REM Sleep Behavior Disorder: Do You Act Out Your Dreams?

man jumping in a dream

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.

 

Diagnosis

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:

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.

 

Treatment

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.

 

Your views

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.

 

251 CommentsLeave a comment

  • My husband is very vocal in his dreams. Loud enough to wake me which is just as well as he lashes out at me. Hitting my face. Kicking my legs. Punched me one night when he thought he was fighting ghosts! These are regular occurrences, every 3rd or 4th day at least. He is on a lot of medication. He’s getting concerned that he may seriously hurt me as he always seems to be in ‘fighting mode’.

  • Hi, I’m a 37 yr old female. I had night terrors as an infant, sleepwalking as a child and teenager, then the acting out began in my early twenties. It started off as me seeing things and taking pictures off the walls and progressed where I’d see people/animals/objects moving around in my bedroom and so I would flip out and react only to discover I was only dreaming. Most of the episodes involve me running across the room or standing over and attacking my husband. He’s gotten very good at defending himself. The episodes got to where it was happening several times a week and sometimes every night for days. I’ve finally gone to the doctor and I didn’t realize what I even had or that so many people have this disorder. I have several people in my family with forms of dementia and I am afraid of what will happen to me in the decades to come. I watched my grandmother forget her children and I could not face forgetting my own. I’m hoping to find a study or some information on the beginning signs of dementia associated with RBD.

  • Hi
    My husband acts out his dreams. We’ve been together 10 years and I’d say it happens roughly once every 1-2 months with something minor like messing with things on the bedside table and talking nonsense. There have however in our 10 years been maybe 7-10 more significant episodes. The most recent was most significant- he attacked me in his sleep. He has had 2 other similar but much more minor episodes- one in 2012 where he was dreaming of wrestling and wrestled me out of the bed and another about 2 years later where he grabbed me and hurt me. He is hard to wake from these episodes and is often briefly confused on waking up. He has a sleep study booked but naturally we’re both very worried about the being diagnosed with RBD and subsequent neuro degenerative disease. We’re both under 40. This article states episodes have to be frequent to be concerning. I’d say the significant episodes where there is large or potentially harmful movements are appropriately annually. What constitutes as frequent and does severity matter in this? Thanks

    • Hi Lou
      Thanks for your comment. I can understand your concern, and it’s great he’s going for a sleep study. Hopefully they will be able to identify something happening with his sleep, though there are no guarantees they will of course.
      I think you’re right to identify the issue of perhaps not being so frequent, but being more severe in terms of what he does during those rare episodes. That’s something to describe in full to the sleep specialist, as I’m sure they will take severity into account as much as frequency.
      Regards
      Ethan

  • My Uncle has been having these episodes where he is kicking, thrashing, & rolling all over violently, sometimes getting up & walking across the room but he yells & grunts in a very angry voice not making any sense or sometimes not even saying words. This has been happening for months & nobody has been able to figure out what’s wrong. Could this be what is going on?

    Sincerely,
    A very concerned niece

    • Hi Niki
      Thanks for your comment. From your brief description, it seems like it could be a possibility worth exploring with his doctor. But really, only a medical professional can properly provide an accurate diagnosis. I’d talk to him about the research you’ve done, and suggest he mentions it to his personal doctor.
      Regards
      Ethan

  • About 5 years ago, I started having RBD episodes that caused black eyes, bruises and overall discomfort (hit my nightstand/dresser). I was in the midst of retiring and moving my parents closer to me so I could help out. I did have sleep study that verified disorder and take 15mg melatonin each night (afraid of the colopram). After about 6 months, those episodes stopped until last night – I never remember dreams but found myself on the floor with head, nose, elbow and feet bruises. I took melatonin just a little later than normal but have done so in the past. Is it possible melatonin has stopped working or can I take more without it hurting me? Thank you for input!!

    • Hi Jan
      Thanks for your comment. I can’t advise you on taking more melatonin – that’s something to discuss with your doctor. If you’re worried about the potential to harm yourself again, it might be worth mentioning to them anyway considering your past history with it.
      Regards
      Ethan

  • my name should not be disclosed. i have twice a week bad dreams and most of the time i try to save myself and i start hitting the other person. please help. I have lot of stress in my life. i realized it happened when i ate late in the night.

