Sleepwalking and REM sleep behaviour disorder (RBD) are two distinct conditions that can be easily confused. Sleepwalking typically occurs during non-REM sleep, while RBD occurs during REM sleep. During non-REM sleep, people rarely dream, and sleepwalkers rarely remember their dreams or act them out. On the other hand, RBD involves dream enactment behaviour, where people may act out vivid and often violent dreams. While sleepwalkers are usually confused upon waking up, those with RBD can easily be awakened and can recall clear details of their dreams. Understanding the differences between these conditions is crucial, as they can have different implications for an individual's health and well-being.
Characteristics | Values |
---|---|
Occurrence | Sleepwalking occurs during non-REM sleep, while REM sleep behavior disorder (RBD) occurs during REM sleep. |
Memory of Dreams | Sleepwalkers typically do not remember their dreams, while people with RBD can recall vivid details of their dreams upon waking up. |
Confusion | Sleepwalkers are usually confused when they wake up, while people with RBD can be easily woken up and are typically alert. |
Eye Movement | Sleepwalkers may have their eyes open, while people with RBD typically have closed eyes. |
Movement | Sleepwalkers may walk, leave the room, eat, drink, engage in sexual activity, or use the bathroom, while people with RBD do not perform these actions. |
Risk Factors | Sleepwalking is not specifically associated with any risk factors, while RBD is more common in men, elderly individuals, and people with neurological disorders such as Parkinson's disease. |
What You'll Learn
- Sleepwalking and REM sleep behaviour disorder in Parkinson's patients
- Differences between sleepwalking and REM sleep behaviour disorder
- Diagnosis and treatment of REM sleep behaviour disorder
- Safety precautions for those with REM sleep behaviour disorder
- REM sleep behaviour disorder as a precursor to Parkinson's disease
Sleepwalking and REM sleep behaviour disorder in Parkinson's patients
Sleepwalking and REM sleep behaviour disorder (RBD) are both associated with Parkinson's disease (PD). Sleep disturbances are common in people with PD, and sleep disorders are thought to influence neurological health. Deep sleep, in particular, is important for restorative sleep and contributes to damage repair and toxin removal in the brain.
Sleepwalking and RBD are distinct conditions. Sleepwalking typically occurs during non-REM and transitional stages of sleep, while RBD occurs during REM sleep. Dreams rarely occur during non-REM sleep, and sleepwalkers rarely remember their dreams or act them out. Sleepwalkers may walk, eat, text, or initiate sex while asleep, and they are usually harder to wake up and more likely to be confused upon awakening than those with RBD. Sleepwalking is often reported by a bed partner or discovered through evidence of activities performed while asleep.
RBD involves dream enactment behaviour, where individuals act out their dreams, which are often vivid and violent. People with RBD are typically aware of their dream content and can recall details of their dreams upon awakening. RBD can lead to injuries to the sleeper and anyone else nearby, as well as property damage.
A study by Xinyuan Zhang et al. (2021) found that probable sleep parasomnias, including both sleepwalking and RBD, were associated with higher odds of having PD in a male population. PD-related neurodegeneration may impair arousal regulation during sleep.
RBD is considered a prodromal symptom of PD, meaning it can occur well in advance of other symptoms. It is also a significant early sign of PD with cognitive impairment (PD-CI) and PD with dementia (PDD). People with PD and RBD are more likely to experience faster motor progression and a higher risk for cognitive decline.
While sleepwalking and RBD have some overlapping features, they are distinct sleep disorders with different characteristics and associations with PD.
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Differences between sleepwalking and REM sleep behaviour disorder
Sleepwalking and REM Sleep Behaviour Disorder (RBD) are two distinct parasomnias with several differences.
Firstly, sleepwalking typically involves walking, having one's eyes open, or leaving the room, whereas people with RBD rarely exhibit these behaviours. Instead, RBD episodes may involve kicking, jumping, punching, flailing, shouting, or leaping out of bed.
Secondly, sleepwalkers are usually confused upon waking and often have no recollection of their dreams. In contrast, individuals with RBD can typically recall clear details of their vivid dreams, and there is a direct correlation between their dream content and their physical behaviour during an episode.
Thirdly, sleepwalking episodes can occur at any stage of sleep, whereas RBD episodes specifically occur during REM sleep, typically at least 90 minutes after falling asleep.
Fourthly, sleepwalking is often associated with other activities such as eating, drinking, sexual activity, or using the bathroom, whereas these behaviours are not typically associated with RBD episodes.
