What Is REM Behavior Disorder?

Date: Jul-12-2012REM behavior disorder, also called REM sleep behavior disorder or RBD is a sleeping condition that has always been present, but was only first described in 1986. RBD is considered a sleep disorder which involves unusual actions or behaviors during the rapid eye movement (REM) sleep phase.

REM behavior disorder is a type of parasomnia. Parasomnias are sleep disorders in which strange or dangerous events occur, that affect or intrude on sleep. Examples include sleep terrors, REM behavior disorder, nocturnal dissociative disorder, somnambulism (sleepwalking), and sleep talking.

During the REM phase of sleep, the body goes through a series of common temporary muscle paralyses, but for people who suffer from RBD, these ordinary paralyses are incomplete or sometimes even not present at all, so the person acts out his or her dreams, sometimes in dramatic or violent ways. Of all cases studied and observed, 90% occur in males, and the average age is 60 years.

Due to the lack of the temporary muscle paralysis, sleepers with RBD become physically extremely agitated, actively moving their limbs, getting up and engaging in actions associated with walking. Some may even talk, shout, scream, hit, and punch, during their sleep.

In some cases, the sleepers with RBD can injure themselves or whoever they share their bed with. If they are having a particularly violent or frightening dream, the likelihood of a physically violent movement is much greater.

If somebody affected by REM is woken up, they may remember their dream, but have no idea that they were moving about.

According to Medilexicon's medical dictionary, REM Behavior Disorder is:

"A disorder characterized by lack of the atonia of voluntary muscles that normally occurs in REM sleep."
What are the causes of REM Behavior Disorder?
Experts are uncertain what the exact causes of REM are. In about 60% of cases, there is no known cause - it is idiopathic.

Neurologists have found that the REM behavior disorder is commonly found among patients with degenerative neurological conditions, such as Parkinson's disease, multisystem atrophy, diffuse Lewy body dementia, and Shy-Drager syndrome. People who suffer from narcolepsy are also more likely to be affected by RBD.

Some studies carried out at the Mayo Clinic found that REM behavior disorder is linked to apathy, lower scores in attention and executive functioning, anxiety, and symptoms of Parkinson's disease. (Link to article)
RBD can also be caused by adverse reactions to certain drugs or during strict drug withdrawal. Alcoholics who suddenly withdraw also have a higher risk of developing RBD.







RBD is known to affect people many years before they develop certain neurodegenerative diseases. In one study, researchers found that 38% of patients with RBD eventually went on to develop Parkinson's disease about 12 to 13 years later.

A 2006 study carried out by researchers from the Mayo Clinic found that REM Behavior Disorder among younger patients may be linked to antidepressant use. (Link to article)
How is REM Behavior Disorder diagnosed?
Most of us go through an REM sleep phase every 1.5 to 2 hours during an ordinary night's sleep. Therefore RBD episodes may take place up to four times a night. In exceptional cases, they may only occur once a week or even once a month. Episodes occur more towards the morning hours, because that is when REM sleep is more frequent.

Some other parasomnias may be confused with RBD. To get an accurate diagnosis, the patient should be assessed at a recognized sleep center which employs staff who are experienced and trained in evaluating paraomnias.

If the patient is kept under observation throughout the night - including monitoring of sleep, brain and muscle activity - any lack of muscle paralysis during REM sleep will be detected. It will also be possible to rule out other possible causes of parasomnias.
What are the treatment options for REM Behavior Disorder?
Fortunately, REM Behavior Disorder can usually be treated successfully.

Medications

Depending on the symptoms in each specific case, there are several medications that have been proven to very effective.

Low doses of clonazepam and benzodiazepine are known to be effective in about 90% of cases. These drugs are specifically targeted to suppress muscle activity and relax the body during sleep. Even if treated with these drugs long-term, it is extremely rare for a patient to develop dependence.

If the patient does not respond to clonazepam, some antidepressants or melatonin may help reduce violent behavior.

The patient should try to adopt a predictable sleep-wake cycle, i.e. a normal sleeping schedule, to avoid sleep deprivation. Alcohol consumption should be avoided.

What you can do at home

In order to keep the patient and his/her sleeping partner safe, you should ideally:

Either have the mattress on the floor, place cushions around the bed, or place the bed against a wall
If falling off the bed is a serious problem, consider installing padded bedrails
If possible, sleep on the ground floor, especially if the sleeper gets up during the night
Keep furniture and sharp objects away from the bed, in case the patient falls off the bed
Make sure there are no potentially dangerous objects in the room

REM sleep behavior disorder is linked to some neurodegenerative disorders, such as dementia, multiple system atrophy and Parkinson's disease. The patient might consider seeing a neurologist to rule out these diseases. As signs and symptoms of Parkinson's disease may not appear for over ten years after the onset of RBD, the doctor should advice the patient to have follow-up checks.
What is the outlook for REM behavior disorder?
If no cause can be identified, the symptoms can be controlled with drugs and there are usually no complications. However, if they are caused by a neurological disease, then the outlook depends on that disease.

Written by Christian Nordqvist

View drug information on Clonazepam.

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