Rapid Eye Movement
(REM) Behavior Disorder is a sleep disorder in which one physically acts out
vivid, often unpleasant dreams with vocal sounds and sudden, violent arm and
leg movements during REM sleep. About 20 percent of your sleep is spent in REM
sleep, the usual time for dreaming, which occurs primarily during the second
half of the night.
Nerve pathways in the brain that prevent muscles from moving are active during normal REM (or dreaming sleep) resulting in temporary paralysis of your body. In REM Behavior Disorder (RBD), these pathways no longer work and you may physically act out your dreams (a parasomnia). RBD can also accompany other parasomnias like sleep-related eating disorder, sleepwalking, confusional arousals, sexsomnia, and night terrors.
The onset of RBD can be gradual or sudden, and episodes may occur occasionally (or several times a night). Once awake, he or she is also able to recall clear details of the vivid dream. The disorder often worsens with time. Symptoms of RBD may include movement such as kicking, punching, arm flailing or jumping from bed, in response to action-filled or violent dreams, such as being chased or defending yourself from an attack; noises, such as talking, laughing, shouting, emotional outcries or even cursing; or being able to recall a dream if you awaken during the episode.
Risk factors associated
with the development of RBD include:
·
Being male and over 50 years old -however, more women
are now being diagnosed with this disorder especially under age 50. Young
adults and children can develop the disorder usually in association with
narcolepsy, antidepressant use, or brain tumors.
·
Having a certain type of neurodegenerative disorder- such as Parkinson's
disease (33%), Multiple System Atrophy (90%), stroke or Dementia with Lewy Bodies.
·
Having narcolepsy- a chronic sleep disorder characterized by
overwhelming daytime drowsiness.
·
Taking certain medications-especially newer antidepressants, or the use
or withdrawal of drugs or alcohol.
·
They
can accidentally strike a bed partner (ironically, while
trying to protect themself from danger in their dream). Sleep
in a separate room from the bed partner until symptoms are under control.
RBD tends to respond to treatment
with medications like Clonazepam, Melatonin, and Klonopin. Treatment also requires the following:
·
Bedroom safety precautions, which include moving objects away
from the patient’s bedside. This includes night stands, lamps, or other objects
that could cause injury. Pad the floor around the bed with a
mattress or pillows (as well as the corners of nearby furniture).
·
Move the bed away from the window by placing a large object such as a
dresser in front of the window. Remove dangerous
objects such as guns or sharp objects from bedroom area. Put your mattress on
the floor so you have less distance to fall. Move furniture away from the
immediate vicinity so won’t hit anything if you run or dive.
·
Maintain a normal total sleep time. Sleep deprivation will increase
RBD. Monitor for any sleepiness. Treat any and all other sleep disorders that
will disrupt your sleep and increase RBD.
·
Avoid certain medications and
alcohol. They can
cause or increase RBD.
·
Undergo regular monitoring for any
neurologic symptoms.
This includes tremor or other Parkinson symptoms.
“But if you want to get into REM sleep, you're going to
have to sleep 90 minutes or so.” (Richard Schwab)[i]
[i] Sources used:
·
“Rapid Eye
Movement Sleep Behavior Disorder” by Psychology Today
·
“REM sleep behavior
disorder” by Mayo
Clinic Staff
·
“REM Sleep Behavior Disorder – Overview & Facts” by AASM
·
“REM Sleep Disorder: Why Acting Out Your Dreams Can
Turn Into a Nightmare” by Cleveland Clinic
This post is dedicated
to comedian Mike Birbiglia, who has this illness.
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