REM Sleep Behavior Disorder
The paralysis that normally occurs during rapid eye movement (REM) sleep
is incomplete or absent in patients with REM Sleep Behavior Disorder (RBD),
allowing the person to "act out" his or her dreams and make
abnormal vocal sounds while sleeping. RBD is characterized by the acting
out of dreams that are vivid, intense, and violent. Dream-enacting behaviors
include sleep talking, yelling, punching, kicking, sitting, jumping from
bed, arm flailing, and grabbing.
During sleep, the patient appears to act out the content of whatever she
or he is dreaming. Normally, the body loses muscle tone during dream (REM)
sleep, preventing most of us from physically reacting to our dreams. For
reasons that are not yet understood, some patients do not lose muscle
power during dream sleep, and thus begin to move about as their dream
content dictates. The danger to the patient and bed partner is that these
movements can cause injury.
Causes, Diagnoses and Treatment Options for REM Sleep Behavior Disorder
The cause of REM sleep behavior disorder is generally unknown, but it may
be associated with other neurological conditions such as
Parkinson's disease, multiple system atrophy, or Lewy body dementia.
To properly diagnose REM sleep behavior disorder, a physical and neurological
examination is done to evaluate the patient. If deemed necessary, an overnight
sleep study in a
qualified sleep disorders center is then conducted to confirm the disorder. A sleep study is a painless
test in which sensors are applied to the patient's skin to assess
eye movements, brain wave activity, oxygen levels, breathing, muscle activity
and heart rate during sleep. The
Hoag Sleep Health Program at Hoag has been studying and treating more than 5,000 sleep disorder
patients annually for the past 20 years.
If a RBD is present, medications can be used to suppress dream (REM) sleep,
which generally also suppress the physical activity. Physical safeguards
in the sleep environment may also be recommended to ensure the patient's safety.