REM Sleep Behavior Disorder

What is REM sleep behavior disorder?

During a typical night’s sleep, you enter the stage called REM (which stands for rapid eye movement) for the first time about 90 minutes after falling asleep. You cycle in and out of it during the night, spending a total of about 20 percent of your sleep time in the REM stage.

REM sleep is when you dream. Also during REM sleep, your arms and legs are usually paralyzed (unable to move) temporarily. But people who have REM sleep behavior disorder (RBD) experience the opposite. Instead of temporary paralysis while in REM sleep and dreaming, they act out their dreams -- and may talk in their sleep.

What are the symptoms of REM sleep behavior disorder?

The symptoms of RBD can be mild and happen only occasionally or they can be so violent that you can injure yourself or your partner while you sleep. Symptoms of acting out dreams during RBD include:

• Hitting, kicking, punching or flailing your arms
• Jumping out of bed
• Talking, yelling, laughing or crying

What causes REM sleep behavior disorder?

Normally, the nerve pathways in the brain that signal temporary muscle paralysis are active during REM sleep. But in someone with RBD, these pathways aren’t working, allowing full use of their muscles to act out their dreams. Other potential causes and/or risk factors include:

• Having a neurological condition, such as Lewy body dementia, Parkinson’s disease or stroke
• Having narcolepsy
• Taking certain antidepressant medications
• Sleep apnea can disrupt your sleep, causing you to briefly wake up and move and may look like RBD

How is REM sleep disorder behavior diagnosed?

In addition to doing an exam and taking a complete health history, your doctor will likely recommend an overnight sleep study.

• Sleep lab study: For this test, you will spend the night at one of our sleep lab locations . Our technicians will connect you to devices that measure your breathing, brain and muscle activity and eye movements. This test can help determine if you lack muscle paralysis during REM sleep (even if you don’t act out a dream during the study).

How is REM sleep behavior disorder treated?

Although we can’t cure REM sleep behavior disorder, the sleep specialists at Henry Ford can help you control it. With the right treatment, both you and your partner can enjoy a more restful night’s sleep. We will work with you on ways to make your sleeping environment safer, treat any contributing conditions, as well as help control the RBD itself.

Safety precautions:

• Taking any dangerous items -- sharp objects, weapons -- out of the bedroom
• Putting some padding around your bed and on the floor next to you
• Having your partner sleep in a different bed or room until your symptoms are controlled

Medications:

• Melatonin: This supplement may help reduce violent behavior during sleep. 
• Clonazepam: This anti-anxiety medication is very effective at curtailing or even eliminating episodes of RBD, although it may cause daytime sleepiness and should be taken only under a doctor’s supervision.