REM BEHAVIOR DISORDER

Overview

Rapid eye movement (REM) sleep behavior disorder is a sleep disorder in which you physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep. This is often referred to as dream-enacting behavior.

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Most of our muscles are usually paralyzed during REM sleep; that way we normally do not move while dreaming during REM sleep. When you have REM sleep behavior disorder, this muscle paralysis is absent.

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The onset of REM sleep behavior disorder is often gradual and it can get worse with time.

REM sleep behavior disorder may be associated with other neurological conditions, such as Lewy body dementia (also called dementia with Lewy bodies), Parkinson's disease or multiple system atrophy.

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Symptoms

The onset can be gradual or sudden, and episodes may occur occasionally or several times a night. The disorder often worsens with time.

Symptoms of REM sleep behavior disorder 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

• Being able to recall the dream if you awaken during the episode.

 

Causes

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 sleep behavior disorder, these pathways no longer work and you may physically act out your dreams.

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Risk factors

Factors associated with the development of REM sleep behavior disorder include:

• Being male and over 50 years old — however, more women are now being diagnosed with the disorder, especially under age 50, and 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, multiple system atrophy, 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

Recent evidence suggests that there may also be several specific environmental or personal risk factors for REM sleep behavior disorder, including occupational pesticide exposure, farming, smoking or a previous head injury.

 

Complications

Complications caused by REM sleep behavior disorder may include:

• Distress to your sleeping partner or other people living in your home

• Social isolation for fear that others may become aware of your sleep disruption

• Injury to yourself or your sleeping partner

 

Diagnosis

To diagnose REM sleep behavior disorder, your doctor reviews your medical history and your symptoms. A physical and neurologic exam, talking to your sleeping partner and a nocturnal sleep study will help make a diagnosis of REM sleep behavior disorder.

 

Treatment

Preventing injury to yourself and sleeping partner is the cornerstone of treating REM sleep behavior disorder along with medications.

 

Physical safeguards

Your doctor may recommend that you make changes in your sleep environment to make it safer for you and your bed partner, including:

• Padding the floor near the bed

• Removing dangerous objects from the bedroom, such as sharp items and weapons

• Placing barriers on the side of the bed

• Moving furniture and clutter away from the bed

• Protecting bedroom windows

• Possibly sleeping in a separate bed or room from your bed partner until symptoms are controlled

 

Medications

Examples of treatment options for REM sleep behavior disorder include:

• Melatonin.  Melatonin may be as effective as clonazepam and is usually well-tolerated with few side effects.

• Clonazepam (Klonopin). Clonazepam which is usually used to treat anxiety if traditionally the drug of choice to effectively control symptoms of REM sleep behavior disorder. Clonazepam may cause side effects such as daytime sleepiness, decreased balance and worsening of sleep apnea.