What is REM Sleep Behaviour Disorder?

What is a parasomnia?

A parasomnia is a sleep problem whereby you have unwanted events happening while you sleep.  REM Sleep Behaviour Disorder (RBD) is a parasomnia.

What is REM Sleep Behaviour Disorder?

This involves acting out vivid dreams as you sleep – they may be action-filled or even violent – and episodes tend to get worse over time.

Don’t confuse REM Sleep Behaviour Disorder (RBD) with sleep walking or night terrors.  In these parasomnias, when the sleeper is wakened he is often confused and takes time to ‘come to’.  With RBD the person wakes easily and can often remember the dream they were having quite well.

What happens during REM Sleep Behaviour Disorder?

During REM Sleep Behaviour Disorder the sleeper may shout, scream, kick, swear, grab and punch.  This can be distressing and potentially dangerous for a bed partner.  However people rarely walk, open their eyes, eat/drink, go to the bathroom, engage in any sexual activity or get out of bed during their episodes.

These incidents happen during REM sleep.  Typically we go into REM sleep about 1.5 hours after we fall asleep and cycle through REM and non-REM sleep all night every 2 hours or so.  This means that the outbursts of RBD could happen up to 4 times each night but could be as rare as once a month depending on the individual.

  • This activity doesn’t happen during napping.
  • People with this sleep disorder are not more violent individuals when they are awake and they do not normally have a mental health problem.

Who gets RBD?

  • It’s most common in men over 50 years of age but can happen at any age.
  • It is uncommon in women and children.
  • It’s a rare disorder – less than 1% of people are diagnosed with it.
  • A higher rate of people with neurological conditions have it – conditions such as Parkinson’s Disease and Multiple System Atrophy.
  • People who are having alcohol withdrawal or sleep deprivation, have had a stroke or brain stem tumours may also be at risk of RBD because these conditions increase the intensity of your sleep.
  • There is no known genetic link for RBD.

Should I see a sleep specialist?

Keep a diary of your symptoms with the help of your bed partner and discuss this with your doctor and sleep specialist when you’re referred.  Yes you should see one as these episodes often get worse.

The Epworth Sleepiness Scale will help you grade your sleep.

You will probably have a sleep study.

You can continue to keep this diary during treatment and this will help to ascertain how effective treatment is for you.

What treatment is there for REM Sleep Behaviour Disorder?

Drug treatment is mainly with clonazepam.  Clonazepam is a benzodiazepine (like diazepam) and is commonly used with people who have epilepsy and panic disorders.  It has been found to be useful for people with RBD too.

Any other sleep disorders, such as narcolepsy or sleep apnea should be treated.

You should also:

  • Move furniture and any other objects that could cause injury away from your bedside.
  • Move the bed away from the window.
  • Your bed partner may want to consider sleeping in another bed if your symptoms are very bad/disturbing until they improve.
  • Avoid alcohol as it can increase your symptoms.
  • Keep to a good bedtime routine and don’t try to stay awake as sleep deprivation will make your symptoms worse.

Elspeth Raisbeck

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