Effective Treatments For Rem Sleep Disorder

REM sleep behaviour disorder (RBD) is a condition that causes people to act out their dreams, sometimes violently. This can result in injury to themselves or their bed partner. RBD is a parasomnia, a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt sleep. While it can occur at any age, it most commonly affects men over 50. The exact cause of RBD is unknown, but it is often associated with other neurological conditions, such as Parkinson's disease and dementia. So, is it treatable?

Safety measures to prevent injury

REM sleep behaviour disorder (RBD) can cause people to physically act out their dreams while remaining asleep. This can lead to injury to themselves or their bed partner, so it is important to create a safe sleeping environment. Here are some safety measures to prevent injury:

• Remove sharp, glass, and heavy objects from the bedroom.
• Place pillows or padding between the bed and surrounding structures, such as the headboard or nightstand.
• Place a mattress on the floor next to the bed in case the person falls out of bed, or use padded bedside rails.
• Sleep in a sleeping bag.
• If the symptoms are severe, the bed partner may need to sleep in a separate room.
• Move the bed away from the window.
• Avoid drinking alcohol, as this can trigger an episode.
• Take prescribed medication to manage symptoms.
• Seek treatment to prevent injury.

Medication

Melatonin is a preferred first-line medication due to its rarity in causing side effects. It is a naturally occurring hormone that regulates the sleep cycle. Doctors often recommend starting with a baseline dose and gradually increasing it until symptoms improve.

Clonazepam, a sedative from the benzodiazepine class of drugs, has proven effective in about 90% of people with RBD. It suppresses muscle activity and relaxes the body during sleep. However, it can cause side effects like sleepiness, forgetfulness, and impaired balance. Due to these side effects, doctors may only prescribe it if melatonin is not effective.

Pramipexole, a dopamine agonist, is primarily prescribed to treat Parkinson's disease and restless leg syndrome. Recent research indicates its potential in treating RBD symptoms. This medication may be effective because RBD may be a dopaminergic deficiency disorder.

Additionally, certain antidepressants may help calm violent behaviour during sleep if other medications are ineffective.

Lifestyle changes

REM sleep behaviour disorder (RBD) is a parasomnia, a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt sleep. During RBD, people act out their dreams while they happen, sometimes in violent ways. This can cause injury to the person with RBD or their bed partner.

Avoid alcohol

Alcohol can trigger an RBD episode and make the condition worse. It is recommended to avoid drinking alcohol to prevent RBD episodes and reduce the risk of injury.

Set a consistent sleep schedule

Adopting a predictable sleep-wake cycle can help avoid sleep deprivation, which may contribute to RBD. Maintaining a regular sleep schedule can help normalize sleep and promote overall sleep quality.

Reduce or eliminate certain medications

Certain medications, such as antidepressants, have been linked to the development of RBD. In some cases, RBD may be an adverse reaction to specific medications or occur during drug withdrawal. If you think a particular medication may be contributing to your RBD, consult your doctor about adjusting your medication or exploring alternative treatments.

Improve sleep hygiene

In addition to the above, there are other general sleep hygiene practices that can be implemented to improve sleep quality and potentially reduce RBD episodes. This includes creating a comfortable and safe sleeping environment, establishing a relaxing bedtime routine, and avoiding stimulating activities or substances before sleep.

Diagnosis

If you think you may have REM sleep behaviour disorder (RBD), it is important to consult a healthcare provider. They will ask you questions about your symptoms and medical history, and may also ask your bed partner or housemates about your sleeping behaviour. A physical exam and neurological exam will also be performed.

To receive a diagnosis of RBD, you will undergo an in-lab video sleep study, or polysomnogram (PSG). Sleep studies are tests that record specific body functions during sleep, such as:

• Breathing rate and airflow
• Brain wave activity
• Muscle movements of the chin and upper extremities

According to the International Classification of Sleep Disorders, a diagnosis of RBD requires the following:

• You have repeated episodes of sleep-related vocalisation and/or complex movement behaviours
• The behaviours are documented by a sleep study (polysomnography) and occur during REM sleep or can be assumed to happen during REM sleep based on your clinical history
• The sleep study shows that you experience REM sleep without atonia (muscle paralysis)
• You do not have seizure-related activity during REM sleep
• The sleep disturbances are not better explained by another sleep disorder, medical condition, or mental health condition, and are also not caused by medication side effects or substance use disorder

If you are diagnosed with RBD, your doctor will also check for underlying causes, such as Parkinson's disease, Lewy body dementia, or multiple system atrophy.

Complications

REM sleep behaviour disorder (RBD) can lead to several complications, the most pressing of which is the risk of injury to oneself or one's bed partner. The violent nature of the movements involved in RBD can cause physical injuries, including head injuries and subdural hematomas, which in some cases can be life-threatening. About 8 in 10 people with RBD experience sleep-related injuries, and up to 90% of partners of people with RBD have sleep issues, with over 60% experiencing physical injury.

The disorder can also cause frequent sleep disruptions, affecting the overall quality of sleep for both the individual with RBD and their bed partner. This can lead to relationship problems. However, it is worth noting that nearly two-thirds of couples continue sleeping together despite the risk of disturbed sleep.

The movements involved in RBD may become more violent over time, and there is also a risk of developing more serious cognitive, emotional, and neurological problems. These can include lower scores in attention and problems with executive functioning.

People with RBD are also at an increased risk of developing other neurological diseases such as Parkinson's disease, Lewy body dementia, or multiple system atrophy. In fact, about 38% of people with RBD may develop these diseases, and in some cases, RBD can occur up to 50 years before the onset of symptoms of these other neurological diseases.

Frequently asked questions