBD, you may:
After waking up, you’ll probably remember details from your
dream. They will match behaviors you acted out while sleeping. For example, if
you dream about someone chasing you, you might jump out of your bed to run
In most cases, your episodes of RBD will happen at least 90
minutes after you fall asleep. Other people will experience these episodes
during the later portions of sleep. You may have as many as four episodes in a night.
You can also experience less frequent episodes.
Sleepwalking is a different condition than RBD. You may
experience similar movements while sleepwalking. However, it’s usually harder
to wake up from a sleepwalking episode than an RBD episode. You’re more likely
to be confused after waking up from sleepwalking. You’re also less likely to
remember your dream. If you have your eyes open, walk around, leave the room,
eat or drink, engage in sexual activity, or use the bathroom while sleeping,
you’re probably sleepwalking.
What Causes REM Sleep Behavior Disorder?
When you sleep, your body goes through stages of both
non-REM and REM sleep. REM sleep is associated with dreams and is a critical
component of your sleep cycle. It occurs for roughly 90 minutes to two hours
During typical REM sleep, your muscles are temporarily
paralyzed while your brain is actively dreaming. In some cases, the chemical
that causes your body to remain still and your brain to remain active doesn’t
function properly. As a result, you can develop disorders such as sleepwalking,
narcolepsy, or RBD.
In RBD, your muscles aren’t temporarily paralyzed like they
should be. This allows your body to react to your dreams. You may begin with
small actions, such as talking or twitching, and progress to larger movements,
such as jumping or kicking. These actions can harm you or your bed partner.
Who Is at Risk of REM Sleep Behavior Disorder?
According to the National
Sleep Foundation, men are more likely to develop this condition than women.
It can appear at any age, but it most commonly occurs after age 50.
You may be at higher risk of RBD if you have a neurological
disorder, such as Parkinson’s disease or multiple system atrophy. This disease
is similar to Parkinson’s, but it involves more widespread damage.
If you have RBD, you’re at a higher risk of developing:
- Parkinson’s disease, a brain disease that leads
to tremors and eventually difficulty walking and moving
- narcolepsy, when you experience “sleep attacks” or
uncontrollable bouts of falling asleep during the daytime
- periodic limb movement disorder, when you
experience cramping or jerking of your legs during sleep
- sleep apnea, when you periodically stop
breathing during sleep
Diagnosing REM Sleep Behavior Disorder
To diagnose this condition, you should talk with a sleep
specialist. Your doctor will need to know your medical history and will perform
a neurological exam. Your doctor may even refer you to a neurologist for more
Your doctor may monitor your sleep patterns by asking you to
keep a sleep diary. They may also ask you to fill out the Epworth Sleepiness
Scale. This scale can help them determine how your sleep patterns are
interfering with your daily life.
You may be asked to perform an overnight sleep study. In
this case, you will sleep in a laboratory attached to a heart rate, brain wave,
and breathing monitor. These monitors will record your sleep stages, how you
move throughout the night, and if you have any other disorders that may be
affecting your sleep.
How Is REM Sleep Behavior Disorder Treated?
In most cases, this condition can be successfully managed
with medication. Clonazepam (Klonopin) is the most frequently used medicine. Your
doctor may also prescribe melatonin, a dietary supplement that can help
eliminate symptoms. You should talk to your doctor to learn which medication is
best for you.
You will likely need to take other precautions to protect
yourself and your bed partner. For example:
- Move objects away from your bedside.
- Move your bed away from the window.
- Maintain a standard bedtime.
- Avoid certain medications and alcohol.
- Treat any other sleep disorders.
This condition can often be treated successfully with
medication. If you take clonazepam to treat RBD, you may experience side
effects. For example, you may experience morning sleepiness, memory problems,
confusion, or decreased balance. The drug can also make sleep apnea worse. If
you notice side effects that are interfering with your daily life, speak with
your doctor. Switching to melatonin might help relieve your symptoms of RBD,
while causing fewer side effects.
You should also be checked regularly for neurological
disorders, such as Parkinson’s disease. In some cases, RBD is the first warning
sign of neurodegenerative disease.