What is REM Sleep Behavior Disorder (RBD)?
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- Опубликовано: 9 фев 2025
- @andyberkowskimd of ReLACS Health explains the sleep condition called REM sleep behavior disorder (RBD) including what is observed, how it is diagnosed and treated, and the potential causes.
There are generally two distinct types of sleep, one called rapid eye movement (REM) sleep and non-REM sleep. REM sleep is an important stage of sleep in which most dreams occur, with the other hallmark feature being rapid movements of the eyes seen on a sleep study. However, the body's muscles are nearly paralyzed during this stage of sleep so that one does not act out dreams. In RBD, there a problem with the switch in the brain to shut off the muscle movement, and one can become un-paralyzed and begin acting out dreams.
REM sleep behavior disorder is one of the more common parasomnias, or behaviors that occur while one is asleep. Parasomnias can include common sleep-talking or mumbling and sleepwalking. RBD also may show up as vocalizations like sleep talking, but to a much greater extent, even to the point that the person appears to be carrying out a conversation. Very purposeful movements mimicking real life actions like punching or kicking, and more complex patterns such as moving the legs like a bicycle can occur, likely mirroring what is going on in the dream. Unlike in other parasomnias, a person with RBD is completely asleep during these activities, and it could potentially lead to injury of a spouse or bedpartner, or to oneself from flinging a limb into the wall or falling out of bed. Those with RBD may rarely stand up but almost never sleepwalk. The dream enactment occurs more toward the end of the night when REM sleep is more likely to take place.
The diagnosis is made through an assessment of symptoms by a sleep clinician, followed by an overnight sleep study (polysomnogram/PSG) that either captures the dream enactment on video or, more commonly, shows an abnormal degree of muscle activity in the muscle sensors during REM sleep, when the muscles should not be moving at all.
The condition is often associated with conditions like Parkinson disease or similar neurological disorders, and can precede the development of the other symptoms of the condition by many years. However, there are other causes of RBD that can including medications such as SSRIs (antidepressants), though a very rare side effect, and other conditions like narcolepsy type 1 (narcolepsy with cataplexy). Often RBD can occur in middle-aged adults for no apparent reason as well.
Treatment primarily involves safety precautions in the bedroom, including mitigating injury to the spouse or the individual themself (e.g. lowering the bed, padding the ground, moving the nightstand away from the bed, sleeping in a separate bed from the bedpartner, etc.). High-dose melatonin is often used first if behaviors are disruptive enough to warrant medications, followed by stronger prescription drugs like clonazepam (Klonopin®) or other sedatives.
To learn about the use of melatonin in the treatment of RBD:
• Melatonin is the Best ...
To learn about the use of clonazepam in the treatment of RBD:
• Clonazepam: The Double...
Over time, the condition may worsen, though sometimes it reaches a peak and then improves over months or years. Some of the RBD that is caused by a medication can resolve completely if the offending drug is eliminated.
To read more in depth about sleep and sleep conditions, read A ReLACSing blog:
www.relacsheal...
These videos are for general medical information, but for those who live in or near Arizona, Michigan, Ohio, or Florida, you can hire @andyberkowskimd of ReLACS Health for consultation regarding your own personal sleep health including dream enactment, sleepwalking, or other parasomnias of concern that require a little more time and attention. Go to www.relacsheal... for more information.
I’ve been having these REM dreams EVERY night since 2018. They are always frustrating dreams. I wake up with hissing in my ears, mild headache in back of my head, tremling in arms, and pain in my lower legs. Going to get a sleep study. And I can remember these dreams clearly when I wake up. I can also remember dreams from 2018 till last night. Going to get a sleep study!!
Hey, doc, I'm flailing an arm or turning over many times an hour. My dad has Parkinson and mom dementia. 54 year old male
it happens too me quite alot i talk fight cry trash about in my sleep i actually punched myself in face twice last night ,woke up with a bust lip, i put it down to my meds i'm prescribed diazepam for anxiety and mirtazipine for sleep issues and depression.
