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What is REM Sleep Behavior Disorder (RBD)? Signs, Symptoms, & Diagnosis

For many people, dreams are a normal part of sleeping and are purely mental activities that happen during your REM (rapid eye movement) cycle. While your body is resting, it’s in your mind that your dreams occur.

However, when you are suffering with REM sleep behavior disorder, you actually act your dreams out due to an increase of movement activity during REM sleep. It is when this acting out’ becomes a danger to you, your bed partner, or others that you begin noticing RBD. You may injure your partner or yourself while you are asleep. Fortunately, you can be treated for this disorder.

What is REM Sleep Behavior Disorder?

It was in 1986 that REM sleep behavior disorder first got its name. This disorder is more prevalent in men who are over 50 years old. It rarely affects children and women and less than one percent of the population has RBD.

This disorder is characterized by a lack of REM atonia with prominent dreaming and motor activity. Your REM sleep cycle typically takes place every couple of hours during a night’s sleep.

When you are in your REM cycle, the muscles of your body are ‘turned off through temporary paralysis. This is completely normal and is meant to keep you from acting out your dreams. But, when you have REM Sleep Behavior Disorder, these paralysis are either incomplete or totally absent, which leads to increase movement activity during REM sleep; sometimes violent. You can move your limbs physically and even engage in various activities like talking, hitting and shouting. You may even fly out of your bed.

In some instances, RBD patients may injure themselves or anyone who is lying in bed next to them. You may have more physical violent movement if you’re having a frightening or violent dream. When awakened, you remember the dream, but you don’t realize you were moving.

RBD tends to occur more often in seniors and in people who are suffering with some type of neurologic disorder. There appears to be a higher rate of occurrence of this disorder in people who have:

  • Multiple System Atrophy (around 90 percent )
  • Parkinson’s Disease (over 30 percent )

Those who have RBD could possibly develop Parkinson’s disease later down the road. One particular study found that around 38 percent of patients who received a diagnosis of the REM sleep disorder ended up developing Parkinson’s disease within a 12 year time-frame from when they first noticed their RBD symptoms. If you have RBD, you should keep an eye out for tremor and other Parkinson’s symptoms.

If you have RBD, you have an increased risk of developing certain sleep disorders such as sleep apnea, narcolepsy, or periodic limb movement disorder. Other factors can contribute to this condition as well as increase the intensity of your REM sleep cycle. These factors include:

  • Stroke
  • Brainstem Brain Tumors
  • Sleep Deprivation
  • Alcohol Withdrawal
  • Certain Medications

You may experience RBD episodes up to four times a night during your different REM phases. In rare cases, episodes can come on only once weekly or once a month. Since your REM sleep cycle happens more in the morning hours, this is when the episodes seem to be triggered the most.

Signs and Symptoms of RBD

With this condition, you don’t experience the typical temporary paralysis of your legs (atonia) and arms when you are in your REM sleep cycle which causes you to act your dreams out. In fact, dream-enacting behaviors are the main symptoms of this condition which can be dramatic at times and non directed.

REM sleep behavior disorder symptoms may include:

  • Physical movement like punching, kicking, jumping out of bed or arm flailing in response to violent or action-filled dreams (i.e. you may be defending yourself in your dream from an attack or are being chased)
  • Noises like laughing, talking, profanity, emotional outcries or shouting
  • Upon waking from an episode, you can remember your dream

A good example of a RBD incident is where a man is dreaming of playing some type of sports game such as football. In his dream he is diving to catch the ball. With this condition, he may actually dive right out of his bed while asleep. Another example would be if you are dreaming about an attacker chasing you and you leap out of your bed in order to run away.

There is a difference between RBD and sleepwalking. With sleepwalking, you may have your eyes open, walk around or leave your bedroom which is rarely done with this REM behavior disorder. You typically don’t drink or eat either or go to the bathroom.

How is RBD Diagnosed?

There are a number of parasomnias (sleep disorders involving abnormal movements) that could be mistaken for RBD. In order to be properly diagnosed, you would need to be evaluated by a sleep clinicianat a sleep center. Once the sleep specialist identifies the potential of RBD, they will require an overnight sleep study to be performed by a sleep technologist. It’s important to have a sleep tech assess you in an overnight study so they can document your dream and your movements during your REM sleep.

You will be observed all night and your sleep, muscle and brain activity will be closely monitored and any lack of atonia or muscle paralysis during your REM sleep. This will help the sleep techs rule out any types and causes of parasomnia.

There are specific criteria for a RBD diagnosis including:

  • You have recurrent episodes of sleep arousal along with physical motor behaviors or vocalization during your REM sleep
  • You are not disoriented or confused after waking up from an episode and are completely alert
  • You either show a lack of atonia on your polysomnographic recording or already have a synucleinopathy disease like multiple system atrophy or Parkinson’s disease or you have a suggestive history of the condition
  • Your episodes cause injury to yourself or your bed partner or cause substantial impairment or distress in occupational, social and other areas of functioning
  • You are not taking any medication that can explain the disturbance
  • You don’t have another medical condition that the episodes can be attributed to

Through a comprehensive sleep study, lack of REM atonia and detailed patient history, you may receive a RBD diagnosis. Modifying your sleep environment should be part of your overall REM sleep behavior disorder treatment if you have sleep-related injury. There are medications that effectively treat REM sleep behavior disorder and can be prescribed by a sleep medicine specialist.

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