Sleep Issues: REM Sleep Behavior Disorder

Estimates indicate that up to 70 million Americans¹ suffer from some kind of sleep disorder. Various sleep disorders prevent people from getting enough quality sleep, which can result in sleep deficiency². Such deficiency can have far-reaching health implications, including a wide range of physical and mental health issues. Indeed, per the American Psychological Association, better quality sleep can make people healthier, safer and happier³. As well as impacting individual sufferers, poor sleep can become a wider public health issue⁴.

Sleep disorders can have various causes⁵, including genetic, physical, psychological, medical, medications and aging. It's estimated that 40 to 70% of seniors have sleep disorders⁶, although issues can affect people of any age, including children⁷. Although some are more common than others, symptoms of sleep disorders⁸ can be wide-ranging, including excessive daytime tiredness, vivid dreams, difficulties falling asleep, excessive snoring and jerking while asleep. Treatments⁹ are equally as wide-ranging, depending on the cause.

While many people have heard of some of the more common sleep disorders¹⁰, such as sleep apnea, restless legs syndrome and insomnia¹¹, other conditions are rarer and less known. One such condition is REM Sleep Behavior Disorder. This article provides an overview of this lesser-known sleep condition.

What is REM Sleep Behavior Disorder?

REM Sleep Behavior Disorder, sometimes abbreviated as RBD, is associated with people acting out their dreams as they sleep. Somewhat similar to sleepwalking¹², RBD involves unconscious actions while asleep.

Unlike sleepwalking, which happens during the NREM stage of sleep¹³, RBD occurs during the rapid eye movement (REM) stage¹⁴. REM sleep is the stage associated with dreaming, as the brain is more active.

RBD is a rare condition, thought to affect only around 1% of the American population. Nevertheless, it can have serious impacts.

Overview of REM Sleep

REM takes its name from the characteristic eye movements that typically happen while someone is in this sleep stage. The first REM stage usually occurs about 90 minutes after falling asleep. As people go through the sleep cycles¹⁵, periods of REM sleep become longer. The first period generally lasts for about 10 minutes, while the final stage can last for up to an hour.

During REM sleep, the body and brain go through several changes. These include increased blood pressure and heart rate, quicker breathing, body temperature changes and limb twitching. For most people, their body also becomes temporarily paralyzed. Known as atonia¹⁶, many scientists believe this muscle paralysis is the body's way of protecting itself against people moving and acting out their dreams. However, people with REM Sleep Behavior Disorder don't experience this protective sleep paralysis.

Causes of RBD

Although the exact causes of REM Sleep Behavior Disorder aren't fully understood, professionals believe that there are several potential reasons for RBD. In some cases, RBD is linked to the use of certain antidepressants. Indeed, statistics indicate that around 6% of antidepressant users will experience RBD¹⁷. Alcohol withdrawal or consumption may also lead to RBD¹⁸. However, in many cases the underlying cause of RBD is unknown, or idiopathic. More than half of all RBD cases are idiopathic¹⁹.

Where the cause isn't known, REM Sleep Behavior Disorder seems to affect certain groups of people more than others. It's more prevalent in men²⁰ than women, and tends to affect older people²¹ more than younger individuals.

Symptoms of REM Sleep Behavior Disorder

As REM Sleep Behavior Disorder involves acting out dreams, it can involve various movements and sounds. Common symptoms include:

• Shouting
• Talking
• Thrashing
• Jumping
• Kicking
• Punching
• Grabbing
• Getting out of bed
• Walking
• Running

Risks Associated with RBD

The most immediate risk associated with RBD is a person unintentionally injuring themselves or others while they are sleeping. For example, if somebody dreams that they are being attacked, they may punch or kick their partner. If someone dreams that they are being pursued, they may jump out of bed to escape. According to the Cleveland Clinic, around 8 in 10 people with RBD will experience injuries in their sleep²². RBD can also have significant impacts on sleep quality for both the sufferer and those they live with.

Research has also found links between idiopathic REM Sleep Behavior Disorder and various neurodegenerative diseases²³, such as dementia, Parkinson's disease, multiple system atrophy and Alzheimer's disease. One study found that 80.8% of people with idiopathic REM Sleep Behavior Disorder went on to develop a neurodegenerative condition²⁴. As such, RBD may be a predictor of future health issues²⁵.

Managing REM Sleep Behavior Disorder

If the cause of RBD is known, such as through alcohol or antidepressant use, clinicians may recommend altering lifestyles and/or medications to resolve the sleep disorder. For idiopathic cases, management is often more complex.

Certain drugs and supplements²⁶ may help improve the symptoms of RBD. Depending on the severity and frequency of disordered behavior, recommendations for managing RBD²⁷ may include:

• