What Is REM sleep behaviour disorder? Causes and treatments

Dreaming occurs during REM (rapid eye movement) sleep – the latter part of each sleep cycle when the brain is at its most active. Crucially, most of your muscles are paralysed during REM sleep to prevent you from acting out your dreams and possibly injuring yourself or others.

For some people, however, paralysis doesn’t happen at this stage of sleep. REM sleep behaviour disorder (RBD) is the uncontrollable and unconscious enactment of vivid dreams¹.

Here, we explore the symptoms and causes of REM behaviour disorder and outline the best ways to manage the condition.

What are the symptoms of REM sleep behaviour disorder?

RBD can develop gradually and often worsens with time. That’s why it’s so important to understand the symptoms to receive an early diagnosis and determine the most suitable REM sleep behaviour treatment.

People with RBD don’t enter the critical state of partial paralysis in sleep, meaning they can physically act out vivid and often unpleasant dreams². Healthy sleep comprises a REM phase every one and a half to two hours a night, and instances of RBD can happen at each stage – sometimes as much as four times per night³.

Most symptoms of RBD are easily noticeable and are often first detected by the person’s bed partner. These could include making noises – laughing, shouting, talking, or cursing – or obvious movements during sleep, like flailing arms, jumping from the bed, kicking or punching. In some cases, those experiencing REM sleep behaviour disorder respond to violent or action-packed dreams and defend themselves from ‘attack’. Individuals with RBD can usually recall the dream if woken during an episode⁴.

It’s not uncommon for people who experience RBD to develop other emotional, neurological, and cognitive issues, such as increased anxiety, poor attention, or apathy⁵.

What causes REM sleep behaviour disorder?

The exact cause of REM sleep behaviour disorder remains unknown. Experts believe the nerve pathways that prevent muscles from moving during REM sleep no longer work in people with RBD.

RBD has also been associated with the following risk factors ⁶:

• Neurodegenerative disorders, like multiple system atrophy, Parkinson’s, stroke, or Lewy body dementia ⁷

• Narcolepsy – a sleep disorder characterised by excessive sleepiness, sleep paralysis, hallucinations, and cataplexy (the sudden loss of muscle control)⁸

• Taking certain medications, particularly newer antidepressants, or the withdrawal or use of alcohol or drugs⁹

• Being male and over 50 years old — researchers around 90% of RBD patients are male¹⁰
   

How common is REM sleep behaviour disorder?

Fortunately, REM sleep behaviour disorder is rare. Less than one per cent of people are estimated to suffer from RBD¹¹.
 

How is REM sleep behaviour disorder diagnosed?

Since certain parasomnias are often conflated with RBD, sleep studies are needed to diagnose the disorder. Once your doctor has completed a physical and neurological exam, they might refer you for an overnight sleep study¹².

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 verify their findings.

REM sleep behaviour disorder treatment

Physical safeguards

To begin with, you should make all the necessary changes to your sleep environment to ensure it’s safe for both you and your partner:

• 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 your symptoms of REM behaviour disorder. Meditation, deep breathing, gratitude journaling, visualisation, yoga, and aromatherapy are simple and effective ways to decrease stress, calm the body and mind, and, ultimately, help you drift into sleep.

You may also consider taking Valerian Root, Theanine & Lemon balm, Magnesium, and 5 HTP, which are often recommended for sleep.

Medication

A benzodiazepine called clonazepam is widely used to manage RBD. It can reduce or fully treat the condition in 90% of cases¹³. Clonazepam relaxes the body and suppresses muscle activity during sleep. However, it can have unpleasant side effects, such as decreased balance and daytime sleepiness, so you should always talk to your GP before taking it.

Although REM behaviour disorder can be alarming and unsettling, the symptoms are usually manageable with the correct treatment. Once you receive a diagnosis from a dedicated sleep centre, you can then make the necessary lifestyle changes 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. Kram. J., Kryger. M., Ojile. J., Pagel. J., Wickwire. E. & Huari. P. (2021). The Sleep Disorders. The National Sleep Foundation. Available online: http://sleepdisorders.sleepfoundation.org [Accessed 25 Sep. 2019].
2. Nielsen. T., Svob. C. & Kuiken. D. (2009). Dream-Enacting Behaviours in a Normal Population. Sleep, 32(12), 1629-1636.
3. Sleepfoundation.org. (2021). REM Sleep Behaviour Disorder - Overview and Facts. Available online: http://sleepeducation.org/sleep-disorders-by-category/parasomnias/rem-sleep-behavior-disorder/overview-facts
4. Mayo Clinic. (2021). REM sleep behaviour disorder - Symptoms and causes. Available online: https://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/symptoms-causes/syc-20352920
5. Hammond. N. (2021). REM sleep behaviour disorder: Symptoms, causes, and treatment. Medical News Today. Available online: https://www.medicalnewstoday.com/articles/247730.php
6. Mayo Clinic. (2021). REM sleep behaviour disorder - Symptoms and causes. Available online: https://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/symptoms-causes/syc-20352920
7. Zhang. J., Xu. C. & Liu. J. (2017). Meta-analysis on the prevalence of REM sleep behaviour disorder symptoms in Parkinson’s disease. BMC Neurology. 17(1). Plazzi. G., Corsini. R., Provini. F., Pierangeli. G., Martinelli. P., Montagna. P., Lugaresi. E. & Cortelli. P. (1997). REM sleep behaviour disorders in multiple system atrophy. Neurology. 8(4), 1094-1096. Britton. T. & Chaudhuri. K. (2009). REM sleep behaviour disorder and the risk of developing Parkinson disease or dementia. Neurology. 72(15), 1294-1295.
8. Billiard. M. (2019). REM Sleep Behaviour Disorder and Narcolepsy. CNS & Neurological Disorders - Drug Targets. 8(4), 264-270. Nightingale. S., Orgill. J., Ebrahim. I., de Lacy. S., Agrawal. S. & Williams. A. (2005). The association between narcolepsy and REM behaviour disorder (RBD). Sleep Medicine. 6(3), 253-258.
9. Postuma. R., Gagnon. J., Tuineaig. M., Bertrand. J., Latreille. V., Desjardins. C. & Montplaisir. J. (2013). Antidepressants and REM Sleep Behaviour Disorder: Isolated Side Effect or Neurodegenerative Signal? Sleep. 36(11), 1579-1585.
10. Sleepdisorders.sleepfoundation.org. (2021). Etiology and Risk Factors for Rapid Eye Movement Sleep Behaviour Disorder (RBD) - Sleep eBook. 
11. American Academy of Sleep Medicine. (2014). The International Classification of Sleep Disorders – Third Edition (ICSD-3). Darien, IL.https://learn.aasm.org/Public/Catalog/Details.aspx
12. Mayoclinic.org (2021). REM sleep behaviour 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. (2021). REM Sleep Behaviour Disorder - National Sleep Foundation. Available online: https://www.sleepfoundation.org/articles/rem-sleep-behavior-disordery

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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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