REM Sleep Behavior Disorder

REM sleep behavior disorder (RBD) is a rare sleeping disorder that enables people to fully act out their dreams. It’s a condition most often found in men over the age of 50 but also found in some women and children.

REM Sleep Behavior DisorderPeople with REM sleep behavior disorder have vivid and intense dreams, often dreaming that they are under attack from strangers or wild animals. This brings out the classic fight or flight response which sees these people punch, kick, run about the bedroom, and shout loudly. The aggressive nature of the dreams is part of the disorder, and the resulting violent behavior often reported to be completely out of character.

While acting out their dreams people with REM sleep behavior disorder have a high risk of injuring both themselves and other people in the room. They have been reported to run into heavy objects at full speed and it is not uncommon to hear about them mistaking their bedside partner as an intruder. This can result in hair pulling, kicking, punching, and even strangling their partner.

Understandably, this causes major disruption to their partner’s sleep, whose sleep has been disturbed and will often not be able to fall back to sleep for a long time after. REM sleep behavior disorder is a condition that often has more of an effect on the partner than it does the patient.

REM sleep behavior disorder gets progressively worse as it develops, which could be rapid or over a number of years. It often starts with slight movements and murmuring while dreaming, before becoming more animated as the dreams become more intense and violent in nature. The frequency of episodes may also increase, from once a month to almost every night.

REM sleep behavior disorder is a relatively new sleep disorder. It was first given its name in 1987. Before then, doctors believed that these patients had actually woken up and were acting confused. They had no idea that they were in fact still asleep and acting out a dream.

REM sleep behavior disorder sounds similar to sleepwalking but it’s actually a completely different condition. Sleepwalking appears in the early part of the night during deep NREM sleep, where as REM sleep behavior disorder appears in the later part of the night during REM sleep. Essentially, these are two very different types of sleep where different things happen in the body. Sleepwalkers very rarely remember their episodes, where as people with REM sleep behavior disorder often can. Also, after an episode people who sleepwalk often feel tired in the morning, where as people with REM sleep behavior disorder don’t account for any lack of sleep.

Causes of REM Sleep Behavior Disorder

REM sleep is a very active stage of sleep. It’s known by sleep doctors as paradoxical sleep, because although it looks like people are fast asleep, their brain activity is almost indistinguishable from waking life.

REM is the stage of sleep where we experience dreams. To prevent us acting out our dreams, the body intentionally paralyses the body during REM sleep. People with REM sleep behavior disorder lack this protective paralysis, and so are free to act out their dreams.

REM sleep behavior disorder is commonly linked to the development of neurodegenerative diseases such as Parkinson’s, dementia and narcolepsy. These diseases sometimes develop before REM sleep behavior disorder, alongside, or after many years of first having REM sleep behavior disorder. However while having REM sleep behavior disorder increases your chances of having a neurodegenerative disease, sometimes they do not develop at all.

REM sleep behavior disorder has also been linked to the following:

  • Certain types of medication – Often certain antidepressants
  • Drug or alcohol abuse
  • Drug or alcohol withdrawal
  • Stroke

Generally REM sleep behavior disorder caused by the above often goes away after a short spell, but is has been reported in a few cases for it to develop further.

Treatment of REM Sleep Behavior Disorder

REM sleep behavior disorder can be treated with medication. Clonazepam works very effectively for the vast majority of patients, even in very small doses. Melatonin is also an option. It is believed that these medications relax the muscles rather than restore the paralysis, but the end result is the same.

Good sleep habits are important to maximize the amount of time you spend in deep sleep, and minimize the time you spend in REM sleep. Not only will this reduce the chances of an episode, you will also feel better rested and more alert during the day. Ways to improve your sleep habits include:

  • Good sleep timing
  • Avoiding caffeine, particularly late afternoon onwards
  • Avoiding alcohol

Depression and anxiety have been found to reduce deep sleep and increase REM sleep. See the article The Link Between Depression and Sleep for more on this and what courses of action you can take.

Despite taking medication, it is always a good idea to make the room as safe as possible, such as by removing any heavy objects that could be thrown, or any glass that could be smashed.

Because of the higher chance of developing neurodegenerative diseases such as dementia and Parkinson’s, regular checkups with your doctor is advised for early detection and treatment should these diseases occur.

REM sleep behavior disorder is a very young disorder and sleep as a whole is a young field so much hope lies in future research, particularly in the area of brain protecting drugs. It is hoped that REM sleep behavior disorder will one day provide an important piece of the puzzle to help us better understand neurodegenerative diseases so they could one day be prevented or cured.