REM Behavior Disorder – What is it?

REM sleep behavior is characterized by either experiencing the normal temporary paralysis of your arms and legs or by physically acting out your dreams, often with vocal sounds and sudden, often violent arm and leg movements, during REM sleep. Most people imagine they are active during a vivid dream but are actually still. However, someone with REM Behavior Disorder (RBD) does not experience the usual muscle paralysis during their sleep, so they are able to act out their dreams by moving their arms and legs, talking, twisting and jerking, or even sleepwalking. Typically RBD worsens gradually over time so one might initially only experience twitching, but over the years that twitching can develop into them fully acting out their dreams.

The most common symptoms of RBD include:

  • Excessive movement, such as: kicking, punching, arms flailing, or jumping from the bed typically in response to action-packed or violent dreams
  • Excessive noises, such as: talking, laughing, shouting, emotional outcries, or even cursing
  • Waking from the episode alert, not confused or disoriented, and being able to remember the dream fully and retell it in extreme detail

Typically REM Behavior Disorder is not noticed until it disrupts one’s sleep, or more often, the sleep of their sleep partner. Sometimes a diagnosis is first made upon someone injuring themselves or their sleep partner. However, RBD can be treated successfully.

What causes it?

The nerve pathways in the brain that usually initiate temporary paralysis in your body while you sleep, keeping your muscles from moving, do not function if you have RBD. Since your muscles no longer work properly they are free to move and keep you active while you sleep, providing the opportunity to physically act out your dreams.

Common risk factors associated with RBD include:

  • Being a male over 50 years of age; however, it is becoming more common recently for women under the age of 50 to be diagnosed
  • Having Parkinson’s disease, multiple system atrophy, a stroke, dementia with Lewy bodies, or other types of neurodegenerative disorders
  • Having narcolepsy, a chronic sleep disorder characterized by overwhelming daytime drowsiness
  • Taking antidepressants, especially newly developed ones, heavy use of alcohol, or withdrawal of drugs

Evidence from recent studies suggests that there could be other specific environmental risk factors to cause RBD, such as: farming, occupational pesticide exposure, smoking, or a previous head injury.

Certain complications caused by RBD can arise, such as:

  • Causing distress or disturbing the sleep of your sleeping partner or other people living in your home
  • Isolating oneself either to protect others from your episodes or to hide the sleeping disorder
  • Injuries to yourself or your sleeping partner

Possible solutions

Physician recommended solutions for RBD can range from adjusting your sleeping environment to medication treatment options. Some environmental changes to establish safeguards for you and your sleep partner include:

  • Padding the floor near the bed
  • Removing any and all sharp or blunt edged objects, or any other objects considered to be dangerous
  • Constructing barriers around the bed
  • Distancing furniture or other clutter from the bed
  • Locking and padding windows for protection
  • In extreme cases, sleeping in separate bedrooms is recommended

Common medicated treatment options for RBD include:

  • Melatonin – Melatonin is a dietary supplement that studies have shown may help to reduce or eliminate RBD symptoms. In addition, it is commonly used to help people fall asleep quicker and fall into a deeper sustained sleep. In some cases, Melatonin has proven to be as effective as clonazepam while offering few side effects.
  • Clonazepam (Klonopin) – Clonazepam is not only used often to treat anxiety but is also the most common choice for treating RBD. It reduces symptoms, but with the possibility of some side effects including daytime sleepiness, decreased balance, and worsening sleep apnea.

Why get treatment?

Doctors agree that RBD is very treatable. You won’t have to worry about injuring yourself or others while you sleep anymore and can rest easy when you lay down to sleep at night. With continuing studies and efforts doctors are developing a better understanding of the cause of RBD and how to combat RBD with the newer medications being developed.

Your next step should be to schedule an appointment with your personal physician or one of our Board Certified Sleep Physicians to discuss your concerns.

Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. This article is for informational purposes only and does not constitute medical advice; the Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.