Gina Johnson
Fighting in your sleep could be a sign of REM sleep behaviour disorder (RBD), a parasomnia in which you physically act out your dreams while in the rapid eye movement (REM) stage of sleep. During normal REM sleep, the body experiences temporary muscle paralysis, but for people with RBD, this paralysis does not occur, allowing them to unknowingly act out their dreams. RBD can lead to accidental injury to oneself or one's bed partner, and it is more commonly observed in people over 50 years of age, with men being more likely to be affected than women.
| Characteristics | Values |
|---|---|
| Name of the disorder | REM sleep behavior disorder (RBD) |
| Cause | A problem with certain nerve pathways in the brain |
| Occurrence | Rare |
| Age | Affects people over the age of 50, with an average onset age of 61 years |
| Gender | More common in men |
| Symptoms | Acting out dreams, vocalizations, arm and leg movements, violent dreams, sleepwalking, sleep terrors, abnormal nocturnal sleep behaviors, disturbed dreams, shouting, punching, kicking, jumping out of bed, sleep talking, sleepwalking, sleep terrors, sleep-related abnormal sexual behaviors, sleep-related dissociative disorder, trauma-associated sleep disorder/post-traumatic stress disorder, periodic limb movement disorder, rhythmic movement disorder, nocturnal scratching disorder, nocturnal seizures, etc. |
| Diagnosis | Sleep study, clinical history, careful clinical interviews, sleep laboratory monitoring, technologist-attended, overnight video-polysomnography |
| Treatment | Melatonin, temazepam, sleeping environment modifications, sleeping in a separate room, pillow barricades, removing dangerous items from the room, sleeping on a mattress on the floor, clonazepam therapy, control of severe OSA with nCPAP |
| Complications | Accidental injury to oneself or one's bed partner, reduced quality of life, severely disrupted sleep |
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What You'll Learn
REM sleep behaviour disorder (RBD)
Fighting in your sleep could be a symptom of REM sleep behaviour disorder (RBD). RBD is a parasomnia, or sleep disorder, that involves unusual and undesirable physical events or experiences that disrupt your sleep. During an episode, people with RBD may talk or make vocal sounds in their sleep, fall out of bed, or make sudden, violent arm and leg motions in response to vivid, troubling dreams. These motions can include flailing, punching, and kicking. Because they are asleep, they are unaware of these unintentional behaviours.
RBD is a complex sleep disorder affecting the brain and is closely related to certain neurodegenerative disorders, such as Lewy body dementia (LBD), Parkinson's disease, and multiple system atrophy (MSA). If RBD develops independently, without an underlying cause, it is considered one of the earliest warning signs of these neurodegenerative disorders. About 97% of people with isolated or idiopathic RBD will have one of these neurodegenerative disorders within 14 years of diagnosis.
The onset of RBD can be either gradual or sudden, with episodes occurring occasionally or frequently, even multiple times per night. The disorder often gets worse over time. RBD is relatively rare, affecting about 1% of the general US population and 2% of people over the age of 50. However, the number of people affected is likely higher, as it can be difficult to diagnose.
Treatment for RBD is important, as the disorder can lead to accidental injury to oneself or one's bed partner. RBD is usually treated with medication, such as melatonin and temazepam, and devices that trigger an alert when a sleeper's movements become excessive.
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NREM parasomnia
Sleep fighting could be a symptom of NREM parasomnia, a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt sleep. NREM parasomnias occur during the first few hours of sleep, during the first three stages of sleep, from first falling asleep to about the first half of the night. They involve physical and verbal activity, such as sleepwalking, sleep talking, sleep sex, and sleep-related groaning.
If you believe you may be experiencing NREM parasomnias, it is recommended to consult a doctor, who may refer you to a sleep specialist for further evaluation and diagnosis. Treatment options typically include medication, psychotherapy, and lifestyle changes.
It is important to note that violent behaviour during sleep can also be a symptom of REM sleep behaviour disorder (RBD), which occurs during the REM stage of sleep and involves acting out dreams, which can lead to injury. RBD is associated with neurodegenerative disorders such as Parkinson's disease and dementia.
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OSA pseudo-RBD
Fighting in your sleep can be a symptom of REM sleep behaviour disorder (RBD). RBD is a parasomnia, a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep. During RBD, people physically and/or vocally act out their dreams while in the rapid eye movement (REM) stage of sleep, and are unaware of their actions. RBD can lead to accidental injury to yourself or your bed partner, so it is important to seek treatment.
Obstructive sleep apnea (OSA) can sometimes mimic symptoms of RBD, and this is known as pseudo-RBD. OSA is caused by repetitive obstruction of the upper airway during sleep, and is extremely common in the general population. OSA-induced hypnopompic REM sleep parasomnia could be misdiagnosed as RBD. Pseudo-RBD symptoms in OSA are a form of confusional arousal after intense apneic episodes with severe oxyhemoglobin desaturations. OSA-induced arousals during REM sleep with vivid dreaming can result in immediate postarousal DEB with locomotion, agitation, and violence.