Finally, sleepwalking and RBD differ in terms of wakeability. It is generally harder to wake someone from a sleepwalking episode, and they are more likely to be confused upon waking. On the other hand, individuals with RBD can usually be easily awakened during an episode and are typically alert and able to recount their dreams upon waking.
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Diagnosis and treatment of REM sleep behaviour disorder
REM sleep behaviour disorder (RBD) is a parasomnia in which people act out their dreams while sleeping. The dreams are often vivid and can involve a wide range of movements. RBD occurs in less than one per cent of the population and can be treated with medication. Diagnosis involves consulting a sleep specialist, who will take a medical history and perform a neurological exam. The patient may also be referred to a neurologist for more comprehensive testing.
To monitor sleep patterns, the doctor may ask the patient to keep a sleep diary and fill out the Epworth Sleepiness Scale, which helps determine how sleep patterns are interfering with daily life. An overnight sleep study may also be recommended, where brain waves, heart rate, and breathing are monitored while the patient sleeps.
Treatment of RBD typically involves medication, with clonazepam and melatonin being the most frequently used. Other precautions may include:
- Removing potential hazards from the bedroom
- Maintaining a standard bedtime
- Treating other sleep disorders
Safety Measures
- Remove weapons, nightstands, lamps, and other objects that could cause injury from the bedroom.
- Move the bed away from windows.
- Pad hard furniture near the bed.
- Use soft carpeting or place a soft mat or rug next to the bed.
- Sleep separately from your partner, or with a pillow between you.
Medication
Clonazepam (Klonopin) is the most frequently prescribed medication for RBD, although it may cause side effects such as morning sleepiness, memory problems, confusion, and decreased balance. Melatonin, a dietary supplement, is another option that may cause fewer side effects. Other medications that have been used to treat RBD include:
- Rivastigmine
- Memantine
- 5-hydroxytryptophan
- Yokukansan
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Safety precautions for those with REM sleep behaviour disorder
REM sleep behaviour disorder (RBD) is a parasomnia, or sleep disorder, in which people physically act out their dreams during the REM stage of sleep. This can cause injury to the person or their bed partner, so it's important to take safety precautions. Here are some safety measures to consider:
- Remove sharp objects, glass, heavy objects, and weapons from the bedroom or at least move them away from the bed.
- Place pillows or padding between the sleeper and surrounding structures, such as the headboard or nightstand.
- Place a mattress on the floor next to the bed in case the sleeper falls out of bed, or use padded bedside rails.
- Sleep in a sleeping bag.
- Move the bed away from windows and place a large object, like a dresser, in front of them.
- Pad hard furniture near the bed, such as the headboard.
- Use soft carpeting or place a soft mat or rug next to the bed.
- If symptoms are severe, the bed partner may need to sleep in a separate room.
- Avoid alcohol, as it can trigger an RBD episode and make the condition worse.
- Maintain a normal total sleep time, as sleep deprivation will increase the likelihood of RBD episodes.
- Avoid certain medications that can cause or increase RBD.
- Treat any other sleep disorders that may be disrupting sleep and increasing RBD episodes.
- Regularly monitor for any neurologic symptoms, such as tremors or other Parkinson's symptoms.
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REM sleep behaviour disorder as a precursor to Parkinson's disease
REM sleep behaviour disorder (RBD) is a parasomnia, characterised by a lack of muscle atonia during the REM sleep phase, resulting in unwanted and occasionally violent motor behaviour during dreams. It is a powerful predictor of neurodegenerative synucleinopathies, including Parkinson's disease.
RBD is a potential precursor to Parkinson's disease, with 33-46% of patients with Parkinson's also suffering from RBD. The risk of developing Parkinson's disease is high for those with RBD: 30% developed the disease at 3 years, 47% at 5 years, and 66% at 7.5 years. RBD is therefore a useful tool for predicting Parkinson's disease, and can be used to identify patients at higher disease risk.
RBD can be diagnosed through a sleep study, which records brain waves, heartbeat, breathing, and arm and leg movements during sleep. It can be treated with medication, such as clonazepam or melatonin.
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Frequently asked questions
Sleepwalking typically takes place in non-REM and transitional stages of sleep, while REM sleep behaviour disorder (RBD) takes place during REM sleep. During sleepwalking, people rarely remember their dreams or act them out, whereas people with RBD can recall vivid details of their dreams.
Yes, RBD can lead to aggressive and violent behaviour, which may result in injuries to the sleeper and anyone else nearby, as well as property damage.
RBD occurs in less than 1% of the population, according to the National Sleep Foundation. It is more common in men and often occurs in people over 50 years old.