Ashwin Lewis
Kicking in your sleep could be a sign of REM sleep behaviour disorder (RBD), a parasomnia in which people physically act out their dreams during the rapid eye movement (REM) stage of sleep. During normal REM sleep, the body enters a state of temporary muscle paralysis called atonia, but for people with RBD, this paralysis doesn't occur, and they may kick, punch, shout, or jump out of bed. RBD is rare, affecting less than 0.5% of the general population, but it's more prevalent in people with certain neurological disorders, such as Parkinson's disease and dementia. Treatment options include medication and creating a safe sleeping environment by removing dangerous objects.
| Characteristics | Values |
|---|---|
| Name of Disorder | Rapid Eye Movement (REM) Sleep Behavior Disorder, Parasomnia |
| Prevalence | Less than 0.5% of the general population |
| Demographics | More common in men, moderate to heavy drinkers, and people with neurological disorders such as Parkinson's disease, Lewy body dementia, or multiple system atrophy |
| Age | Average onset is about 61 years old |
| Symptoms | Kicking, punching, arm flailing, shouting, jumping out of bed, sleep-talking, laughing, yelling for help, unpleasant dreams, violent dreams |
| Diagnosis | Sleep study, medication to suppress muscle movements, clinical drug trials |
| Treatment | Medication to help sleep, padded flooring near the bed, removing sharp objects from the bedroom, separate sleeping spaces, pillow barricades, mattress on the floor |
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What You'll Learn
REM sleep behaviour disorder (RBD)
Kicking in your sleep could be a sign of Rapid Eye Movement (REM) sleep behaviour disorder, also known as RBD. This is a rare parasomnia, affecting less than 0.5% of the general population, in which people physically act out their dreams while in the REM stage of sleep. During normal REM sleep, the body experiences temporary muscle paralysis, but for people with RBD, this paralysis does not occur, and they may experience anything from small muscle twitches to violent movements such as punching, kicking, shouting, and jumping out of bed. They may recall dream content associated with their behaviour if they wake up, such as trying to defend themselves from an attack.
The main symptom of RBD is the physical acting out of dreams, but other symptoms include making noises such as talking, laughing, shouting, or yelling for help; being easily awakened during an episode and coherent afterward; and experiencing unpleasant dream content such as arguments, accidents, or attacks. Episodes often occur in the second half of the night and into the morning when longer phases of REM sleep are experienced.
RBD appears to be linked to a problem with certain nerve pathways in the brain and is more prevalent in people with neurological disorders such as Parkinson's disease, Lewy body dementia, or multiple system atrophy. Other risk factors include stress, poor sleep quality, taking certain medications such as antidepressants, and the use or withdrawal of alcohol or other drugs. Diagnosis can often be made through a detailed sleep history, but an inpatient sleep study may also be recommended to measure muscle tension during REM sleep.
Treatment for RBD aims to manage the condition and may include providing physical safeguards in the sleep environment, such as padded flooring near the bed and removing sharp or dangerous objects from the bedroom. Medication may also be prescribed in severe cases to help reduce arousal during the night, although this can have side effects such as daytime drowsiness, impaired balance, and slower breathing. Improving sleep hygiene, which refers to a healthy approach to sleep and wakefulness, can also help improve sleep quality and manage RBD symptoms.
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Potential causes of RBD
Kicking in your sleep could be a sign of Rapid Eye Movement (REM) sleep behaviour disorder, also known as REM sleep behaviour disorder (RBD). During the REM stage of sleep, the eyes move around quickly, but skeletal muscle tone is lost, causing temporary paralysis. However, people with RBD do not experience this paralysis and instead act out their dreams, which can include kicking.
There are several potential causes of RBD, including:
Neurological Disorders
RBD is associated with a higher risk of developing neurodegenerative diseases, including Parkinson's disease, Lewy body dementia, and multiple system atrophy. According to sources, RBD affects about 50% of people with Parkinson's disease, 80% of people with Lewy body dementia, and nearly 100% of people with multiple system atrophy. Isolated or idiopathic RBD, which occurs without an underlying cause, often leads to the development of these neurodegenerative conditions.
Medication and Neurological Conditions
Certain medications and neurological conditions can also contribute to RBD. Anxiety and other neurocognitive disorders have been linked to RBD.
Age and Gender
RBD appears to be more prevalent in older individuals, with an average onset age of around 61 years old. Additionally, it is more commonly diagnosed in men, with some sources estimating that 87% of people with RBD are male.
Alcohol Consumption
While not a direct cause, excessive alcohol consumption is one of several modifiable risk factors associated with RBD. Reducing alcohol intake may help mitigate the risk of developing RBD.
Genetics
There may also be a genetic predisposition to RBD, as some research suggests a link between specific gene variations and an increased risk of developing the disorder.
It is important to consult a healthcare professional if you suspect you or your bed partner may have RBD. They can recommend a sleep study, establish a clear diagnosis, and suggest appropriate treatment options to improve symptoms and ensure a safe sleeping environment.
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Treatment options for RBD
Kicking in your sleep could be a sign of Rapid Eye Movement (REM) sleep behaviour disorder, also known as RBD. During normal REM sleep, the body enters a state of temporary muscle paralysis called atonia, but for people with RBD, this paralysis does not occur, and they may act out their dreams physically and vocally.