It is important to distinguish pseudo-RBD associated with OSA from RBD concomitant with OSA because these two conditions have different clinical implications for neurodegeneration and different treatment options. Video polysomnography (vPSG) is mandatory to establish an accurate diagnosis of RBD, and CPAP treatment is necessary to confirm the diagnosis in patients with clinical uncertainty. CPAP is the first treatment option for patients diagnosed with concomitant RBD and OSA.
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Neurodegenerative disorders
Sleep is a complex biological process that plays a critical role in maintaining overall health and well-being. It serves as a time for restorative processes, memory consolidation, and the regulation of various bodily functions. Neurodegenerative diseases, a group of chronic and progressive disorders affecting the nervous system, pose a significant global health challenge. These conditions, including Alzheimer's disease, dementia with Lewy bodies disease, Huntington's disease, Parkinson's disease, and others, are characterized by the gradual deterioration of nerve cells, leading to a decline in cognitive, motor, and functional abilities.
There is a significant burden of neurodegenerative disorders globally, and it is expected to increase with a rising older adult population. Sleep disturbances in these patients are primarily related to the neurodegenerative condition and add to the morbidity caused by the disorder itself. The relationship between sleep and neurodegeneration is bidirectional. Neurodegenerative disorders can impact brain regions that control sleep, while sleep disturbances can accelerate or worsen neurodegeneration by impairing protein clearance and increasing oxidative stress. Sleep disorders are common yet often overlooked complications of neurodegenerative conditions. These disturbances significantly contribute to morbidity and can adversely affect patients' overall prognosis and quality of life.
Sleep disturbances, such as insomnia, hypersomnia, nightmares, and circadian rhythm disorders, frequently co-occur with neurodegenerative disorders. Alzheimer's disease (AD) is widely recognized as the prevailing neurodegenerative disorder, distinguished by the destruction of neurons and the accumulation of b-amyloid in neurofibrillary tangles within the hippocampus and cortex. Both insufficient sleep duration and obstructive sleep apnea (OSA) have been identified as risk factors for Alzheimer's disease.
Individuals with neurodegenerative diseases frequently experience disrupted sleep patterns, such as insomnia, excessive daytime sleepiness, and REM sleep behaviour disorder (RBD). RBD is a parasomnia, a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep. RBD is strongly associated with certain neurodegenerative disorders. About 97% of people who have isolated (idiopathic) RBD will have Parkinson's disease, Lewy body dementia, or multiple system atrophy within 14 years of diagnosis. RBD can lead to accidental injury to oneself or one's bed partner, so it is important to seek treatment. Safety measures are vital, such as creating a safe sleep environment by removing potentially harmful objects from the bedroom.
Treatment approaches should be individualized, considering the patient's overall health, disease stage, and specific sleep-related symptoms. Multidisciplinary collaboration involving neurologists, sleep specialists, psychologists, and other healthcare professionals is often necessary to optimize treatment strategies for sleep disturbances in the context of neurodegenerative diseases. Understanding the specific types of sleep disorders associated with these neurodegenerative conditions is essential for effective diagnosis and management.
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Treatment options
- Lifestyle changes: This includes avoiding triggers such as alcohol and certain antidepressants, which have been linked to RBD. It is recommended to keep track of when you drink before bedtime to identify any patterns.
- Medication: Melatonin, for example, has been found to improve symptoms in a third of RBD cases when given in doses ranging from 2 to 6 mg.
- Sleep hygiene: This involves following good sleep habits, such as maintaining a consistent sleep schedule, eliminating outside noise, and sleeping in a cool, dark room.
- Safe sleeping environment: This is crucial to prevent injuries to both the person with RBD and their bed partner. Modifications can include sleeping in a separate room, using pillow barricades, removing potentially dangerous items from the room, or sleeping on a mattress on the floor.
- Neuroprotective drug trials: As RBD is often an early sign of neurodegenerative diseases, there may be opportunities for patients with RBD to enrol in neuroprotective drug trials to prevent the progression of these diseases.
- Hypnosis: In some cases, hypnosis has been found to be effective in controlling RBD.
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Frequently asked questions
Fighting 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 acting out dreams, but other symptoms include vocalisations, shouting, punching, kicking, and jumping out of bed.
RBD appears to be caused by a problem with certain nerve pathways in the brain. It is often associated with neurodegenerative diseases such as Parkinson's, Lewy body dementia, or multiple system atrophy.
RBD is usually first reported by a patient's bed partner, then it is formally diagnosed with a sleep study. A doctor will ask about sleep behaviour and may ask the patient to keep a sleep diary.
Yes, RBD can be treated with medication such as melatonin and temazepam, as well as sleeping environment modifications such as separate rooms, pillow barricades, and removing dangerous items from the room.
