Rem Sleep Disorder: Who's At Risk And Why?

REM sleep behaviour disorder (RBD) is a condition that causes people to act out their dreams, sometimes in violent ways. The chances of having RBD are relatively low, affecting less than 1% of the general population. However, it is more common in men over 50, with men being nine times more likely to be affected than women. RBD can be difficult to diagnose, and many people with the condition are unaware they have it. If you suspect you may have RBD, it is important to consult a doctor or sleep specialist for an accurate diagnosis.

REM sleep behaviour disorder (RBD) is a parasomnia

RBD occurs when the temporary paralysis that usually occurs during REM sleep does not happen. This paralysis is called muscle atonia and allows individuals to dream safely without acting them out. For people with RBD, this temporary paralysis does not occur, enabling them to physically act out their dreams.

The symptoms of RBD can vary in severity and tend to worsen over time. They can occur once or multiple times during a sleep period and can develop suddenly or gradually. While RBD is relatively rare, affecting about 1% of the general US population and 2% of people aged 50 or older, the actual rates may be higher due to the difficulty in diagnosing the disorder.

There are two main types of RBD: isolated (idiopathic) and symptomatic (secondary). Isolated RBD occurs spontaneously without an underlying cause, while symptomatic RBD happens due to an underlying cause such as Type 1 narcolepsy or certain antidepressants, which can cause drug-induced RBD. RBD is strongly associated with neurodegenerative disorders, and most people with idiopathic RBD will eventually develop Parkinson's disease, Lewy body dementia, or multiple system atrophy (MSA).

The treatment for RBD focuses on creating a safe sleeping environment and can include lifestyle changes, medication, and injury prevention techniques. Melatonin is often the first-line medication due to its relatively mild side effects, followed by clonazepam and pramipexole if melatonin is ineffective.

RBD causes people to act out their dreams

REM sleep behaviour disorder (RBD) is a sleep disorder that causes people to act out their dreams physically and vocally during the REM stage of sleep. During this stage, the body usually experiences temporary paralysis, known as atonia, while the brain shows activity similar to wakefulness. However, for those with RBD, this paralysis does not occur, allowing them to act out their dreams.

The dreams associated with RBD are often vivid, intense, and frightening, and the person may dream about being chased or attacked. The person then unknowingly enacts the dream in real life, which can include actions such as punching, kicking, grabbing their bed partner, or jumping out of bed. These movements can be dangerous to the person with RBD as well as their sleeping partner, and can result in physical injuries.

The exact cause of RBD is unknown, but it is believed to be related to certain neural pathways in the brain. Specifically, an issue in the part of the brainstem called the pons may lead to REM sleep without atonia, allowing for the physical acting out of dreams.

RBD is a rare disorder, affecting an estimated 0.5% to 1% of adults, with a higher prevalence in men and adults over 50. It is important to seek treatment for RBD to prevent injuries and create a safe sleeping environment. Treatment options include lifestyle changes, medication, and injury prevention techniques.

RBD is more common in men over 50

REM sleep behaviour disorder (RBD) is a parasomnia, a sleep disorder in which people physically act out their dreams while remaining asleep. This can cause injury to themselves or their bed partner, especially if they are acting out a violent nightmare. RBD is relatively rare, affecting about 1% of the general US population and 2% of people aged 50 or older. However, this figure may be higher in reality as RBD can be difficult to diagnose, and almost half of those with the condition are unaware they have it.

RBD most commonly affects people over the age of 50, with an average age of onset of 61 years. While it can occur at any age, it is uncommon in women and children. Among people over 50, men are nine times more likely than women to have RBD.

There are two main types of RBD: isolated (idiopathic) and symptomatic (secondary). Isolated RBD occurs spontaneously without an underlying cause, while symptomatic RBD is due to an underlying cause such as Type 1 narcolepsy or certain antidepressants (known as drug-induced RBD). People with symptomatic RBD may also have an alpha-synucleinopathy such as Parkinson's disease, Lewy body dementia, or multiple system atrophy (MSA), and when this is the case, it is considered secondary RBD.

Isolated RBD is strongly associated with certain neurodegenerative disorders. About 97% of people with isolated RBD will develop an alpha-synucleinopathy within 14 years of their diagnosis, with Parkinson's disease being the most likely.

Symptomatic RBD is also associated with neurodegenerative disorders. Up to 36% of people with Type 1 narcolepsy have symptomatic RBD, and about 6% of people who take antidepressants have drug-induced RBD.

Risk factors for RBD include being over 50 years old, having a neurological disorder, and using certain medications or antidepressants.

RBD can be treated with medication

REM sleep behaviour disorder (RBD) is a parasomnia disorder affecting between 1 and 7% of community-dwelling adults, most frequently older adults. RBD is characterised by nocturnal complex motor behaviour and polysomnographic REM sleep without atonia. The main goal of treatment for RBD is to create a safe sleeping environment for the patient and their bed partner. This can involve safety measures and medication.

Safety measures include removing sharp objects and heavy objects from the bedroom, placing pillows between the patient and surrounding structures, placing a mattress on the floor next to the bed, and sleeping in a sleeping bag. If symptoms are severe, it may be safest for the bed partner to sleep in a different room.

If safety measures are insufficient to prevent injury, medication may be prescribed. While there are no U.S. Food and Drug Administration (FDA)-approved medications specifically for RBD, studies have shown that melatonin, clonazepam and pramipexole can reduce symptoms in some cases.

Melatonin is considered the first-line medication for treating RBD as it rarely causes side effects. It is a hormone that the pineal gland naturally makes and is essential for regulating the sleep cycle. Providers will likely recommend starting at a baseline dose and then increasing the dose until symptoms improve.

Clonazepam is a sedative. It is not known exactly why it helps treat RBD, but most people with RBD who take a low dose before they sleep have few or no nightmares, vocalisations or dream enactment behaviours. However, clonazepam can cause unpleasant side effects, so it may only be prescribed if melatonin doesn't help.

Pramipexole is a dopamine agonist. It is primarily prescribed to treat Parkinson's disease and restless leg syndrome, but recent research shows that it can help treat the symptoms of RBD. It is thought that this medication works because RBD may be a dopaminergic deficiency disorder.

RBD may indicate a neurodegenerative disease

REM sleep behaviour disorder (RBD) is a parasomnia characterised by excessive muscle activity during the REM stage of sleep, which is normally characterised by temporary paralysis. This excessive muscle activity can lead to people acting out their dreams, which are often violent or frightening. RBD is relatively rare, affecting between 0.38% and 2% of the general population, but is much more common in patients with neurodegenerative diseases, especially synucleinopathies.

RBD is strongly associated with certain neurodegenerative disorders. About 97% of people with isolated (idiopathic) RBD will go on to develop a neurodegenerative condition, specifically Parkinson's disease, Lewy body dementia or multiple system atrophy (MSA). These conditions are called alpha-synucleinopathies. The onset of RBD usually precedes the development of neurodegeneration by several years. One study found that 38% of men aged 50 or older with RBD eventually developed one of these conditions, usually within 13 years. That number increased to nearly 81% in a follow-up study conducted 16 years later. Another study found that the risk for developing neurodegenerative diseases was 33.5% at five years of follow-up, 82.4% at 10.5 years and 96.6% at 14 years. The majority of RBD patients converted to Parkinson's Disease (43%), followed by Dementia with Lewy Bodies (25%).

The link between RBD and neurodegenerative diseases is well-established, and RBD may be used as an early marker of neurodegenerative diseases. It is thought that RBD may be caused by an issue in the part of the brainstem called the pons, which is also associated with Parkinson's disease, Lewy body dementia or MSA.

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