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REM Sleep Behavior Disorder – Causes, Diagnosis, and Treatment

Here is everything that you should know about one of the biggest sleep-related problems. REM sleep behavior disorder can happen at any age. Read on to learn more about this disorder.

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Rapid eye movement (REM) sleep behavior disorder is a serious sleep disorder in which you may go through vivid and unpleasant dreams.

Not that these dreams are extremely vivid, but they also come with strong sounds and strong and violent leg and arm movements during REM sleep. This behavior is sometimes called dream-enacting behavior.

During REM sleep, you don’t move because this sleep phase occurs many times during the night. Did you know that around 20% of your sleep you actually spend in the REM sleep phase?

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This stage is also responsible for dreaming and occurs primarily during the second half of the night.

REM sleep behavior disorder can often be linked with many neurological conditions, such as Lewy body dementia (also called dementia with Lewy bodies), Parkinson’s disease, or multiple system atrophy.

REM Sleep Behavior Disorder

For most people, dreaming is a mental activity, where dreams occur in mind, while the body is busy resting. However, this isn’t the case with people who suffer from REM sleep behavior disorder (RBD) as they act out their dreams.

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People with this disorder tend to be active while sleeping as they would move their limbs, get up, and even engage in activities such as walking.

Some people may even experience sleep talking, screaming, shouting, punching, or hitting. Some may even jump from the bed while sleeping.

This condition is usually noticed when it causes danger to the sleeping person, their bed partner, or others they encounter.

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In some cases, some sleepers may even hurt themselves. The good news is that RBD can usually be treated successfully.

REM Sleep Behavior Disorder Symptoms

With REM sleep behavior disorder, you physically act out your dreams. These dreams may be extremely vivid, and acting them out physically can happen once during asleep, or a couple of times. REM sleep behavior worsens with time.

Here are the most common symptoms of this sleep disorder:

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  • Strong movement while sleeping, such as kicking, punching, jumping from bed
  • You may act as defending yourself while sleeping
  • Stong noises are present, including laughing and shouting
  • Some people may experience emotional outcries or even cursing
  • Being able to recall the dream if someone wakes you during the episode

People with RBD often move their arms and legs while others can talk in their sleep, or even start sleepwalking, as mentioned earlier. This all may vary from person to person.

Injuries are common because sometimes dreams can be violent, and a person will try to fight, which, as a result, can cause injury to the sleeper and bed partner.

REM Sleep Behavior Disorder Causes

People still have a lot to learn about sleep. Various studies are conducted every way so that scientists can understand the sleeping pattern and sleep-related behaviors.

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Interestingly, studies of animals may explain REM sleep behavior disorder. Animals who have suffered lesions in the brain stem have exhibited symptoms similar to RBD.

Cats who have lesions demonstrated similar motor activity to humans while sleeping: they will hiss, arch their backs, and bare their teeth for no reason as if they are preparing to fight.

In the meantime, their brain waves register normal REM sleep. The human body is rich in various nerves that are responsible for specific actions.

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Thanks to various studies, scientists manage to list certain risk factors that can lead to REM sleep behavior disorder.

Here are the most common risk factors for REM sleep behavior disorder:

  • Being male and over 50 years old. This is not yet a general rule because more and more women are being diagnosed with this disorder. Young adults and children can develop this disorder as well, and it can be followed with narcolepsy, antidepressant use, and even with brain tumors in some cases.
  • Having a certain type of neurodegenerative disorder. This includes multiple system atrophy, dementia, stroke, or Parkinson’s disease.
  • Having narcolepsy. It turns out that people who suffer from narcolepsy are more prone to REM sleep behavior disorder. Narcolepsy is characterized by overwhelming daytime drowsiness.
  • Taking certain medications. New medicine can affect our bodies in unusual ways, especially if they are newer antidepressants. Also, the usage of drugs and alcohol can lead to sleep disturbance and severe disorders.

