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What Is REM Sleep Behaviour Disorder? Causes and Treatments

What Is REM Sleep Behaviour Disorder? Causes and Treatments

Dreaming occurs in the mind during REM (rapid eye movement) sleep — the latter part of each sleep cycle, when the brain is at its most active. At this stage, most of your muscles are paralysed to prevent you from physically acting out your dreams, and possibly injuring yourself or others. REM sleep behaviour disorder (RBD), however, is the uncontrollable and unconscious enactment of vivid dreams.i

Here, we explore the symptoms and causes of RBD, as well as outlining the best ways to manage the disorder.


What are the symptoms of REM sleep behaviour disorder?

RBD can develop gradually and often gets worse with time. That’s why it’s vitally important to understand the symptoms to receive an early diagnosis and determine the most suitable treatment options.

People with RBD often don’t enter the state of partial paralysis which happens during REM sleep, which means they are able to physically act out their dreams.ii Normal sleep comprises of several REM phases every one and a half to two hours a night and instances of RBD can happen at each phase — sometimes four per night.iii 

Most symptoms of RBD are easily noticeable, most often by the person with the condition or their bed partner. These could include making noises — such as laughing, shouting, talking or cursing — or obvious movements during sleep, like flailing arms, jumping from the bed, kicking or punching. Sometimes, those experiencing RBD respond to violent or action-packed dreams, and defend themselves from “attack”. They will usually be able to accurately recall the dream if they are woken during an episode. iv

People who experience RBD may also develop other emotional, neurological, and cognitive problems such as anxiety, poor attention or apathy at a later point.v


What causes REM sleep behaviour disorder?

The exact aetiology of RBD is still largely unknown. Experts believe the nerve pathways that prevent muscles from moving during REM sleep no longer work in people with RBD. One study on animals with lesions in the part of the brain stem which involves the inhibition of locomotor activity seems to support this theory.vi

RBD has also been linked to certain associated disorders and risk factors, includingvii:

  • Neurodegenerative disorders, like multiple system atrophy, Parkinson’s, stroke, or Lewy body dementiaviii

  • Narcolepsy — a sleep disorder characterised by excessive sleepiness, sleep paralysis, hallucinations, and cataplexy (the sudden loss of muscle control)ix

  • Taking certain medications, particularly newer antidepressants, or the withdrawal or use of alcohol or drugsx

  • Being male and over 50 years old — researchers purport that approximately 90% of RBD patients are malexi

 

How is REM sleep behaviour disorder diagnosed?

Since certain parasomnias are often confused with RBD, meticulous sleep studies are required to evaluate and diagnose the disorder. Once your doctor has completed a physical and neurological exam, they might recommend an overnight sleep study.xii One comprehensive night of monitoring the brain, muscle activity, and sleep will almost always determine if there’s a lack of paralysis during REM sleep. Your doctor may also want to discuss your condition with your sleeping partner to corroborate findings.


What are the treatment options for RBD?


Physical safeguards

To begin with, you should make the necessary changes to your sleep environment to make it safe for both you and your partner. It can help to do the following:

  • Remove any potentially dangerous objects from your bedroom, such as weapons and sharp objects

  • Move clutter and furniture away from the bed

  • Place extra padding on the floor near your bed

  • Protect bedroom windows

  • Consider sleeping in a separate bedroom to your partner until your symptoms have been managed

 

Relaxation

Practising relaxation and stress management techniques before bedtime may help reduce RBD symptoms. Meditation, deep breathing, gratitude journaling, visualisation, yoga, and aromatherapy are simple and effective ways to decrease stress, calm the body and mind, and support quality sleep. Valerian Root and Theanine & Lemonbalm may promote more restful sleep, too.


Medication

A benzodiazepine called clonazepam can reduce or fully treat the condition in 90% of cases.xiii This medication relaxes the body and suppresses muscle activity during sleep. However, clonazepam may cause unpleasant side effects, such as decreased balance and daytime sleepiness, so you should always talk to your GP.

Although RBD can be an alarming and unsettling condition, the symptoms are usually manageable. Once you receive a diagnosis from a dedicated sleep centre, you can implement the necessary lifestyle changes, relaxation strategies and even explore the possibility of taking medication, should you require it.

You can find more helpful guidance on sleep hygiene via our sleep health hub.
 



References:

  1. , , , , & The Sleep Disorders. The National Sleep Foundation. Available online: http://sleepdisorders.sleepfoundation.org [Accessed 25 Sep. 2019].

  2. , & Dream-Enacting Behaviors in a Normal Population. Sleep, 32(12), 1629-1636.

  3. Sleepfoundation.org. REM Sleep Behavior Disorder - Overview and Facts. Available online: http://sleepeducation.org/sleep-disorders-by-category/parasomnias/rem-sleep-behavior-disorder/overview-facts

  4. Mayo Clinic. REM sleep behavior disorder - Symptoms and causes. Available online: https://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/symptoms-causes/syc-20352920

  5. REM sleep behavior disorder: Symptoms, causes, and treatment. Medical News Today. Available online: https://www.medicalnewstoday.com/articles/247730.php

  6. Sleepfoundation.org. REM Sleep Behavior Disorder - National Sleep Foundation. Available online: https://www.sleepfoundation.org/articles/rem-sleep-behavior-disorder

  7. Mayo Clinic. REM sleep behavior disorder - Symptoms and causes. Available online: https://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/symptoms-causes/syc-20352920

  8. , & Meta-analysis on the prevalence of REM sleep behavior disorder symptoms in Parkinson’s disease. BMC Neurology. 17(1). , , , , , , & REM sleep behavior disorders in multiple system atrophy. Neurology. 8(4), 1094-1096. & REM sleep behavior disorder and the risk of developing Parkinson disease or dementia. Neurology. 72(15), 1294-1295.

  9. REM Sleep Behavior Disorder and Narcolepsy. CNS & Neurological Disorders - Drug Targets. 8(4), 264-270. , , , , & The association between narcolepsy and REM behavior disorder (RBD). Sleep Medicine. 6(3), 253-258.

  10. , , , , , & Antidepressants and REM Sleep Behavior Disorder: Isolated Side Effect or Neurodegenerative Signal? Sleep. 36(11), 1579-1585.

  11. Sleepdisorders.sleepfoundation.org. Etiology and Risk Factors for Rapid Eye Movement Sleep Behavior Disorder (RBD) - Sleep eBook. Available online:

  12. Mayoclinic.org REM sleep behavior disorder - Diagnosis and treatment - Mayo Clinic. Available online: https://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/diagnosis-treatment/drc-20352925

  13. Sleepfoundation.org. REM Sleep Behavior Disorder - National Sleep Foundation. Available online: https://www.sleepfoundation.org/articles/rem-sleep-behavior-disordery

   

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Our Author - Olivia Salter

Olivia

Olivia Salter has always been an avid health nut. After graduating from the University of Bristol, she began working for a nutritional consultancy where she discovered her passion for all things wellness-related. There, she executed much of the company’s content marketing strategy and found her niche in health writing, publishing articles in Women’s Health, Mind Body Green, Thrive and Psychologies.

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