REM Behavior Disorder (RBD)

Last updated: May 31, 2019

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

Rapid Eye Movement (REM) sleep is one of the stages of sleep. This is the stage of sleep where a person consolidates memories and a vital stage to learning. REM is also important in balancing an individual’s mood and it is when dreams occur.

A dream is a mixture of images, emotions, and sensations that happens in a person’s mind. . However, there are people who “act out” their dreams. They move their limbs when they dream. Some of them even get up from their bed. In some cases there are those who sleep talk, scream, or punch while dreaming. This is a condition known as REM sleep behavior disorder.

What causes REM Sleep Disorder?

Nobody knows what is the exact cause of REM sleep disorder. What researchers do know is that this disorder is common in those with degenerative neurological conditions. These include Parkinson’s disease and multisystem atrophy. Shy-Drager syndrome and diffuse Lewy body dementia also belong to this group.

In 55% of cases of RBD doctors are unable to determine the cause. However, in 45% of cases, there is an association with alcohol. Or a connection with sedative-hypnotic withdrawal, tricyclic antidepressants, or serotonin uptake inhibitors. Antidepressants are also thought to be connected to the disorder.

Most of the time RBD develops prior to neurodegenerative diseases. RBD oftentimes precedes these diseases by several years. One study states that 38% of patients with RBD develop Parkinson’s disease. Sixty-nine percent of patients with Parkinson’s disease and multisystem atrophy have RBD. However, this doesn’t necessarily mean that when someone has RBD that person will also develop Parkinson’s disease.

There are also researches that explain the connection between RBD and brain damage. This is a result of studies of animals. Symptoms similar RBD showed up in animals suffering from lesions in the brain. Cats affected with brain lesions showed motor activity during REM sleep. During REM sleep affected cats will arch their backs, hiss and bare their teeth. These happen while their brain waves showed REM sleep. These lesions affect the part of the brain stem involved in the inhibition of locomotor activity.

How is RBD Diagnosed?

It can be difficult to diagnose RBD. This is because its symptoms are similar to other parasomnias. For this reason a formal sleep study is necessary. This will require an overnight stay in a sleep center. During a sleep study sensors will monitor the patient’s heart, brain, and lung activities. Sensors will also monitor the patient’s breathing patterns and blood oxygen levels. Medical technicians will also monitor the patient’s arm and leg patterns as well as vocalizations. It is not unusual for a videotape to record the patient’s behavior during this test. This will allow a doctor to review the patient’s actions during REM sleep cycles.

Physical and neurological exam

It is also possible for a doctor to conduct a physical and neurological exam on the patient. This is a way of assessing not just the patient’s RBD behavior but for other sleep disorders as well. This test will help rule out the existence of other sleep disorders such as narcolepsy, sleep apnea or restless legs syndrome.

During a consultation it is also vital to have the patient’s sleeping partner present. This will allow the doctor to interview the sleeping partner as well. The sleeping partner can present observations such as how the patient acts during sleep. He or she can also tell the doctor if the patient flails their arms, talks, walks, or screams during sleep.

How is RBD treated?

There are a few treatment options for RBD. A doctor may prescribe melatonin supplement. This may help reduce or even eliminate the symptoms of RBD.

Clonazepam is also a possible treatment. This is an anxiety treatment. However, it is also effective in reducing the symptoms of RBD. Unfortunately Clonazepam has side effects such as excessive daytime sleepiness.

Additional Resources: