REM Sleep Behavior Disorder

Those affected by REM sleep behavior disorder perform their dreams while remaining asleep.

During the rapid eye movement (REM) stage of the sleep cycle, the body experiences temporary paralysis of most of its muscles while the brain is dreaming. For those with REM sleep behavior disorder, this paralysis does not take place and instead, their body and voice perform their dreams while they remain asleep.

Less than one percent of people are estimated to have this rare condition. REM sleep behavior disorder is more common in men and adults over age 50. It’s also associated with neurodegenerative disorders, such as Parkinson’s disease, Lewy Body dementia, and multiple system atrophy.

What is REM Sleep Behavior Disorder?

REM sleep behavior disorder is a condition in which paralysis does not occur during the REM sleep stage and a person’s body and voice perform their dreams while they sleep.

The symptoms, which generally worse over time, can include:

• Minor movements of the limbs
• Larger body movements such as punching, sitting up, kicking, flailing, or getting out of bed
• Talking, yelling, or screaming in your sleep

The condition typically requires treatment, as it can increase the risk of injury to oneself or others.

Oftentimes, people aren’t aware of their symptoms until they are informed by their bed partner or roommate. Episodes can occur once or multiple times per night. REM sleep typically begins 90 minutes after falling asleep, so episodes often occur in the second half of the night. People experiencing an episode of REM sleep behavior disorder can typically be easily awakened, are alert and coherent once awake, and often recall the content of their dream.

Diagnosis and Treatment

Individuals with REM sleep behavior disorder can put themselves, and anyone they share a bed with, at risk due to the unpredictable nature of their movements during the night. Up to 90 percent of spouses of those with REM sleep behavior disorder report having sleep issues and over 60 percent have experienced a physical injury. Because of this, early diagnosis and treatment are very important.

The Academy of Sleep Medicine’s International Classification of Sleep Disorders defines four criteria for diagnosis of REM Sleep behavior Disorder:

• You have repeatedly experienced episodes of acting out your dreams with vocalizations or arm and leg movements that correspond to what’s taking place in your dream.
• Episodes occur during REM sleep, as confirmed by an in-laboratory polysomnogram (in-lab sleep study) or your clinical history.
• Episodes include sleep without atonia (temporary paralysis of one’s arms and legs), as confirmed by polysomnography.
• The episodes are not attributed to something else, like another sleep or mental health disorder, a side effect of medication, or substance abuse.

Treatment of REM sleep behavior disorder must be tailored to the individual. In some cases, medications like melatonin or clonazepam will be prescribed for the treatment of this disorder. A sleep physician should be consulted to determine what medication to take and dosage. Another common path of treatment is lifestyle changes and injury prevention techniques. This could range from determining and avoiding triggers that contribute to the disorder to taking steps to establish a safe sleep environment.

Some recommendations for injury prevention may include:

• Removing sharp objects and weapons from the bedroom
• Placing padding on the floor around the bed
• Installing padded bed rails on the side of the bed
• Putting the mattress on the floor
• Moving furniture and clutter away from the bed
• Padding the corners of furniture in the bedroom
• Protecting bedroom windows

The first step on the path to safe and restful sleep is to schedule an appointment with your doctor or sleep specialist who will take a comprehensive and individualized approach to treating your sleep disorder head-on. REM sleep behavior disorder doesn’t have to disrupt your life.

Schedule your first appointment today by clicking here.