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.