    • Hi
      No problem, I deleted your name. It sounds like there are two things you can try doing, which you recognise yourself:
      1. Tackle stress in your life.
      2. Don’t eat heavy meals late at night.

      I would try eating a bigger lunch, and a lighter dinner – earlier in the evening. As for stress, I think it’s good to do relaxation exercises before or while in bed. But it’s also perhaps more useful to tackle it during the daytime in a more ongoing process. There are lots of stress reduction tactics you can try – my favorites are going for long walks, meditation and yoga.
      Regards
      Ethan

  • Tonight I googled “physically acting out dreams”, as it is happening to me a lot lately. Kicking things off the bedside table, jumping out of bed and landing on my already sore knees and scratching my fingers as I land. Swearing loudly, screaming at people to get out, punching the pillow, mumbling a lengthy dialogue all if which I remember when I wake up. They are nightmares and I am very angry while in them. A lot of them involve my father who was a disciplinarian figure in my life who even in death still seems to control my life. He always frightened me and it is not receding. I am on antidepressants and I always wake up very depressed and defeated.

    • Hi Robyn
      Thanks for your comment. Sorry to hear you’re experiencing these symptoms, it must be distressing. I think if it’s this frequent and affecting your sleep and daily life, it’s important to talk to your doctor about it. They might look at whether the meds could be a factor, and even if counseling might help you considering what you mentioned.
      Regards
      Ethan

  • The other night I believe I was sleep walking. I vaguely remember getting up and started to walk to what seems like out the room. I walked right into the edge of my bed with my foot. That knocked me to the ground on my hands and knees. I was in so much pain, I thought I broke my foot. My husband jumped out of bed because he heard the noise and got scared. I was so confused as to why I was up. It was 1:33 am!

    Luckily my foot wasnt broken, just a very bruised pinky toe and bruised around my foot.

    That whole night has me so confused. I do suffer from sleep paralysis here and there for the last 15 years.

    Has anything like this happened to anyone else?

    • Hi Nallely
      Thaks for your comment. I’ve actually done something similar several times. I usually put it down to having big feet, a bedframe that sticks out and having to walk around the corner of the bed to get to the door to go to the bathroom in the night. And when I wake up half asleep, walk too fast to the door in the dark, I bang my foot. It really hurts! I started putting padding around that bed leg to stop it…
      Regards
      Ethan

  • I keep having this same dream, I feel like I open my eyes and the person led next to me isn’t my boyfriend. I immediately jump out of bed and start shouting ‘is it you, is it you matthew’ its horrible I get so scared, my boyfriend wakes with a start and says yes its me come on get back in to bed, but it doesn’t sound like him so I start crying and keep saying is it you? it takes for him to turn the light on and I come around then and get back In to bed but I am so panicked and scared it takes ages to get back to sleep, same for my boyfriend, its horrible. why do I keep dreaming this?

    • Hi Nik
      Thanks for your comment. I can understand your distress. It almost sounds like it could be a confusional arousal. If it’s happening a lot and distressing you this much, I think it’s a good idea to speak to your doctor about it. Have a read of this article about confusional arousals too, as it might make some sense, and the tips there could be helpful.
      Regards
      Ethan

  • Last night I had a dream that I was trying to knock a large bug off my shoulder, and I tried to hit it. I then woke up and I hit my spouse and freaked her out. I’m 30 now and this has happened once before when I was around 21. Not frequent but still concerned. Why may this be happening?

    • Hi Steven
      Thanks for your comment. If it’s that uncommon, there’s probably nothing to worry about. It has to be much more frequent or severe for doctors to be concerned. Most people have occasional strange things happen in their sleep, and it’s quite normal. It’s only if it becomes regular and very distressing that you’d need to speak to someone about it.
      Ethan

  • For me these episodes started maybe a year ago. I’m 70 and never had trouble sleeping or acting out during sleep. At first, we joked about the dreams because they were funny…I was standing next to the bed yelling at my husband for kissing an old girlfriend. But last night I kicked him as I was dreaming that I was recovering his wallet from a thief.
    I appreciate your article and these comments so much. I will contact my doctor on Monday and try the melatonin spray tonight. Thank you SO much

