Introduction:
In REM sleep, one tends to have vivid dreams. Several REM cycles occur while sleeping at night. The first REM cycle commences about 90 minutes after one falls asleep and lasts for about 10 minutes. The consequent REM cycles last longer and longer. REM sleep behavior disorder is a type of sleep disorder known as parasomnia (disruptive sleep-related disorders). In this sleep disorder, strange or dangerous events occur that can disrupt one’s sleep. Though this condition can occur at any age, men above the age of 50 are commonly affected.
What Are the Types of REM Sleep Behavior Disorders (RBD)?
The following are the two types of REM sleep behavior disorders:
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Isolated or Idiopathic RBD: This type of RBD occurs when the condition manifests spontaneously without any underlying reason or cause. A majority of individuals with idiopathic RBD will develop a neurodegenerative condition, particularly Lewy body dementia (a type of dementia that occurs when clumps of proteins named Lewy bodies accumulate in the brain), Parkinson’s disease (a central nervous system disorder that affects one’s movements leading to tremors), or multiple system atrophy (a rare nervous system condition that causes progressive damage to the brain’s nerve cells). These conditions are referred to as alpha-synucleinopathies.
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Symptomatic or Secondary RBD: This condition manifests as a result of an underlying cause, such as Type 1 narcolepsy (a long-term sleep disorder that results in overwhelming daytime drowsiness). If an individual has both an RBD and alpha-synucleinopathy, it is regarded as a secondary RBD.
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Drug-Induced RBD: Individuals who consume certain kinds of antidepressants may develop drug-induced RBD.
RBD can result in the accidental injury of an individual or their partner. There can be an elevated risk of violent movement if one experiences a frightening or aggressive dream. Hence, it is important to seek medical help. Upon waking up, a person can recollect their dream but may not be aware of the movement that they were engaged in. An episode can manifest with each cycle of REM, which sums to about four per night. They can manifest either once a week or once a month in rare cases. The episodes usually manifest during the morning hours when REM sleep occurs frequently.
What Are the Reasons for REM Sleep Behavior Disorder?
While sleeping, the body passes through both REM and non-REM stages of sleep. REM sleep is linked with dreams and constitutes an important component of the sleep cycle. Its duration lasts from 90 minutes to two hours every night. During the REM phase of sleep, the muscles of the body tend to be in a temporarily paralyzed state while the brain is actively dreaming. At times, the chemical that is responsible for keeping the body still and the brain to remain active does not function as it needs to. Consequently, one can develop disorders like narcolepsy, RBD, or sleepwalking.
In RBD, the muscles are not in a temporarily paralyzed state as they ought to be, which facilitates the body to respond to dreams. One can initially respond through small actions like twitching or talking and make a transition to larger movements like kicking or jumping. These actions can harm an individual or their bed partner.
Who Is Prone to Develop REM Sleep Behavior Disorder?
REM sleep behavior disorder, or RBD, usually affects individuals over the age of 50. Though rare, children and young adults may also be affected. The average age of onset of this condition is 61 years. This disorder has a male predilection.
About 97 percent of individuals with isolated sleep RBD may have neurodegenerative disorders like Lewy body dementia, Parkinson’s disease, or multiple system atrophy. About 36 percent of individuals with Type 1 narcolepsy may have secondary RBD, and about six percent of individuals on antidepressants may experience drug-induced RBD.
What Are the Symptoms of REM Sleep Behavior Disorder?
The following are the symptoms of REM sleep behavior disorder:
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Shouting.
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Talking.
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Screaming.
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Kicking or punching.
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Sleepwalking.
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Cursing.
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Can recall the dreams clearly upon waking.
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Lashing out physically.
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Jump or fall out of bed.
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Arm flailing.
Many individuals may come to know that they have RBD only if their roommate or bed partner complains about their behavior.
How Can REM Sleep Behavior Disorder Be Diagnosed?
It is necessary to consult a physician if one has symptoms of REM sleep behavior disorder. The physician will carry out a physical and neurological examination and enquire the individual and their housemates or bed partner about their sleeping behavior. Based on these examinations, one might be referred to a sleep specialist. REM sleep behavior disorder is diagnosed using an in-lab video sleep study or polysomnogram (PSG). Sleep studies are tests that make a record of specific functions in the body during sleep like the:
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Heart rate.
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Brain wave activity.
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Airflow and breathing rate.
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Muscle movements of the chin and upper extremities.
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Eye movements.
According to the International Classification of Sleep Disorders, RBD diagnosis involves all of the following:
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One experiences repeated episodes of sleep-related vocalization or movements involving complex behaviors.
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The sleep study indicates that one experiences REM sleep without muscle paralysis (atonia).
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The behaviors of the individual are documented by polysomnography (sleep study) and manifest during REM sleep or can be assumed to manifest during REM sleep in accordance with one’s clinical history.
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One does not have seizure-related occurrences during REM sleep.
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Sleep disturbances are not a result of other sleep disorders, mental health conditions, or medical issues. Also, the behaviors are not due to any side effects of any medication or substance use disorder.
What Are the Ways to Treat REM Sleep Behavior Disorder?
The management of RBD involves taking the prescribed medications and making some lifestyle changes. The following are a few treatment ways to treat RBD:
Medications: Depending on the symptoms, numerous medications have proven to be effective in cases of REM sleep behavior disorder. A medication called Clonazepam which belongs to the benzodiazepine class of drugs when taken in low doses, has been found to be effective in about 90 percent of individuals with RBD. These drugs suppress the activity of muscles and keep the body relaxed during sleep.
In case Clonazepam is ineffective, melatonin or certain antidepressants may aid in controlling violent behavior during sleep. These drugs should be taken by strictly adhering to the physician’s instructions.
Lifestyle Changes: The following strategies can be adopted by an individual with REM sleep behavior disorder to keep themselves and their partner safe:
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Padded bed rails can be installed.
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Bed partners or roommates should sleep in a separate bed or room until the symptoms of RBD are under control.
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The bed should be moved far away from the window.
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A mattress can be used on the floor, cushions can be placed around the bed, or a bed can be placed against the wall.
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An individual with RBD who wakes up at night should preferably sleep on the ground floor if possible.
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Sharp objects, furniture, and other dangerous objects should be kept away from the bed.
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A standard bedtime should be maintained.
Can REM Sleep Behavior Disorder Be Prevented?
REM sleep behavior disorder cannot be prevented since the condition is linked with certain risk factors that cannot be changed or prevented, such as one’s age or having a neurodegenerative condition or narcolepsy. If the disorder is worsened by substances like alcohol, refraining from using these substances can help one get rid of RBD.
Conclusion:
REM sleep behavior disorder is a disorder in which the muscle movements during REM sleep are not fully turned off, due to which an individual tends to act out their dreams. This can result in violent and strange actions like shouting or punching. The individual can even jump out of bed and walk around while staying asleep. This can cause harm to oneself as well as others. Treatment involves medications and lifestyle changes to minimize the risk of injury while sleeping. Based on the nature of underlying conditions, the symptoms are manageable. One must not hesitate to consult a physician if they experience symptoms of REM sleep behavior disorder.
