How To Avoid Disruptions During Rem Sleep

REM sleep is one of the two major natural sleep stages, characterised by rapid eye movement, paralysis of most muscles, and vivid dreams. A lack of REM sleep can lead to fatigue, irritability, and changes in mood and memory. It can also have physical symptoms, such as an increased risk of type 2 diabetes, cancer, and neurodegenerative diseases.

REM sleep behaviour disorder (RBD) is a chronic sleep condition characterised by dream enactment and loss of REM atonia. It can be caused by antidepressants, neurological lesions, and neurodegenerative disorders.

Alcohol consumption

In the first half of the night, when blood alcohol levels are high, alcohol acts on the neurotransmitter GABA, increasing inhibition between nerve cells and creating a calming effect. This suppresses REM sleep, reducing dreaming. As a result, people tend to experience deeper sleep during this period.

However, in the second half of the night, as alcohol levels drop, the brain kicks into overdrive, leading to a rebound arousal. This disruption causes people to toss and turn, resulting in interrupted sleep patterns. Additionally, the diuretic effect of alcohol increases urine output, leading to more frequent urination and further sleep interruptions.

The suppression of REM sleep in the first half of the night is followed by a rebound in the latter half, leading to more vivid and stressful dreams. The fragmented sleep pattern and increased dream recall contribute to an overall poorer quality of sleep.

The impact of alcohol on sleep is influenced by various factors, including the amount consumed, drinking frequency, age, gender, and body composition. Excessive alcohol consumption can lead to shorter sleep duration and insomnia, with larger quantities causing more significant disruptions.

Caffeine and cigarette use

Cigarette smoking is also associated with sleep disturbances, particularly prolonged sleep onset latency. Nicotine, a stimulant found in cigarettes, can mask exhaustion and disrupt sleep patterns. Smoking increases the release of dopamine and serotonin, which can promote wakefulness and inhibit REM sleep. Furthermore, withdrawal symptoms associated with quitting smoking, such as anxiety and irritability, can also disrupt sleep.

Medication, including antidepressants

Antidepressants are a class of drugs that can significantly impact REM sleep, and their effects are usually more pronounced in the initial weeks of treatment. They can disrupt sleep continuity, prolong sleep latency, increase the number and duration of awakenings, decrease sleep efficiency, and cause early morning awakenings. These changes can lead to increased daytime sleepiness and fatigue, irritability, and cognitive issues.

Antidepressants with activating effects, such as serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs), tend to disrupt REM sleep. Specifically, they increase REM sleep latency and suppress REM sleep duration. Examples include fluoxetine, venlafaxine, and paroxetine. On the other hand, antidepressants with sedative properties, such as doxepin, mirtazapine, and trazodone, can rapidly improve sleep in the short term but may cause oversedation during long-term treatment.

It is important to note that the effects of antidepressants on REM sleep are complex and depend on various factors, including the specific type of antidepressant, its dose, the time of drug administration, and the duration of treatment. Additionally, individual factors, such as age, hypertension, and chronic kidney disease, can also influence the impact of antidepressants on REM sleep.

While antidepressants can disrupt REM sleep, they are also used to treat certain sleep disorders, such as REM sleep behaviour disorder. However, it is crucial to carefully consider the potential benefits and drawbacks of using antidepressants for sleep issues, as they can have complex and sometimes detrimental effects on sleep quality and overall well-being.

Sleep disorders

There are several ways to improve your sleep and increase your REM sleep. These include:

• Developing a sleep schedule: Try to go to bed and wake up at the same time every day.
• Avoiding stimulants: Do not drink caffeine or smoke cigarettes later in the day.
• Avoiding alcohol: Alcohol interferes with sleep, particularly REM sleep.
• Establishing a relaxing sleep routine: Try warm baths, listening to relaxing music, or reading before bed.
• Getting regular exercise: Aim for about 30 minutes of exercise a day, but try to exercise several hours before bed.
• Creating a suitable environment for sleep: Ensure your bedroom has no bright lights, is not too hot or cold, and that you do not watch TV or work on a computer in bed.
• Getting up if you can't sleep: If you are lying awake in bed, get up and do something quietly in another room until you feel sleepy.
• Replacing your pillows: Consider replacing your pillows if they are over a year old.

If these tips do not help, you may want to consult a healthcare professional or sleep expert to evaluate your sleeping patterns and determine other options.

Mental health conditions

Medications, including antidepressants, can also affect the quality of REM sleep. Antidepressants can interfere with REM sleep quantity and quality. Selective serotonin reuptake inhibitors (SSRIs) can cause REM sleep behaviour disorder (RBD) in up to 6% of users. RBD is a chronic sleep condition characterised by dream enactment and loss of REM atonia. It can result in violent movements during sleep, and individuals may hurt themselves or their bed partner.

RBD is often a symptom of another condition, such as Parkinson's disease, Lewy body dementia, or multiple system atrophy. It can also be brought on by antidepressants, or by neurological lesions affecting sleep/wake regulatory brain regions, most commonly within the brainstem.

Frequently asked questions