    • Hi Kathy
      Thanks for your comment. I’m glad to hear the article and comments were useful for you. Let me know if your doctor has any helpful advice, as it’s always interesting to know how people manage this condition.
      Ethan

  • My husband has been diagnosed with sleep apnea. I do notice be stops breathing for bits in his sleep. He has a history of acting violently during Dream session and upon abruptly awakening. He acts out Dreams sometimes and has jumped out of the Bed head first into the dresser. Then dragged me out of the bed on my knees causing rug burns, a sinking shop Dream.Another time ran straight into the wall. Of course I don’t react well to these occurrences. I yell at him to stop and wake up. And he acts like I’m the bad guy. I don’t know what to do. He has had sleep study. I did notice that if a sound or I accidentally bump him he has an occurrence like these. Can a doctor do anything?

    • Hi Kathy
      Thanks for your comment. That sounds very stressful for both of you. Has he been prescribed treatment, like a CPAP machine? Hopefully treating the apnea will also help with other sleep disruption. If you’re worried about your safety in the meantime, I would consider sleeping in separate beds for a while if that’s a possibility. As for what a doctor can do, he would need to be diagnosed first before they treat it with medication.
      Regards
      Ethan

  • I just started sleep walking in my 30s and Im 33 now. I seem to be acting out my dreams from waking up to throwing eggs on the floor too taking dangerous medication. After waking up to taking the medication I had to spend 12 hours in the hospital. This sleep walking is effecting my heath and is very dangerous to me and my family.

    • Hi Alicia
      Thanks for your comment. Sorry to hear you had that worrying incident. I think you should speak to your doctor about this. And get a mini-safe you can lock away any medication in at night.
      Regards
      Ethan

  • When I was a child and running a temperature I always had the same nightmare and still do if I’m really poorly. In recent years I have had episodes where during sleep I have tried to throttle my partner, sitting upright and screaming, wetting myself during a bad dream and last night I scratched my partners face causing his face to bleed. I am 49 years old and recovering from leg surgery at the moment and was wondering if this latest episode could be connected to my recent surgery. I can vividly remember the dreams that have caused these episodes. Should I be worried or laugh it off?

    • Hi Jay
      Thanks for your comment. Personally, I wouldn’t laugh it off considering the episodes you describe. Perhaps when you’re more mobile again, it would be good to mention it to your doctor. It’s possible the injury and stress are affecting your sleep, so try to give yourself some TLC at night before going to bed and see if that helps.
      Regards
      Ethan

  • I have dreams which I act out, then wake immediately and remember the incident. It is usually things like talk/Mumble. My husband said it’s not loud neither is it a scream of fear. Today I had 3 episodes in my recliner and woke immediately. One I was folding something, second I was picking things from one place and placing them else where and third I was talking in a very low tone. I’m going to make a follow up with my neurologist to discuss. I will keep you all imformed.
    I’m recuperating from an anterior cervical fusion surgery. These episodes were happening before my surgery.

    • Hi Cindy
      Thanks for your comment. It doesn’t sound like it’s too severe in terms of what you do, so that’s a good thing. It will be interesting to see if your neurologist has any thoughts about it.
      All the best with the recovery.
      Regards
      Ethan

  • Hello, when I was younger I started to have a dream about a beautiful farm house but when I went inside the upstairs had a beautiful marble staircase and marbled floors big beautiful rooms. But it was haunted. I am still having the same dream only things are added on such as me and my husband buying it. Sometimes I will fall asleep and I will start to dream and it scares me and I wake up but on falling back to sleep my dream will start over where it left off. I reach up with my hands to fight off someone. I reach over and pinch my husbands elbow, I have punched him in the back. It is getting concerning since I have done these things since I was a child. I am 53 now. Any advise?