Recent evidence suggested that there may also is some specific environmental or even personal risk factors that can lead to REM sleep behavior disorder. Some of them are:

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  • Pesticide exposure
  • Farming
  • Smoking
  • Head injury

Complications of REM Sleep Behavior Disorder

REM sleep behavior disorder may lead to certain complications, such as:

  • Stress to a body
  • Distress to people sharing living space with a sleeper
  • Relationship issues to vivid sleeping
  • Social isolation for fear that others may learn about sleep disruption
  • Possible injury

Diagnosis of REM Sleep Behavior Disorder

A number of parasomnias may be easily confused with RBD, so it is necessary to conduct formal sleep studies.

Sleep studies are performed at sleep centers that are experienced in evaluating parasomnias in order to establish a diagnosis.

A single night of monitoring of sleep, brain, and muscle activity should easily reveal the lack of muscle paralysis during REM sleep, which will easily eliminate other causes of parasomnias.

When trying to diagnose REM sleep behavior disorder, the neurological exam is common. However, since some symptoms of other disorders may be the underlying cause of RBD, other tests should be considered as well.

1. Polysomnography

Polysomnographic video is one of the most important steps when it comes to diagnostic testing.

This test is conducted in a sleep study center. The person is required to sleep at the center. During that time, the following parameters are monitored:

  • The electrical activity of the brain (electroencephalogram, or EEG)
  • The electrical activity of the heart (electrocardiogram, or ECG)
  • Movements of the muscles (electromyogram)
  • Eye movements (electrooculogram)
  • Respiratory movements

These parameters are measured as a person goes through different sleep stages.

2. Imaging Studies

CT scan and MRI of the brain can be done if some abnormality is detected during the neurological exam. Imaging studies are also recommended for younger patients younger than age 40 when there is no known precipitant cause such as alcohol or medication use.

3. Talking With Your Sleeping Partner

Sometimes the doctor may ask about your sleeping schedule, sleeping habits, and how your sleeping partner sleeps next to you.

Your doctor may even talk to your sleeping partner directly and ask about your behavior while sleeping.

Your doctor will want to know from your sleeping partner how you act out while sleeping and how it looks. There may be a questionnaire to be filled in.

Treatment of REM Sleep Behavior Disorder

RBD tends to respond to treatment with medications. Many doctors prescribe Clonazepam, although this may vary from person to person. Overall, treatment for REM usually includes physical safeguards and medications.

Physical Safeguards

Your doctor will always recommend you to think about your sleeping habits and style.

Therefore, you may expect to hear advice on making changes in your sleep environment to make it safer for you and your partner. These changes may include:

  • Padding the floor near the bed
  • Removing dangerous objects from the bedroom
  • Placing barriers on the side of the bed
  • Moving furniture away from your bed
  • De-cluttering your sleeping area
  • Protecting bedroom windows

If your acting out is too vivid, the doctor may suggest sleeping in a separate bed or room from your bed partner until the condition is under control.


As mentioned above, Clonazepam is a frequent solution. This medicine is often used to treat anxiety.

In some cases, this medicine may cause side effects such as daytime sleepiness, decreased balance, and worsening of sleep apnea.

Another medicine, or rather supplement, often prescribed is melatonin, which may help reduce or even eliminate REM sleep behavior disorder.

You can also think about incorporating these tips into your sleeping routine:

  • Move the bed away from the window
  • Maintain a normal sleeping routine
  • Maintain recommended sleep time based on your age
  • Avoid screening before you go to bed
  • Avoid certain medications and nightcap before bed
  • Have regular check-ups

The Bottom Line

If not treated, RBD is a disorder that can get worse over time. This condition can put you and your partner in real danger.

RBD can often be linked to other medical problems, which is why it’s important to speak with your doctor and have regular checkups, especially if you feel as if something is wrong.

Use only medications that your doctor prescribes you and never search for any solutions that aren’t backed up by science.

Also, think about your sleeping routine. Do you have a routine? People are fast to say that they don’t have any routine, and that’s because they don’t see scrolling phone for hours is also a routine. It may not be the best one, but it’s still a routine.

So, if you recognize your habits think about how your body benefits from them. Do you spend hours before bed lighting weight? If yes, you shouldn’t know that not even that is a good routine.

Anything that’s intense before bedtime can seriously affect your health. Implement better-sleeping habits into your life today, so you can sleep better. Start small and build up from there.

Replace coffee with tea and keep your bedroom devices-free and try to wake up at the same time every day.

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