Colin Snow
REM sleep behaviour disorder (RBD) is a sleep disorder characterised by dream enactment and loss of REM atonia. It is a parasomnia, which is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt sleep. During the REM stage of sleep, the body usually experiences temporary paralysis of most skeletal muscles, however, for people with RBD, this temporary paralysis does not occur, and they physically act out their dreams. This can cause injury to themselves or their bed partner, especially if they are acting out a violent nightmare. RBD is associated with antidepressant use and narcolepsy, and has a strong correlation with neurodegenerative alpha-synucleinopathies such as Parkinson's disease, Lewy body dementia, and multiple system atrophy.
RBD is diagnosed by confirmation from an in-laboratory sleep study (polysomnography) with video recording, which helps to assert abnormal behaviours during REM sleep and excludes other sleep disorders. The treatment of RBD focuses on injury prevention and the treatment of underlying conditions, as well as pharmacological treatment using oral medications such as melatonin or clonazepam.
| Characteristics | Values |
|---|---|
| Type of Disorder | Parasomnia |
| Affected Muscle Groups | Legs, Arms, Chin |
| Age of Onset | 6th or 7th decade of life |
| Prevalence | 0.5% - 1% |
| Treatments | Melatonin, Clonazepam, Pramipexole |
What You'll Learn
What is REM sleep behaviour disorder?
REM sleep behaviour disorder (RBD) is a sleep disorder in which a person physically acts out their dreams while in the rapid eye movement (REM) stage of sleep. During the REM stage of sleep, a person's eyes move rapidly, breathing becomes steady, blood pressure rises, and there is a loss of muscle tone (paralysis). This paralysis does not occur in people with RBD, who instead act out their dreams through vocalisations and physical movements. These can include talking, yelling, screaming, punching, kicking, jumping out of bed, and grabbing. The person is usually unaware of their actions and can only find out about their behaviour if their sleeping partner informs them or if they wake up with injuries. RBD can be dangerous for both the person with the disorder and their sleeping partner, and it is recommended that safety measures are put in place to prevent injuries.
There are two main types of RBD: isolated (idiopathic) and symptomatic (secondary). Idiopathic RBD occurs spontaneously without an underlying cause, while secondary RBD is caused by an underlying condition, such as Type 1 narcolepsy, or the use of certain antidepressants, which is known as drug-induced RBD.
RBD is usually seen in people over the age of 50, with an average onset age of 61. It is more common in men, who are nine times more likely to be affected than women. RBD is strongly associated with neurodegenerative disorders, particularly Parkinson's disease, Lewy body dementia, and multiple system atrophy (MSA). In fact, about 97% of people with isolated RBD will develop one of these conditions within 14 years of their RBD diagnosis.
The diagnosis of RBD is made through a combination of patient history, physical and neurological exams, and an in-lab video sleep study, or polysomnography. Treatment focuses on creating a safe sleeping environment and may include medications such as melatonin, clonazepam, and pramipexole.
Dream Pain: Can We Feel It During REM Sleep?
You may want to see also
What are the symptoms?
REM sleep behaviour disorder (RBD) is a sleep disorder characterised by dream enactment and loss of REM atonia. During sleep, people with RBD physically act out their dreams, often violently, and can cause injury to themselves or their bed partner. The symptoms of RBD can vary in severity and frequency, from mild muscle twitches to jumping or falling out of bed. People with RBD may talk, shout, scream, kick, punch, or grab their bed partner or the air.
People with RBD are usually unaware of their behaviours during sleep and often only find out when their bed partner or roommate tells them, or when they wake up with an injury. When a person with RBD is having an episode, they can usually be woken up easily and will be alert and coherent upon waking, able to recall the content of the dream.
Episodes may occur once during a sleeping period or several times, and can happen every time a person sleeps or just occasionally. The symptoms tend to be more severe if a person is acting out a violent nightmare.
RBD can be divided into three categories: idiopathic RBD, drug-induced RBD, and secondary RBD due to a medical condition. Idiopathic RBD is most suggestive in neurodegenerative synucleinopathies, including dementia with Lewy bodies, Parkinson's disease, olivopontocerebellar degeneration, multiple-system atrophy, and Shy-Drager syndrome. Drug-induced RBD is common in individuals who take antidepressants, particularly serotonin reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors. Secondary RBD is often associated with narcolepsy, traumatic brain injury, post-traumatic stress syndrome, and congenital and neurodevelopmental disorders.
Living Without REM Sleep: Is It Possible?
You may want to see also
What are the causes?
REM sleep behaviour disorder (RBD) is a parasomnia involving dream enactment behaviour associated with loss of atonia during rapid eye movement (REM) sleep. RBD can be divided into three categories: idiopathic RBD, drug-induced RBD, and secondary RBD due to a medical condition.
