Definition:

REM sleep behavior disorder (RBD) is a parasomnia. A parasomnia involves undesired events that happen while sleeping.

RBD occur when you take action out vivid dreams as you sleep. These dreams are often filled with action. They may even be violent. Episodes tend to get worse over time. Early episodes may involve mild activity. Later episodes can be more violent. RBD is often ignored for years. At some point it is likely to result in an injury. Either the person dreaming or the bed partner may be hurt.

RBD can be confused with sleepwalking and sleep terrors. In these supplementary disorders, the sleeper is usually confused upon waking up. He or she does not become rapidly alert. In contrast, it is normally easy to wake a person with RBD who is acting out a dream. Once awake, he or she is also able to recall clear details of the vivid dream.

Causes of REM Sleep Behavior Disorder:

The exact cause of REM sleep behavior disorder (RBD) is unidentified, although the disorder may occur in association with various degenerative neurological conditions such as Parkinson disease, multisystem atrophy, diffuse Lewy body dementia, and Shy-Drager syndrome. In 55% of persons the cause is unknown, and in 45%, the cause is associated with alcohol or sedative-hypnotic withdrawal, tricyclic antidepressant (such as imipramine), or serotonin reuptake inhibitor use (such as fluoxetine, sertraline, or paroxetine) or other types of antidepressants (mirtazapine). Another characteristic of REM sleep is a general state of atonia, or muscle paralysis. So, while the brain is very active during REM sleep, the body is usually still.

Symptoms of REM Sleep Disorder:

The main symptom of REM sleep behavior disorder is dream-enacting behaviors, sometimes violent, causing self-injury or injury to the bed partner.

The dream-enacting behaviors are usually nondirected and may include punching, kicking, leaping, or jumping from bed while still asleep.

The person may be awakened or may wake spontaneously during the attack and vividly recall the dream that corresponds to the physical activity.

Treatment of REM Sleep Disorder:

Depending on the severity of episodes, treatment usually includes modifying the sleep environment to make it safer, lifestyle changes to decrease the likelihood of episodes, and possibly medication. Patients are also regularly monitored for any signs of a neurological disorder.

Medical Treatments: Clonazepam (Klonopin) is highly effective in the treatment of REM sleep behavior disorder (RBD), relieving symptoms in nearly 90% of patients with little evidence of tolerance or abuse. The response usually begins within the first week, often on the first night. The initial dose is 0.5 mg at bedtime, with some persons requiring a rapid increase to 1 mg. With continued treatment for years, moderate limb twitching with sleep talking and more complex behaviors can reemerge. The treatment should be continued indefinitely, as violent behaviors and nightmares promptly recur with discontinuation of medications in almost all persons with RBD.

Melatonin, a dietary supplement, can reduce or eliminate REM sleep behavior disorder symptoms in some patients, without the side effects of other medications. A Mayo Clinic study of 14 people with REM sleep behavior disorder showed that 57 percent of participants found melatonin helpful, and two patients found it ineffective. Melatonin reduced participants’ physical aggressiveness and the nightmarish quality of their dreams, decreasing the potential for injury. Additional studies are needed to more thoroughly understand melatonin’s effectiveness.

Even though melatonin is available over-the-counter at drugstores, Mayo specialists do not advocate self-medicating for REM sleep behavior disorder. They recommend that patients confer with a sleep specialist to get a proper diagnosis prior to treatment.