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REM Sleep Behavior Disorder

REM sleep behavior disorder is more than just a sleeping problem. This article defines the difference between normal REM sleep behavior and REM sleep behavior disorder. Keep reading for tips on REM sleep behavior disorder (RBD) treatment.

What Is Normal REM Sleep Behavior?

In order to understand REM Sleep Behavior Disorder, it's important to know what normal REM sleep behavior is. When a person who does not have a sleep disorder goes to sleep, he or she experiences two states called Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM) sleep.

NREM sleep—about eighty percent of normal sleep—has four stages and is dreamless and characterized by low blood pressure, low heart rate, and slow, regular breathing, and involuntary muscle jerks.

During normal REM sleep—the other twenty to twenty-five percent of sleep—besides the rapid eye movements that give it its name, sleepers experience a rise in blood pressure, irregular breathing, and atonia, or paralysis. REM sleep is frequently associated with dreaming and using an EEG to record electrical activity in the brain reveals patterns that are similar to those found in a person who is awake.

REM Sleep Behavior Disorder

REM Sleep Behavior Disorder (abbreviated RBD for REM Behavior Disorder) has a significant change in the characteristics of REM sleep. Unlike a person with normal REM sleep, a person with REM sleep behavior disorder does not experience the paralysis or atonia that is normally associated with that state, or may experience it incompletely. Because the muscles are not prevented from moving, the person may act out dreams. Sometimes the issue is called REM sleep without atonia or RSWA.

Types of behavior that people may experience when in this state of REM sleep without paralysis of the muscles includes vocalizations, such as yelling, changes in posture, such as sitting or jumping out of bed, and actions of the arms and legs, such as punching, grabbing, flailing the arms, or kicking. These actions are capable of harming the sleeper or a bed partner.

It is usually middle-aged or elderly people who experience REM sleep behavior disorder, and more men than women suffer from it, but the exact cause is not known. In some cases, it can be associated with degenerative neurological conditions, including Parkinson disease and dementia, and may appear before they receive a neurological diagnosis. However, in nearly half the people who experience REM sleep behavior disorder, the experience is associated with withdrawal from alcohol, sedative, serotonin reuptake inhibitor, tricyclic antidepressants, or other medication for depression.

Treatment of REM Sleep Behavior Disorder

Before REM Sleep Behavior Disorder can be treated, as much as possible about its origins is ascertained. Because of its association with Parkinson disease and other neurological disorders, a neurologic examination is conducted. Often a sleep study, called polysomnography, is done. In this diagnostic procedure, the person goes to sleep at a sleep center, while being monitored  for electrical activity in their brain, heart, muscles, and eyes, using an electroencephalogram (EEG), electrocardiogram (ECG), electromyogram, and electrooculogram, as well as respiration. 

Treatments for REM sleep behavior disorder may include creating a safe environment for both the affected sleeper and sleep partner, as well as medications, one of which is Clonazepam. If there is a neurological condition, that will be treated as well. 

Related Article: When to Seek Help >>

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