Preventing Rem Sleep Disorders: A Comprehensive Guide

REM sleep behaviour disorder (RBD) is a parasomnia disorder characterised by nocturnal complex motor behaviour and the loss of muscle atonia during REM sleep. It can cause sleep-related injuries and is often a precursor to neurological disorders such as Parkinson's disease. The current approach to managing RBD is twofold: symptomatic treatment to prevent injury, and prognostic counselling and longitudinal surveillance for the development of neurodegenerative disorders.

The first-line treatment for RBD is drug therapy, with clonazepam and melatonin being the most commonly used and recommended medications. However, their efficacy has not been proven in randomised clinical trials, and they do not completely stop dream enactment behaviours. Other drugs such as temazepam, lorazepam, zolpidem, zopiclone, pramipexole, donepezil, ramelteon, agomelatine, cannabinoids, and sodium oxybate have also been used with varying levels of success.

Non-pharmacological approaches include bed alarms, which can be useful for patients who leave their bed during dream enactment, and hypnosis, especially for those with psychiatric RBD.

Avoid alcohol and prescription drugs

Alcohol and prescription drugs can have a detrimental effect on REM sleep. Drinking alcohol before bed can disrupt the sleep cycle and reduce sleep quality. Alcohol can also contribute to sleep apnea and snoring, increase the need to urinate, and interrupt the body's natural circadian rhythm.

Research on how alcohol affects REM sleep is conflicting. Some studies report that alcohol does not reduce REM sleep but does reduce overall sleep quality. However, a review of historic sleep research found several instances where the duration and quality of REM sleep were lower following alcohol intoxication.

Prescription medications can also impact REM sleep. Drugs that suppress the central nervous system, such as benzodiazepines and sedative-hypnotics, can cause sedation and drowsiness, leading to daytime sleepiness and increased risk of falls and accidents. Antidepressants, which affect serotonin, dopamine, and norepinephrine, can also worsen sleep for some people.

To prevent REM sleep disorders, it is advisable to avoid alcohol and prescription drugs, especially close to bedtime. Creating a consistent bedtime routine and a relaxing environment can also help improve sleep quality and increase the amount of REM sleep.

Adopt a consistent sleep schedule

Adopting a consistent sleep schedule is a crucial step in preventing REM sleep disorders. Here are some detailed tips to help you establish and maintain a healthy sleep schedule:

Set a fixed bedtime and wake-up time: Try to go to bed and wake up at the same time every day, even on weekends. This helps to regulate your body's internal clock and promote a consistent sleep-wake cycle.

Practice a relaxing bedtime routine: Engage in calming activities before bed to signal to your body that it's time to wind down. This could include reading a book, listening to soothing music, practising meditation or deep breathing exercises, or taking a warm bath. Avoid stimulating activities, such as intense exercise or watching thrilling movies, close to bedtime.

Create a sleep-friendly environment: Ensure your bedroom is cool, dark, and quiet. Consider using blackout curtains, earplugs, or a white noise machine if necessary. Make sure your mattress and pillows are comfortable and supportive, and limit the use of electronic devices before bed as the blue light they emit can interfere with your sleep.

Limit daytime naps: While napping can help make up for lost sleep, long or frequent naps during the day can disrupt your nighttime sleep. If you must nap, aim for 20–30 minutes in the early afternoon.

Avoid stimulants close to bedtime: Caffeine and nicotine are known stimulants that can interfere with your sleep. Avoid consuming coffee, tea, energy drinks, or cigarettes close to bedtime. Instead, opt for sleep-promoting drinks such as chamomile tea or tart cherry juice.

Exercise during the day: Regular physical activity can improve your sleep quality. However, try to avoid vigorous exercise close to bedtime, as it may make it harder to fall asleep. Aim to finish your workout at least two hours before your bedtime.

Remember, maintaining a consistent sleep schedule is a crucial part of preventing REM sleep disorders. A healthy sleep routine will help you fall asleep more easily, improve your sleep quality, and ensure you get the restorative sleep your body needs.

Remove dangerous objects from the bedroom

Removing dangerous objects from the bedroom is crucial for creating a safe sleeping environment, especially for those with REM sleep behaviour disorder (RBD). Here are some detailed instructions to ensure your bedroom is free from potential hazards:

Weapons and Sharp Objects:

Keep weapons such as knives, scissors, or anything with sharp edges away from the bed and bedroom. This includes kitchen utensils, letter openers, and even decorative swords or knives. Ensure these items are securely stored in a different room or locked away if possible.