Idiopathic RBD
Idiopathic RBD is most suggestive in neurodegenerative synucleinopathies, including dementia with Lewy bodies, Parkinson's disease, olivopontocerebellar degeneration, multiple-system atrophy, and Shy-Drager syndrome. The literature suggests that RBD is precipitated by aberrant connections between the brainstem control of muscle tonicity and the cortex. Studies have also suggested associations with traumatic brain injury (TBI), post-traumatic stress syndrome (PTSD), and congenital and neurodevelopmental disorders.
Drug-induced RBD
Drug-induced RBD is common in individuals who are taking antidepressants. The most likely antidepressants that will incite an RBD episode are serotonin reuptake inhibitors (fluoxetine), tricyclic antidepressants (mirtazapine, protriptyline, amitriptyline, nortriptyline, desipramine, imipramine), and monoamine oxidase inhibitors (phenelzine and selegiline). Other acute transient forms of RBD involve toxic metabolic encephalopathy—most commonly involving ethanol use.
Secondary RBD
RBD with concomitant narcolepsy may be considered a distinct phenotype of RBD. It is characterised by less violent or complex behaviour during REM sleep, earlier age of onset, equal sex distribution, and hypocretin (orexin) deficiency (a lab diagnosis specific for narcolepsy type 1).
REM Sleep: Can Less Be More?
You may want to see also
How is it diagnosed?
The diagnosis of REM sleep behaviour disorder (RSBD) involves a comprehensive evaluation of the patient's sleep patterns, medical history, and symptoms. Due to the potential
REM Sleep: A Metabolism Booster?
You may want to see also
How is it treated?
REM sleep behaviour disorder (RBD) is a parasomnia, a sleep disorder that involves abnormal and undesirable physical events or experiences that interrupt sleep. Treatment for RBD is tailored to the individual and can involve a combination of lifestyle changes, medication, and injury prevention techniques.
Lifestyle Changes
Because the use of certain drugs or alcohol can contribute to RBD, making lifestyle changes to reduce or eliminate their use may be part of a person's treatment. These changes can be part of a larger set of steps to improve sleep hygiene, such as setting a consistent sleep schedule, that normalise sleep and promote sleep quality. It is recommended that people with RBD avoid drinking alcohol, as it can trigger an RBD episode and make the condition worse.
Medication
Melatonin is the preferred, first-line medication for RBD. It usually has fewer side effects than other medication options but has similar efficacy. It is also a safer option for elderly individuals, individuals with dementia, fall risk, or those with sleep apnea. The dosage of melatonin for RBD is different from when it is taken to fall asleep, and one should consult a sleep physician.
The prescription drug clonazepam has proven effective in reducing symptoms for 50-80% of individuals with RBD. However, it can cause some side effects, including sleepiness, forgetfulness, and impaired balance in the morning. It can also contribute to or worsen sleep apnea.
Pramipexole is a dopamine agonist primarily prescribed to treat Parkinson's disease and restless leg syndrome. Recent research shows that it can help treat the symptoms of RBD. Researchers think this medication works because RBD may be a dopaminergic deficiency disorder.
Injury Prevention Techniques
Establishing a safe sleep environment is one of the most important things someone with RBD can do. Recommendations for injury prevention include:
- Removing sharp objects and weapons from the bedroom
- Placing padding on the floor around the bed
- Installing padded bed rails on the side of the bed
- Putting the mattress on the floor
- Moving furniture and clutter away from the bed
- Padding the corners of furniture in the bedroom
- Protecting bedroom windows
- Sleeping in a separate bed or room from a partner, if necessary
Do REM Sleep Masks Work? Exploring Their Effectiveness
You may want to see also
Frequently asked questions
REM sleep behavior disorder (RBD) is a sleep disorder in which people physically act out their dreams while in the rapid eye movement (REM) stage of sleep. This can include vocalisations and violent movements, which may result in injuries to the person or their bed partner.
The symptoms of RBD include sleep-related vocalisations and complex movements, such as punching, kicking, jumping out of bed, and falling out of bed. People with RBD are often unaware of their behaviours and only find out when their bed partner or roommate tells them, or when they wake up with an injury.
RBD is relatively rare, affecting about 1% of the general US population and 2% of people aged 50 or older. However, these rates may be higher as RBD can be difficult to diagnose, and almost half of people with the condition don't realise they have it.
The primary goal of RBD treatment is to reduce the risk of injury to the patient and their bed partner. This may involve creating a safe sleeping environment by removing dangerous objects from the bedroom, padding sharp furniture, and in some cases, sleeping in a separate room. Medications such as melatonin and clonazepam can also be used to reduce symptoms.
