What to Look Out For in REM Sleep Behavior Disorder
Everything sleep technologists should know about REM sleep behavior disorder
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by loss of the usual muscle atonia that occurs during REM sleep, allowing patients to act out their dreams. They physically move their limbs or even engage in activities associated with waking such as talking, shouting, screaming, hitting or punching. REM sleep behavior disorder is usually taken seriously when it causes danger to the patient, the patient's bed partner or others they encounter.
What we call "sleep" involves transitions between three different states: wakefulness, rapid eye movement (REM) sleep, which is associated with dreaming, and non rapid eye movement (NREM) sleep. There are a variety of characteristics that define each state, but to understand RBD it is important to know that it occurs during REM sleep. During this state, the electrical activity of the brain, as recorded by an electroencephalogram, looks similar to the electrical activity that occurs during waking. Although neurons in the brain during REM sleep are functioning much as they do during waking, REM sleep is also characterized by temporary muscle paralysis.
In some sleep disorders such as narcolepsy and parasomnias, like REM sleep behavior disorder, the distinctions between these different states breaks down; characteristics of one state carry over or "invade" the others. Sleep researchers believe that neurological "barriers" that separate the states don't function properly, though the cause of such occurrences is not entirely understood.
Thus, for most people, even when they are having vivid dreams in which they imagine they are active, their bodies are still. But, persons with RBD lack this muscle paralysis, which permits them to act out dramatic and/or violent dreams during the REM stage of sleep. Sometimes they begin by talking, twitching and jerking during dreaming; this may occur for years before they fully act out their REM dreams.
In the course of "acting out their dreams," people with RBD move their arms and legs in bed or talk in their sleep, or they might start sleepwalking without waking or realizing they're dreaming. The only sensations the sleeper experiences are what is occurring in their dream. And many of these dreams can be violent or frightening, causing injury to the sleeper and his bed partner.
What are the risk factors associated with REM sleep behavior disorder?
RBD most often occurs in men. It can appear at any age but it most often emerges in men who are over 50 years old. It is uncommon in women and children. but appears more often in the elderly. RBD is also seen more often in people with some neurologic disorders.
People found to have RBD may develop Parkinson’s disease many years later. Those diagnosed with RBD should watch for symptoms of Parkinson’s such as tremor. People with RBD are at higher risk for other sleep disorders like narcolepsy, periodic limb movement disorder and sleep apnea.
What is the treatment for REM behavior disorder?
The AASM released a Best Practice Guide for the Treatment of REM Sleep Behavior Disorder (RBD) which describes in-depth some of the latest and safest treatment methods that are recommended by sleep physicians that technologists in the field should be aware of.
To learn more about the treatment options and process for patients with REM behavior disorder check out our CEC eligible Case of The Month on REM Sleep Behavior Disorder here.