Disturbing Sleep Disorders That Will Keep You Up At Night (pt.5): REM Sleep Behavior Disorder

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Rapid eye movement (REM) sleep behavior disorder causes dream enactment. Typically, your body experiences a state of temporary paralysis, or sleep atonia, that helps keep you safely in bed while you’re asleep. 

With REM sleep behavior disorder, however, you maintain muscle control and can act out your dreams. Although challenging, there are several ways to manage the condition. Let’s dive deeper.

What is REM Sleep Behavior Disorder?

Rapid eye movement sleep behavior disorder (RBD) is a type of parasomnia. This group of sleep disorders leads to unexpected movements and behaviors during sleep.

It’s commonly associated with neurodegenerative diseases like Parkinson’s disease and Lewy body dementia.

Safety is a concern with RBD. For example, you may hurt yourself while moving during sleep or harm a loved one around you. 

Symptoms of REM Sleep Behavior Disorder 

A sign of RBD is abnormal behaviors during REM sleep. REM sleep typically occurs at least 90 minutes after you first fall asleep.

Behaviors might include:

  • falling or walking out of bed
  • waking up abruptly and alert
  • recalling dreams vividly
  • hand motions
  • punching
  • kicking
  • reaching gestures 

Most are aware of their dream-enactment behaviors, but the frequency can vary depending on the individual.

REM sleep behavior disorder occurs typically around the age of 50 years. Also, an estimated 0.4 to 5 percent of the general population lives with the disorder today.

Causes and Risk Factors of REM Sleep Behavior Disorder 

RBD comes in three categories:

  • secondary
  • medication-induced
  • idiopathic

Secondary RBD

There’s a strong link between REM Sleep Behavior Disorder and neurodegenerative diseases, including:

  • Lewy body dementia
  • Parkinson’s disease
  • Shy-Drager syndrome

RBD may even be an early predictor of these types of conditions. They seem to cause imbalances in sleep-wake patterns and muscles during the REM sleep stage.

RBD might also occur along with traumatic brain injuries and post-traumatic stress disorder (PTSD). 

Medication-induced RBD

Antidepressant medications are associated with REM Sleep Behavior Disorder, but it’s unclear exactly how they’re related. More research is needed to find out whether antidepressants cause RBD, or simply makes episodes more apparent.

Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) are all medications that have been linked to RBD. The changes in serotonin levels from the medication can disrupt REM, but it isn’t a common side effect. 

Alcohol can have a similar effect.

Idiopathic RBD

This type of RBD is rare. It means that RBD occurs without connection to a neurodegenerative disease or any drugs or medications.

However, even if there aren’t currently any signs of medical issues, it could take 8 to 10 years to present with symptoms of a neurodegenerative disorder. It’s important to monitor your symptoms closely and let your doctor know of any changes. 

Diagnosis of REM Sleep Behavior Disorder 

Your doctor will look for two tell-tale signs of REM Sleep Behavior Disorder:

  1. a loss of normal atonia during REM sleep
  2. dream enactment behaviors

If present, they may order a sleep study or polysomnography (PSG) with video recording. The test also helps to rule out other sleep disorders.

You may undergo further screening and muscle testing if the PSG is uneventful.

RBD vs. Sleepwalking 

RBD seems a lot like sleepwalking, but they are different disorders that affect different stages of sleep.

Sleepwalking is also known as somnambulism. With this parasomnia, you’ll experience unwanted behaviors in non-rapid eye movement (NREM) slow-wave sleep. 

It’s not as common as RBD in those with neurodegenerative diseases. But studies show that an estimated 10 percent of those with Parkinson’s disease experience sleepwalking. 

Treatment Options 

The goal of treatment is to keep you and your loved ones safe. So, you’ll want to work with your healthcare team to reduce your risk of injury.

Clonazepam (Klonopin) is a prescription medication that’s often the first line of treatment. Clonazepam works by reducing limb movement during REM sleep. But it isn’t ideal for everyone due to side effects and risk of dependence. 

Your doctor may also recommend over-the-counter melatonin. The natural hormone might reduce RBD symptoms. 

Living with REM Sleep Behavior Disorder 

There are some changes you can make to your sleep environment to help manage RBD and keep you safe. 

Sleep environment

To help keep you protected at home, you might consider:

  • Lower your risk for falls. You may prevent fall injuries by lowering your bed closer to the ground or adding bed rails.
  • Safety-proof home surfaces. Add cushions or padding to the floor and cover sharp furniture edges. 
  • Safely restrain your body during sleep. Consider sleeping in a zipped-up sleeping bag or wear safe sleepwear.
  • Keep sharp and dangerous objects out of reach. Lock up all firearms, knives, and weapons. 
  • Sleep in a separate bedroom. This creates a boundary and prevents injury to your partner at night.
  • Install a bed alarm. Anytime you get out of bed, it sounds to wake you up. 

A nasal CPAP device may also lessen RBD behaviors if you’re also diagnosed with obstructive sleep apnea.

Finally, you’ll also want to prioritize good sleep hygiene and a healthy lifestyle. 

Sleep hygiene

Good sleep habits help improve your quality of sleep. Some tips to consider include:

  • Go to bed at the same time each night while waking at the same time each morning.
  • Ensure your bedroom is dark, quiet, and at a cool temperature. 
  • Keep electronic devices like smartphones and TVs out of the bedroom.
  • Avoid eating large meals, caffeine, and alcohol before bedtime.

Healthy lifestyle

Improving your overall health and well-being is a great way to manage your symptoms of RBD. 

You do this by:

Forming these habits helps you build a healthier lifestyle. As a result, conditions like REM Sleep Behavior Disorders might be easier to manage. 

Takeaway

REM Sleep Behavior disorder causes you to act out your dreams. Research suggests that people living with neurodegenerative diseases like Parkinson’s Disease are more prone to experience it. 

There isn’t a cure for the disease, but it’s manageable. A priority in treatment is your safety and the safety of those around you.

Your doctor may run tests if you’re experiencing symptoms. They may also recommend medications to help.

Maintaining a healthy lifestyle and good sleep hygiene is another way to treat RBD. If you think you might be experiencing symptoms, consider sharing them with your doctor.

Source List

Basit H, et al. (2021). Clonazepam. https://www.ncbi.nlm.nih.gov/books/NBK556010/

Healthy lifestyle. (2022). https://www.heart.org/en/healthy-living/healthy-lifestyle

Pham C, et al. (2022). Rapid eye movement sleep disorder. https://www.ncbi.nlm.nih.gov/books/NBK555928/

Roguski A, et al. (2020). A neurologist’s guide to REM sleep behavior disorder. https://www.frontiersin.org/articles/10.3389/fneur.2020.00610/full

St Louis E, et al. (2017). REM sleep behavior disorder: Diagnosis, clinical implications, and future directions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095693/

Tips for better sleep. (2016). https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html

Zergham A, et al. (2022). Somnambulism. https://www.ncbi.nlm.nih.gov/books/NBK559001/

Zhang X, et al. (2021). Association of sleepwalking and REM sleep behavior disorder with Parkinson disease in men. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778518

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