Understanding Rem Sleep Disorder: Signs And Symptoms

REM sleep behaviour disorder (RBD) is a parasomnia characterised by a loss of muscle paralysis during REM sleep, leading to people acting out their dreams. Symptoms include physical movements such as punching, kicking, and flailing, as well as vocalisations like talking, yelling, or screaming. People with RBD are often unaware of their behaviour and only find out when told by a bed partner or roommate. RBD is associated with other neurological conditions, including Parkinson's disease, Lewy body dementia, and multiple system atrophy.

Sufferers may experience violent dreams and act them out physically

Sufferers of REM sleep behaviour disorder may experience violent dreams and act them out physically. This is because, during the REM phase of sleep, the muscles in the body usually enter a state of temporary paralysis. However, in people with REM sleep behaviour disorder, this paralysis is incomplete or non-existent, meaning that they act out their dreams. The risk of violent movement is higher if the person is having an aggressive or frightening dream.

People with REM sleep behaviour disorder may punch, kick, shout, jump out of bed, or walk around while asleep. They may injure themselves or their bed partner. In one case, a man from China with this disorder bit his wife while dreaming of eating an apple, and was divorced four times as a result of his violent sleep behaviour.

Episodes can occur once or multiple times during the night, or even just once a week or once a month. They tend to occur towards the morning, when REM sleep is more frequent.

The disorder is characterised by a loss of muscle paralysis during REM sleep

REM sleep behaviour disorder (RBD) is characterised by a loss of muscle paralysis during REM sleep. This allows those affected by the disorder to physically act out their dreams, which can range from minor movements of the limbs to more pronounced body movements such as punching, flailing, kicking, sitting up in bed, or jumping out of bed. These movements can cause harm to the person or anyone sharing their bed.

During normal REM sleep, the body experiences temporary muscle paralysis, known as atonia, while the brain shows activity similar to wakefulness. This temporary paralysis of REM sleep allows us to dream safely, lying still while the brain is active. This paralysis involves most skeletal muscles and excludes muscles that help us breathe, digest, and some muscles of the eyes.

In individuals with RBD, normal muscle paralysis does not occur, enabling the person to physically act out their dreams. The lack of paralysis causes sleepers with RBD to become physically agitated, actively move their limbs, leave the bed, and engage in other actions linked to being awake. In some cases, people with RBD might injure themselves or whomever else shares their bed. The risk of violent movement is higher if the person is having an aggressive or frightening dream.

RBD occurs most often in middle-aged to elderly people, affecting men more than women. It is relatively rare, affecting between 0.5 to 1 percent of adults. It usually begins after age 50, and the disease is associated with other neurodegenerative disorders, including Parkinson’s disease, Lewy body dementia, and multiple system atrophy. Symptoms may be gradual or sudden, and they usually worsen over time.

It is more common in men over 50

REM sleep behaviour disorder (RBD) is a sleep disorder characterised by acting out dreams through vocalisations and physical movements during the REM stage of sleep. The disorder is associated with other neurological conditions, including Parkinson's disease, Lewy body dementia, and multiple system atrophy.

RBD is more common in men over 50, with the average age of onset being 61 years old. Among people over 50, men are nine times more likely than women to have RBD. The disorder affects between 0.5% to 1% of adults, and up to 2% of people over 50 years old.

The reasons for the higher prevalence in men over 50 are not entirely clear, but it is believed that hormonal changes and differences in brain structure between men and women may play a role. Additionally, men over 50 are more likely to experience other neurological disorders that are associated with RBD, such as Parkinson's disease.

The symptoms of RBD can include minor movements of the limbs, more pronounced body movements such as punching and kicking, and vocalisations such as talking or shouting. People with RBD are often unaware of their behaviours during sleep and may only find out about their condition when told by a bed partner or roommate. The episodes can occur once or multiple times during the night and can develop suddenly or gradually.

Due to the violent nature of their movements, individuals with RBD can put themselves and their bed partners at risk of physical injury. Therefore, it is essential to seek treatment and create a safe sleeping environment to prevent injuries.

It can be treated with melatonin or prescription medications

REM sleep behaviour disorder (RBD) can be treated with melatonin or prescription medications. Melatonin is the preferred, first-line medication for REM sleep behaviour disorder. 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 one should take for REM sleep behaviour disorder is different from when taking it to fall asleep, and one should consult a sleep physician.

The prescription drug clonazepam has proven effective in relieving symptoms in nearly 90% of individuals with REM sleep behaviour disorder. 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. The initial dose is 0.5 mg at bedtime, with some persons requiring a rapid increase to 1 mg. After years of continued treatment, moderate limb twitching with sleep talking and more complex behaviours can re-emerge. The treatment should be continued for as long as your doctor says. If you decide to stop, the medicine should be slowly tapered, watching for signs of withdrawal such as nightmares or agitation.

It is associated with other neurological conditions

REM sleep behaviour disorder (RBD) is associated with other neurological conditions, including Parkinson's disease, Lewy body dementia, and multiple system atrophy. In fact, RBD is often considered an early warning sign of these conditions. Research has shown that 38% of men over 50 with RBD eventually developed one of these neurodegenerative diseases within 13 years, with that number rising to 81% in a follow-up study conducted 16 years later.

RBD is a parasomnia, a sleep disorder that involves abnormal and undesirable physical events or experiences that disrupt sleep. During the REM stage of sleep, the body usually experiences temporary paralysis, known as atonia, while the brain remains active and dreaming. However, for individuals with RBD, this paralysis does not occur, allowing them to physically act out their dreams.

The symptoms of RBD can include minor movements of the limbs, more pronounced body movements such as punching or kicking, and vocalisations such as talking or screaming. These episodes can occur once or multiple times during the night and can put individuals and their bed partners at risk of physical injury.

Due to its association with other neurological conditions, individuals diagnosed with RBD may be at a higher risk of developing neurodegenerative disorders. RBD is also more common in individuals who already have certain neurological disorders. For example, up to 36% of people with Type 1 narcolepsy have secondary RBD. Additionally, certain medications, such as antidepressants, can induce RBD by causing imbalances in dopamine and serotonin, which are involved in REM sleep.

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