Overview
REM sleep behavior disorder (RBD) is a sleep disorder characterized by physically acting out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during Rapid Eye Movement (REM) sleep. Normally, people don't move during REM sleep, which is a normal stage of sleep that occurs multiple times throughout the night and is the primary time for dreaming. RBD may be associated with other neurological conditions, such as Lewy body dementia, Parkinson's disease, or multiple system atrophy. Complications of RBD may include distress to sleeping partners, social isolation, and injury to oneself or the sleeping partner.
Understanding the disease
Symptoms
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, along with noises like talking, laughing, shouting, emotional outcries or even cursing. Additionally, people with REM sleep behavior disorder are able to recall their dreams if they awaken during an episode.
Risk Factors
The risk factors associated with the development of REM sleep behavior disorder include:
- Being male and over 50 years old, although the disorder is becoming more common in women, especially those under 50, and in young adults and children, 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. It's important to note that recent evidence suggests several specific environmental or personal risk factors, including occupational pesticide exposure, farming, smoking, or a previous head injury may also contribute to the development of REM sleep behavior disorder.
Development
REM sleep behavior disorder (RBD) is thought to develop due to a decrease or loss of the normal inhibitory mechanisms in the brain that normally prevent muscles from moving during REM sleep. This can occur for several reasons:
- Age-related: As people age, there is a natural decline in the inhibitory mechanisms in the brain. This can lead to the onset of RBD, particularly in men over 50 years old. However, it can also occur in younger individuals, especially those with certain medical conditions or taking certain medications.
- Neurological conditions: Certain neurological disorders, such as Parkinson's disease, multiple system atrophy, stroke, or dementia with Lewy bodies, can contribute to the development of RBD. In these cases, the nerve pathways that prevent muscle movement during REM sleep may be affected.
- Narcolepsy: Individuals with narcolepsy, a chronic sleep disorder characterized by excessive daytime sleepiness, often experience RBD as well. The connection between narcolepsy and RBD is not fully understood, but it may be related to the loss of the inhibitory mechanisms in the brain.
- Medications: Certain medications, especially newer antidepressants, can increase the risk of developing RBD. Additionally, drug or alcohol withdrawal can also trigger the onset of RBD in some individuals.
- Environmental or personal risk factors: Recent research has suggested that occupational pesticide exposure, farming, smoking, and a previous head injury may also contribute to the development of RBD. If you are experiencing symptoms of REM sleep behavior disorder or have other sleep-related problems, it is essential to consult with your doctor to determine the best course of treatment.
Assessment and Diagnosis
Triage
If you or your sleeping partner experience symptoms of REM sleep behavior disorder, such as physically acting out dreams with movements or making noises during REM sleep, it's important to consult a doctor. The doctor will help determine the underlying cause and provide appropriate treatment options. If you are experiencing other sleep-related problems or have any concerns about your sleep patterns, it's also advisable to seek medical advice. Remember, it's always better to address sleep issues early on to ensure proper rest and overall well-being.
Diagnosis
To diagnose REM sleep behavior disorder, your doctor will typically review your medical history and symptoms. The evaluation may include a physical and neurological exam, as well as discussing your sleep behaviors with your sleeping partner. It's also helpful to keep a sleep diary for two weeks before your appointment, recording any sleep issues that occurred the previous night.
Management and Treatment
Complications
Potential complications of REM sleep behavior disorder include distress to the sleeping partner or other people living in the home, social isolation due to fear of others becoming aware of sleep disruption, and injury to oneself or the sleeping partner.
Home Remedies
It is recommended to consult with a healthcare professional for proper diagnosis and treatment of REM sleep behavior disorder.
Treatment
The onset of REM sleep behavior disorder is often gradual and can worsen with time. If you are experiencing symptoms or other sleep problems, it is advised to talk to your doctor.
Preparing for medical consultation
To prepare for an appointment for REM sleep behavior disorder (RBD), you should:
- Keep a sleep diary: For two weeks before your appointment, keep a sleep diary in the morning, recording the sleep issues of the previous night.
- Bring your sleeping partner: Consider bringing your sleeping partner, family member, or friend along to your appointment. They can provide additional information and help you remember the doctor's advice.
- Make a list of medications: Prepare a list of all medications, vitamins, herbs, or supplements you are taking, including dosages and any recent changes.
- Gather previous sleep studies: Bring the results of any prior sleep studies or other tests to your appointment or ask your doctor to forward them to your sleep specialist.
- Write down your symptoms: Record your symptoms, including those unrelated to sleep, and when they began.
- Discuss personal information: Note any major stresses or recent life changes that might be relevant to your doctor.
- Be prepared to discuss your sleep habits: Be ready to discuss your sleep habits, including your sleep schedule, bedroom environment, and any factors that may affect your sleep quality. Remember to be open and honest with your doctor about your sleep issues and any concerns you may have. Following these preparation steps can help ensure your doctor has a comprehensive understanding of your sleep situation and can provide the most appropriate treatment recommendations.