REM Sleep Behavior Disorder

Dreaming for a vast majority of people is a mental process; the body is usually at rest. This is not the case for those who suffer from REM sleep behavior disorder (RBD). In this condition, the patient literally act out everything that is in your dream. In short, REM behavior disorder makes you do activities that are associated with the state of wakefulness.

REM sleep behavior disorder patients may talk, walk, shout, fight or even cook while in sleep. Some reports indicate that some people even fly out of their bed!! Like most other parasomnia (abnormal events during sleep) the sleeper is not aware of the events. They may not even remember the events when they wake up.  REM sleep behavior disorder is most at times first diagnosed or noticed by the sleeping partner.

REM Sleep Behavior Disorder REM Sleep Behavior Disorder: Characteristics

There are generally three stages of sleep that human being go through during sleep: wakefulness, Rapid Eye Movement (REM) and non-REM. REM is associated with dreaming and it is where REM behavior disorder is experienced. Normal sleep is composed of 20-25% REM. The following are the characteristic of REM sleep:

  • Breathing is irregular.
  • Blood pressure goes up.
  • Atonia (muscle paralysis occurs).

The above listed events are important in order to maintain sleep. However, one thing stands out in REM: brain activity and electrical activity is the same as during wakefulness.  In REM sleep behavior disorder, atonia or paralysis of muscles is partial or completely absent. Since the brain is still active and muscles are not paralyzed, acting the dream is very easy.

In REM sleep behavior disorder, the distinction that is usually so obvious in normal sleep is lost. The characteristics of REM may “invade” n-REM. It becomes difficult to know whether the person is asleep or awake as the patient may rapidly transition from one state to another.

Interesting Facts

This condition has been observed in dogs. In humans, the only feelings and sensations in REM sleep behavior disorder are embedded in the dream. Pain is in the dream. Bleeding or bruising experienced during the event is real and can be seen when the person wakes up.

The specific reason for REM sleep behavior disorder (RBD) is unknown, although the disorder may occur in association with various degenerative neurological conditions such as Parkinson’s disease, multi system atrophy and diffuse Lewy body dementia.

REM sleep behavior disorder was first described in the year 1985 by Horward and Schenck from the University of Minnesota. From their case studies, they identified the following facts:

  • More that 90% of the patients were men.
  • REM sleep behavior disorder is observed in person over the age of 50.
  • Most patients are remarkably calm during the day.
  • This condition affects about 0.5% of the general population.

Diagnosis and Treatment

With the few symptoms identified in this article such as sleepwalking and sleep talking, it is clear that this condition can be easily misdiagnosed as other parasomnia. It is therefore important that conclusive diagnosis be done using polysomnography.  The good news about REM sleep behavior disorder is that it is treatable.

One of the most effective drugs for treating REM sleep behavior disorder is clonazepam. It has a 90% success rate when administered in low doses. It works by restoring muscles paralysis during sleep. However, the mechanism in which it does so is still not known. Melatonin is a more natural remedy for this condition. REM sleep behavior disorder patients should ensure the following:

  • Not objects that can cause injury should be in your sleeping environment.
  • Drinks such as coffee and should be avoided as the serve to increase brain activity.
  •  Sleeping on the floor (with a mattress) rather than on the bed is best.

REM Sleep Behavior Disorder Video Education