Do you or your partner sometimes act out your dreams in your sleep? Do you sometimes accidentally hurt yourself or others by punching, kicking or lashing out?
Perhaps you show more complex behavior such as jumping out of bed or running across the room. And to add to the spectacle you might even shout, scream or sleep talk.
If so, it could be a sleep disorder known as REM sleep behavior disorder, also abbreviated to RBD. In this article I’ll be looking at what it is, what it might mean for you as well as strategies to treat it and limit the risk.
Hopefully you’ll gain a clearer understanding and be able to help either yourself or someone you know deal with it.
What is REM sleep behavior disorder?
RBD belongs to the category of sleep disorders known as parasomnias. To understand what it is exactly, it’s useful to first take a look at the stages of sleep.
During the night you cycle through different sleep stages, one of which is called the rapid eye movement stage, or REM stage for short.
It’s a stage which usually occurs during the second half of the night. You spend around 20% of the night in the REM stage, transitioning through the different stages during the night.
You usually dream during this stage, and your body becomes paralyzed to prevent you from injury by moving whilst asleep.
But sometimes the paralysis doesn’t quite work as it should, which is the case with REM sleep behavior disorder.
So when you enter the REM stage during the night, there’s the risk that you’ll do things which reflect your dream. This is particularly the case if it’s very dramatic, full of action or violent.
Cause and symptoms
Each time you enter the REM stage of sleep, nerve pathways in your brain prevent your muscles from moving. This then creates paralysis for the duration of the stage. But these pathways don’t function properly in people with RBD, so they don’t become paralyzed.
The main symptoms are:
- Repeated episodes of dream enactment behavior. This could be movements like jerking, punching, kicking, flailing, jumping out of bed or other potentially dangerous actions. Often the person begins with jerking or twitching, followed by more aggressive or dramatic movement.
- Making noises, usually reflecting a frightening dream such as loud shouting, screaming or swearing.
- If woken during the episode you should be able to remember the dream content and not be confused. The dream often involves frightening scenarios such as being chased or attacked. You may remember the dream in detail for a long time afterwards.
It’s often tempting to diagnose yourself with sleep disorders. Sometimes it feels clear that what you experience is exactly the same as a medical definition.
RBD can easily be confused with other sleep disorders though, and some symptoms can also be caused by other conditions. So a doctor or sleep specialist needs to rule out other possible causes for the behavior, such as:
- Twitching due to hypnic jerks
- Restless legs syndrome
- Sleep walking
- Night terrors
- Post traumatic stress disorder
- Obstructive sleep apnea
- Medication, drugs or alcohol
- Confusional arousals
- Psychological issues such as panic attacks
- Nocturnal seizures
A doctor would take a careful history to both rule those out and check if you exhibit the symptoms of RBD.
And because the diagnosis needs to be based on evidence of muscle atonia and for the behavior to occur during REM sleep, it’s recommended that you’re assessed at a sleep center.
A sleep study is also very important if the dream enacting behavior is causing injury, or could cause it.
For more technical information about the way a polysomnogram sleep study is important in diagnosing RBD, have a look at this research article by Boeve in 2010. The article also provides detailed theories about the brain activity responsible for the lack of paralysis.
Understandably, not everybody has access to a sleep center which can make diagnosis difficult to achieve. But if you do have access to healthcare, then it’s important if your doctor suspects you may have RBD.
Finally, remember that most people sometimes do some strange things in their sleep from time to time. Before rushing to any conclusions that you have RBD, it’s important to remember that it needs to happen on a regular basis.
Fortunately there is treatment for RBD which is known to be effective. The most commonly prescribed medication is Clonazepam. Melatonin has also been found to help reduce symptoms. Your doctor may try other medication if they aren’t effective.
As well as taking medication there are practical steps you can take to reduce the risk of injury:
- Make sure there are no sharp objects near the bed.
- Make sure there are no sharp surfaces or breakable objects near the bed.
- Making sure any windows or mirrors are either protected or far from the bed.
- Put a padded surface or mattress on the floor next to the bed.
- Use raised sides on the bed.
- Some people decide to sleep in a sleeping bag or wear padding around their hands.
- If necessary you and your partner can sleep in separate beds. Only sharing a bed when you want to be intimate.
In addition to this, you may find it useful to do the following to help reduce the episodes:
- Try to keep a stable sleep pattern.
- Don’t allow yourself to become overly tired.
- Avoid alcohol or recreational drugs.
- Treat any other sleep disorders you may have.
Coping with other people
You may feel embarrassed with a new partner or if sharing a room or house with friends or family. You can talk to your doctor about this who may arrange for counseling. They can help you find strategies to deal with both the symptoms and how they affect you.
In many ways one of the best courses of action is to be honest about the sleep disorder. Explain it to people who may inevitably see or hear you acting in a way they find unusual. And if necessary work with them to find ways to reduce the risk of injury or annoyance.
Association with neurodegenerative disorders
Research has shown (Shecnck et al in 1998 and the mayoclinic in 2012) that there’s a possible association between RBD and certain neurodegenerative disorders. For example, mild cognitive impairment (MCI), parkinson’s and Lewy body disease.
Understandably, this information can cause concern. It’s important to note though that not everyone who has RBD will develop a disorder later in life. So please don’t panic if you’re reading this because you have or suspect you may have RBD.
The research shows that if RBD is associated with one of these disorders, it often occurs years or decades before they develop. So the key is that you discuss your concerns and symptoms early with your doctor.
If you are diagnosed with RBD, your doctor may decide to monitor you for signs of the disorders. If one does develop in later years, you can deal with it as early as possible.
Do you or someone in your household have REM sleep behavior disorder, or do you suspect that you might have? If so, what type of behavior do you exhibit? Have you undergone any treatment, or do you take any protective measures?
It’s always useful for other readers to share experiences. Sometimes a reader can provide excellent advice which benefits many others. And often just knowing that you’re not alone can be a reassurance. So please feel free to share your story in the comments below.