Description

Rapid eye movement (REM) sleep behavior disorder is a sleep disorder in which you physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep — sometimes called dream-enacting behavior.

Normally don't move during REM sleep, a normal stage of sleep that occurs many times during the night. Approximately 20 percent of your sleep is spent in REM sleep, the usual time for dreaming, which occurs primarily during the second half of the night.

The onset of REM sleep behavior disorder is often gradual and may worsen with time.

REM sleep behavior disorder may be associated with other neurological conditions, such as dementia with Lewy bodies (also called dementia with Lewy bodies), Parkinson's disease or multiple system atrophy.

REM sleep behavior disorder care at Mayo Clinic

Symptoms

With REM sleep behavior disorder, instead of experiencing the normal temporary paralysis of the arms and legs (weakness) during the REM sleep, which physically act out their dreams.

The onset can be gradual or sudden, and the episodes can occur from time to time, or several times a night. The condition often becomes worse with time.

The symptoms of disorder of REM sleep behaviour may include:

  • The movement, such as kicking, punching, arm waving, or jump out of bed, in response to the action of filling, or violent dreams, such as being chased or to defend against an attack
  • Noise, such as talking, laughing, shouting, emotional voices, or even cursing
  • To be able to remember the dream if you wake up during the episode

When to see a doctor

If you have any of the above symptoms or have other sleep problems, talk with your doctor.

Causes

Neural pathways in the brain that prevent the muscles of movement was active during the REM or dreaming sleep, which results in temporary paralysis of your body. In REM sleep behavior disorder, these pathways do not work anymore and that they can physically act out their dreams.

Risk factors

Factors associated with the development of REM sleep behavior disorder include:

  • The fact of being male and over 50 years of age — however, more women are being diagnosed with the disorder, especially those under 50 years of age, and the young adults and children can develop the disorder, usually in association with narcolepsy, the use of antidepressants or brain tumors
  • The need for a certain type of neurodegenerative disorders, such as Parkinson's disease, multiple system atrophy, stroke, or dementia with Lewy bodies
  • Have narcolepsy, a chronic sleep disorder characterized by overwhelming daytime drowsiness
  • Taking certain medications, especially antidepressants, newer, or the use of or withdrawal from drugs or alcohol

Recent evidence suggests that they also may be one of several specific environmental or personal risk factors for REM sleep behavior disorder, including occupational exposure to pesticides, agriculture, tobacco, or a previous injury to the head.

Complications

The complications caused by the REM sleep behavior disorder may include:

  • The anguish of his sleeping partner, or other people living in your home
  • Social isolation for fear that others may become aware of the sleep disruption
  • Injury to you or your sleeping partner

Diagnosis

To diagnose the behavior disorder REM sleep, your doctor will review your medical history and your symptoms. Your evaluation may include:

  • Physical and neurological examination. The doctor performs a physical and neurological exam and evaluates you for REM sleep behavior disorder and other sleep disorders. REM sleep behavior disorder may have symptoms similar to those of other sleep disorders, or it may coexist with other sleep disorders such as obstructive sleep apnea or narcolepsy.
  • Talking with your sleeping partner. Your doctor may ask your sleep partner if he or she has ever seen seem to act their dreams while you sleep, such as perforation, waving their arms in the air, scream or yell. Your doctor may also ask your partner to fill in a questionnaire on sleep behaviors.
  • Nocturnal sleep study (polysomnography). Doctors may recommend an overnight study in a sleep laboratory. During this test, the sensors monitor your heart, lungs, and brain activity, breathing patterns, arm and leg movements, vocalizations, and blood oxygen levels during sleep. Normally, you will be in a video to document your behaviour during REM sleep cycles.

Diagnostic criteria

To diagnose the disorder of REM sleep behaviour, sleep medicine doctors typically use the symptom criteria in the International Classification of Sleep Disorders, Third Edition (ICSD-3).

For a diagnosis of disorder of REM sleep behaviour, the criteria include the following:

  • We have repeated times of arousal during sleep where you talk, make noises, or perform complex motor behaviors such as punching, kicking or running movements that often relate to the content of their dreams
  • Remember the dreams associated with these movements or sounds
  • If you wake up during the episode, which is alert and not confused or disoriented
  • A sleep study (polysomnography) shows that you have a greater muscle activity during REM sleep
  • Your dream is not caused by another sleep disorder, a mental health disorder, drug or substance abuse

REM sleep behavior disorder may be the first indication of the development of neurodegenerative diseases, such as Parkinson's disease, multiple system atrophy, or dementia with Lewy bodies. So if you develop REM sleep behavior disorder, it is important to follow up with your doctor.

Treatment

Treatment for the disorder of REM sleep behaviour may include physical security measures and medications.

Physical security measures

Your doctor may recommend that you make changes to your sleep environment to make it safer for you and your bed partner, including:

  • Fill the floor near the bed
  • The removal of dangerous objects from the bedroom, such as sharp objects and weapons
  • The placement of barriers on the side of the bed
  • Transfer of furniture and other clutter away from the bed
  • Protection of bedroom windows
  • Possibly sleep in a separate bed or the room of your partner in bed until symptoms are controlled

Drugs

Examples of treatment options for the disorder of REM sleep behaviour include:

  • Melatonin. Your doctor may prescribe a dietary supplement called melatonin, which may help reduce or eliminate symptoms. Melatonin can be as effective as clonazepam and is generally well tolerated with few side effects.
  • Clonazepam (Klonopin). This prescription medication, is often used to treat anxiety, it is also the traditional choice for the treatment of REM sleep behavior disorder, that appear in the reduction of symptoms. Clonazepam can cause side effects such as daytime drowsiness, decreased balance and worsening of sleep apnea.

Doctors continue to study many other medicines that can treat the disorder of REM sleep behaviour. Talk with your doctor to determine the most appropriate treatment for you.

Preparing for your appointment

You can start by seeing your primary care physician. Your doctor may refer you to a sleep specialist. Consider the possibility of bringing its equity partner, a family member or friend along, if possible. Someone who accompanies you can help you remember what the doctor says or provide additional information.

Here's some information to help you prepare for your appointment.

What you can do

Keeping a sleep diary for two weeks before your appointment can help your doctor to understand what is happening. In the morning, record everything that you know of your (or your partner) sleep problems that occurred the previous night.

Before your appointment, make a list of:

  • All the drugs, vitamins, herbs, or other supplements you are taking, as well as the dose and the recent changes
  • The symptoms you are experiencing, including any that may seem unrelated to the reason for the appointment
  • Key personal information, including any major stresses or recent life changes
  • Questions to ask your doctor to make the most of your time together

Some questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes?
  • What kinds of tests do I need?
  • Is my condition likely temporary or long-term?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor may ask you a series of questions. Be prepared to answer to reserve a time to go through any of the points that you want to devote more time. Your doctor may ask:

  • When did you begin experiencing symptoms?
  • If you have a sleeping partner, what sleep behavior has been observed?
  • Have you or your sleep partner have been hurt by their sleep behaviors?
  • In addition to his dream-enacting behaviors, have you ever experienced sleepwalking?
  • Have any of the motor symptoms, such as problems of handwriting, tremors, unsteadiness when walking or dizziness when standing up?
  • You have memory problems?
  • Has had sleep problems in the past?
  • Does anyone else in your family has trouble sleeping?
  • What medications are you taking?
  • Do you have problems breathing during sleep, such as loud, annoying snoring or witnessed pauses in breathing?
Symptoms and treatment of the disorder of REM sleep behaviour