- Medication: Doctors may prescribe medications such as clonazepam (Klonopin), melatonin, or other drugs to suppress muscle movements and improve RBD symptoms. However, it is important to note that the efficacy of some of these drugs has not been proven in randomized clinical trials.
- Sleep Environment Modifications: Modifying the sleep environment is recommended to create a safe space for both the patient and their bed partner. This may include padded flooring near the bed, removing sharp objects from the bedroom, and ensuring the safety of the patient and others.
- Clinical Sleep Study: Enrolling in a clinical sleep study can help diagnose and monitor RBD.
- Address Underlying Causes: RBD is associated with certain neurological disorders such as Parkinson's disease, Lewy body dementia, and multiple system atrophy. Treating or managing these underlying conditions may help improve RBD symptoms.
- Alternative Therapies: Some alternative therapies have shown efficacy in short- and medium-term clinical trials with a low number of patients. These include rivastigmine, memantine, 5-hydroxytryptophan, and the herbal medicine yokukansan.
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Periodic Limb Movement Disorder (PLMD)
Kicking in your sleep could be a sign of a sleep disorder known as Rapid Eye Movement (REM) sleep behaviour disorder. This is a parasomnia in which people physically act out their dreams during the REM stage of sleep. This can include anything from small muscle twitches and whispering to punching, kicking, shouting, and jumping out of bed.
However, kicking in your sleep could also be a sign of Periodic Limb Movement Disorder (PLMD), a sleep disorder characterised by repetitive cramping or jerking of the legs during sleep. PLMD is the only movement disorder that occurs exclusively during sleep. The "periodic" in PLMD refers to the repetitive and rhythmic nature of the movements, which occur about every 20-40 seconds. These movements can disrupt sleep and lead to daytime sleepiness.
PLMD can be primary or secondary. Secondary PLMD is caused by an underlying medical problem, whereas primary PLMD has no known cause. However, it has been linked to abnormalities in the regulation of nerves travelling from the brain to the limbs. It is often linked with Restless Legs Syndrome (RLS), but they are not the same thing. At least 80% of people with RLS have PLMD, but the reverse is not true.
While there is no cure for PLMD, treatments can help ease the symptoms. For example, if the patient has a lack of iron, a doctor may prescribe supplements. It may also help to avoid food and drinks with caffeine. Therapy can also help relieve symptoms. Medication can either reduce the movements or help the patient sleep through them. Benzodiazepines, for example, are sedatives that help patients sleep through the movements. Clonazepam (Klonopin) has been shown to reduce the total number of periodic limb movements per hour and is probably the most widely used drug to treat PLMD. Dopaminergic agents increase the levels of dopamine, an important neurotransmitter in regulating muscle movements.
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RBD and risk of neurodegeneration
Kicking in your sleep could be due to several factors, but if it is a recurring habit, it may be indicative of a condition called Rapid Eye Movement (REM) sleep behaviour disorder (RBD). This is a parasomnia in which people physically act out their dreams, vocalising and making sudden, often violent, movements with their arms and legs.
Now, onto the relationship between RBD and neurodegeneration. Several studies have found an association between RBD and neurodegenerative diseases, specifically synucleinopathies. The onset of RBD often precedes the development of neurodegeneration by several years. The risk for developing neurodegenerative diseases was 33.5% at five years, 82.4% at 10.5 years, and 96.6% at 14 years. The average conversion rate was 31.95% after a mean duration of follow-up of 4.75 ± 2.43 years.
Isolated or idiopathic RBD occurs when the condition develops spontaneously without an underlying cause. Most people with idiopathic RBD will eventually develop a neurodegenerative condition, specifically Parkinson's disease, Lewy body dementia, or multiple system atrophy (MSA). These conditions are called alpha-synucleinopathies.
Symptomatic or secondary RBD happens due to an underlying cause, such as Type 1 narcolepsy or the use of certain antidepressants, which can induce RBD.
The presence of RBD marks a less favourable disease phenotype. For example, in Parkinson's disease, the presence of RBD is associated with a greater non-motor burden and a more adverse prognosis.
The prognosis for RBD depends on the subtype. Patients diagnosed with RBD secondary to medication have the most promising prognosis of RBD resolution once the causative medication is withdrawn. However, it is possible that the medication simply brought forward an underlying pathology, and so the RBD may persist following medication cessation.
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Frequently asked questions
Kicking in your sleep could be a sign of REM sleep behaviour disorder (RBD). This is a parasomnia, or sleep disorder, in which you physically act out your dreams while in the rapid eye movement (REM) stage of sleep.
The main symptom of RBD is physically acting out dreams, such as kicking, punching, shouting, jumping out of bed, or falling out of bed. This is because the body isn't immobilised as it usually would be during REM sleep. People with RBD may also make noises like talking, laughing, shouting, or yelling for help.
It's not clear exactly why RBD happens, but it appears to be related to a problem with certain nerve pathways in the brain. It's also strongly associated with neurodegenerative diseases, including Parkinson's disease, Lewy body dementia, and multiple system atrophy.
If you think you may have RBD, it's important to talk to a healthcare provider. They may recommend a sleep study to diagnose the disorder and suggest treatment options. Treatment may include medication to suppress muscle movements during sleep, or preparing your sleep space to minimise risk, such as by removing sharp or dangerous objects from the bedroom.