    • Hi Angie
      Thanks for your comment. If it’s a regular occurrence and it’s disturbing you and your husband’s sleep, I would talk to your doctor about it to see what they can recommend.
      Regards
      Ethan

  • Hi There, I have had wakeful dreams since teenage years (Im 36 now) but find I am having them almost every night now, even through heavy sleep tablets like Temazapam and Restavit. I wake what seems like constantly through the night in the same dream and actually see people and things in my house, I have been known to pull light bulbs out of lights and bump my head so hard that I have a scar left. I remember the dream some times but other times struggle to bring them into words, most details seem to disappear as I wake up. I have tried Psychologists and Hypnotherapy, medication.. and still nothing works. I am unsure what to do but at my wits end. I wake my husband nearly every night either trying to tell him about the people and show him where they are standing and what they want or screaming for him to help me. Its getting too much for he both of us. I wish someone could help me sleep.

  • My wife says I lash out in my sleep and it’s either the bedside cabinet, on the right, or her on the left that gets hit. I suffer from sleep apnea, for which I use a CPAP machine and I have a raised side on the bed.
    I have had a number of sleep studies where I take a CPAP recorder home to use over night, would these have shown up RBD? Should I confer with my GP?
    I have had Osteoarthritis in my lower spine, and elsewhere, for a number of years but recently popped a disc out, which I managed to reduce, but since then I wake up in pain and my back feels quite unstable.
    Any advice will be greatly welcomed.

    • Hi Ralph
      Thanks for your comment. I don’t think the CPAP recorder would show this sleep disorder. You should definitely speak to your GP about it, as they might want to send you for further tests.
      Regards
      Ethan

  • This happens to me once when I was about 7 or 8, I tried to jump out of a car doing 70 MPH, I managed to get the door open a little but my mother pulled me back. Just recently in the last 3 years it has happened 3 times. My wife has been at the receiving end of an elbow to the face (I was being held down in the dream), kicking out at her 3 times in a row (I was being chased and trying to defend myself) and a near miss to her head (again I was being held down). It does worry me. Except the jumping out of the car – the others are after drinking alcohol. It doesn’t happen every time though, after alcohol.

    • Hi Barry
      Thanks for your comment. Thank goodness for your mother’s quick reactions! If you know that alcohol is a trigger for you, that’s something to work with I think. Perhaps a particular type or quantity is more likely than others? If you stop drinking earlier in the evening and drink water before bed, does it still happen? And perhaps on the nights you do have a drink, you could sleep separately if you’re worried about your wife?

  • Really interesting article – The past few months I have started kicking out and punching in self-defence in my sleep…or thinking I am playing football and kicking the ball. The other night, I thought I was in goal and dived to make a save and cut my hand open on the corner of the bedside cabinet…I think it may be time to see the doc!

    • Hi Michael
      Thanks for your comment and compliment. Yes, if you’re injuring yourself or it’s disrupting your sleep and worrying you, it’s a good idea to talk to your doctor about it.
      Regards
      Ethan

  • According to my wife I’ve talked jibberish while asleep for years. Quite recently this has gone to hitting out unfortuntly the wife receives the punishment. I find this very distressing as I may seriously hurt her.

    • Hi Malcolm
      Thanks for your comment. In this situation, I think it’s a good idea to discuss it with your doctor. And in the meantime, perhaps sleep separately if you think the risk of hurting her is high.
      Regards
      Ethan

  • I have had these types of dreams off and on for many years; however in the past 2 weeks I have had 3 of them. In the first one, my sister had a snake and was jabbing it at me and I guess I was trying to get away from it because I ended up landing on the floor hard. Bruises on my arms and elbow. In the second one, this young kid was trying to kill me with a bow and arrow and I was running straight at him, jumped into the air and karate chopped his neck. Well I jumped out of bed ended up hitting the wall, fell back and hit my head on the bottom of my bed. That one really hurt. More bruises on my back and a knot on my head. Then just this morning, someone was chasing after me in my dream and I came to a dead end and my only choice was to jump off the ledge which I did. Woke up when I hit the floor on my arms and knees. My elbows are bruised and so are my knees. My husband freaks out because he wakes up to a “ loud thud” when this happens. I don’t understand why these are happening more frequently but I need to do something because my body cannot take the hard landings anymore.

    • Hi Me’Chelle
      Thanks for your comment. The first thought is to pad the floor around your bed, at least as an option to help prevent injury. I’d also try the self-help advice in the article, and consider talking to your doctor about what’s happening.
      Regards
      Ethan

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