Hi, I’ve been thinking I have this for some time now. Currently on waiting list for sleep study. My mother had Huntington’s Disease. I really hope this is not what I have as if so it could hint that I will go on to develop Huntington’s Disease myself. I have been thinking this for a while now. Hopefully I hear about the sleep study soon!
Experiencing a traumatic event like a lose of three parents, one by suicide, and a very difficult divorce, could these increase your chance of RBD? If so, are cases like this more likely to return to normal baseline or is it more likely for the RBD to stay with the patient even through several years of treatment?
Happened to me recently it mostly involves me kicking my legs up I was dreaming that there was a cockroach on my ceiling right above me and fell on my blanket and I kicked off the blanket leading me to kick up my legs it woke me up. I also had 1 incident where I was I bed and I was dreaming there was an animal about to fall or jump on my bed and when it did it felt very realistic leading me to jump off my bed completely it is so strange I'm almost 33 even though they say it happens mostly to elderly men
Thanks for sharing. Sleep clinicians are often responsible for distinguishing between causes of weird behaviors that occur while an individual is sleeping. REM sleep behavior disorder, confusional arousals, and trauma-related sleep disorder are three of the most common. Sometimes they will order an overnight sleep study that may help to investigate or distinguish from a variety of causes.
@@andyberkowskimdi do the same thing does this mean ill have Parkisons disease?
I Talk and fight in my sleep plus I dream something different from the talking and fighting. Not seeming to be a nightmare or terror. What can I do?
Can certain medications cause this? My husband takes meds for afib and has started doing violent things in his sleep. He’s very physically fit & strong, and I woke up with his big fist pushing into my face. Very scary! Before that, he had jumped out of bed a couple of times, and has yelled out many times. Only started after taking those heart meds. He’ll discuss this with his Dr. next visit, but just wondering if anyone else has experienced this after starting new meds.
Was and wasn't flying?
Is there any truth to caffeine being linked with the bodies self paralyzing defense mechanism, partially not relaxing, pre-rem rest?
This happened to me just once but it was painful, I was in Thailand at the time, I dreamt I woke up and there was a cobra at the foot of the bed coiled and with it's head back ready to strike, I threw the sheet over it jumped out of bed and ran for the door, in the dream the doorway with open door was a few feet away from the doorway in reality so I actually ran headfirst into the wall.
Sometimes RBD has to be distinguished from another type of sleep behavior call confusional arousal in which one partial wakes up from sleep and does something. A thorough discussion with a sleep specialist and sometimes a sleep study are used to distinguish. RBD is with the person fully sleeping and in dream sleep (REM) rather than partially awakening like non-REM parasomnias.
@@andyberkowskimdThanks for mentioning confusional arousal. I thought I had REM sleep disorder but it only happens maybe once a year if that. My symptoms are something bothers me in my sleep, something brushes against me and I react to what was in my dream but I'm awake and don't know it. When my wife says someone to me I mention whatever it was that was bothering me in my dream. Like a snake for example. Obviously there aren't snakes in my bed but my brain has not caught up.
Can you please tell me if Trazadone could cause RBD? Waiting on a sleep study for my veteran husband with a confirmed TBI, but also suspected CTE. He’s been on trazadone for 10 years for sleep, and the movement in his sleep has only started in the past year. I would think if it was trazadone, it would have caused it before now.
This is a complex question. RBD can be associated with neurodegenerative conditions like Parkinson Disease. There can be cases of "secondary" RBD that can be triggered by antidepressants and resolve when someone goes off the drug causing it. However, in those with trauma or brain injuries, including veterans there is a trauma-associated sleep disorder that is increasingly recognized that has many similarities to RBD but probably a distinct condition. Here is one article on the topic:
jcsm.aasm.org/doi/10.5664/jcsm.7642#:~:text=Trauma%2Dassociated%20sleep%20disorder%20(TASD,%2Denactment%20behavior%20(DEB).