REM Sleep Behavior Disorder – Symptoms and Treatment

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When you sleep, our bodies do not go into a completely “silent” mode. While a person may seem very peaceful during sleep, their brain might be much more active than you might think. 

Sleep consists of five different stages, which is often divided into two major categories – non-rapid eye movement sleep, or NREM sleep, and rapid eye movement sleep, or REM sleep.

During the final phase of sleep, the rapid eye movement sleep phase, you experience a significant increase in brainwaves. This is the phase where you start to dream. The entire body's muscles go into a relaxed state, and the heart starts pumping faster.

You also breath faster and shallower than during the other phases of sleep. Even though scientists are still conducting some research to understand REM sleep thoroughly, it is known that this phase plays a vital role in our overall sleep quality and the many effects that sleep have on our overall health.

When our body is in the REM phase of sleep, our muscles are relaxed – you are put in a type of paralysis state. With REM Sleep Behavior Disorder (RBD), the paralysis state does not occur, which causes the affected individual to act upon what they are dreaming. This may include violent and intense actions, such as yelling, grabbing, kicking, punching, and more.

Here is a short recording of the REM Sleep Behavior Disorder:

Causes

Sleep experts have conducted extensive research on RBD but is still unable to pinpoint the exact cause of this sleep disorder. There are, however, specific risk factors that seem to make a person more likely to experience the symptoms that are associated with the condition. In particular, the following diseases and conditions seem to put a person at a significantly higher risk of developing RBD:

  • Parkinson’s Disease
  • Lewy Body Dementia
  • Multisystem Atrophy
  • Shy-Drager Syndrome

In over half of all patients with RBD, the exact cause of the condition is never discovered. In approximately 45% of patients that are diagnosed with the condition, the cause is usually linked to withdrawal symptoms associated with the patient giving up the use of alcohol or certain types of sedatives. There are certain antidepressants, including fluoxetine, paroxetine, mirtazapine, and imipramine, that can also cause symptoms associated with RBD as a withdrawal side-effect.

Symptoms Of RBD

The symptoms of RBD can be somewhat challenging to identify in the patient affected by the condition since the actions and events caused by the condition happen during sleep. In many cases, someone else, such as a partner sleeping in the same bed as the affected patient, would be the one to identify the symptoms and presence of this sleep disorder in the patient.

The patient may act out a series of different events that occur in their dreams. These actions may include:

  • Sitting up in bed unknowingly
  • Jumping up from the bed
  • Grabbing in random directions
  • Randomly talking or yelling in their sleep
  • Punching or kicking in their sleep

RBD Diagnosis

The diagnosis is a relatively a complicated process. Merely complaining about experiencing the symptoms associated with this condition is not enough for a physician to officially diagnose the patient. To diagnose a patient with RBD, a thorough sleep study needs to be conducted. Such a sleep study will monitor the patient during a single night’s sleep in most cases. Various factors will be monitored during the period that the patient is asleep, such as brain activity and muscle activity. This will help the physician determine if REM Sleep Behavior Disorder is the most appropriate diagnosis and if other types of parasomnia-related conditions may be present in the patient.

Treatment

The treatment for RBD usually depends on the severity of the patient’s symptoms. When the symptoms are not considered serious, then certain changes may be recommended to the environment where the patient sleeps at night. Level B and C REM Sleep Behavior Disorder calls for a more advanced treatment protocol, usually with the use of specific medication. Clonazepam is a highly recommended drug to assist in reducing these symptoms but is appropriate for all patients. Melatonin is another option that can be used and has a lower risk profile associated, as compared to Clonazepam.

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