Electronic Devices:

While it may be tempting to keep your phone or laptop close by, these devices can be a source of distraction and disrupt your sleep. Remove all electronic devices, including phones, tablets, and laptops, from your bedroom. If this is not possible, at least ensure they are kept out of arm's reach and do not use them for an hour before bedtime. Place them in a drawer, silence notifications, and consider using 'airplane mode' to reduce the temptation to check them.

Hazardous Furniture:

Assess your bedroom furniture for any potential hazards. Move heavy or unstable furniture away from the bed to prevent accidental injury if you get up during the night. Avoid placing furniture with sharp corners or edges close to the bed. If this is unavoidable, consider adding soft padding to the corners to minimise the risk of injury.

Windows:

Windows pose a potential safety risk, especially if you are prone to sleepwalking or acting out dreams. Ensure windows are securely closed and locked before bedtime. Consider installing locks or security bars if you live in a high-rise building. Alternatively, move your bed away from the window to reduce the risk of accidental falls.

Clutter:

A cluttered bedroom can be a safety hazard, especially in low-light conditions. Keep the bedroom tidy and ensure walkways are clear, reducing the risk of tripping or bumping into objects. If you have a tendency to act out your dreams, a clutter-free space can help prevent accidental injury.

Remember, creating a safe bedroom environment is essential, especially if you or your bed partner has RBD. By following these instructions, you can significantly reduce the risk of injury and create a more peaceful sleeping space.

Exercise regularly, but not close to bedtime

Exercising is great for your body and mind, and it can also help you get a good night's sleep. However, it is important to avoid exercising too late in the day, as this can interfere with your sleep.

Benefits of Exercise

According to studies, exercise helps you fall asleep more quickly and improves your sleep quality. Moderate aerobic exercise, in particular, increases the amount of slow-wave sleep you get, referring to deep sleep where the brain and body rejuvenate. Exercise can also stabilize your mood and help decompress the mind, aiding the natural transition to sleep.

Timing of Exercise

The timing of your workouts is crucial. While some people may find that exercising close to bedtime keeps them up, others may not experience any difference in sleep quality regardless of the time of day they exercise. However, as a general guideline, it is recommended to exercise at least 1 to 2 hours before bedtime. This allows endorphin levels to decrease and gives your brain time to wind down.

Exercise and Core Body Temperature

Exercise raises your core body temperature, which signals to your body clock that it's time to be awake. After about 30 to 90 minutes, your core body temperature starts to fall, facilitating sleepiness. Therefore, if you exercise too close to bedtime, you may still be experiencing elevated body temperatures that interfere with your sleep.

Recommendations

• Set a regular bedtime and adopt a relaxing bedtime routine.
• Turn off electronic devices at least 15 to 30 minutes before bedtime.
• Ensure your bed is comfortable, and your bedroom is dark, quiet, and cool.
• Avoid long naps during the day. If necessary, restrict naps to 20 to 30 minutes in the early afternoon.

Keep the bedroom dark

Keeping the bedroom dark is an important step in creating a sleep-conducive environment. Light is the most significant external factor that affects sleep. Darkness triggers the pineal gland in the brain to produce melatonin, a serotonin-derived hormone that promotes sleepiness.

To ensure your bedroom is dark, consider investing in blackout curtains or blinds. These can block out light from the sun, moon, streetlights, or security lights. Alternatively, you can cover your windows with aluminium foil, a low-cost option that effectively blocks outdoor light. If you don't want to make these changes, an eye mask can be a good solution, but it must be worn throughout the night to be effective.

Even small amounts of light can disrupt your sleep. The light that enters through the gap between the door and the floor can be blocked by placing a rolled-up towel against the gap. It is also a good idea to turn off any hallway lights before going to bed.

In addition to blocking external light sources, reducing internal light sources in the bedroom is also important. Blue light, emitted by many electronic devices, has been found to significantly impact melatonin and circadian rhythm. Therefore, it is best to put away your phone, laptop, and tablet at least 30 minutes before bed. If this is not possible, turn down the brightness of these devices as much as possible and avoid using them right before bedtime.

Frequently asked questions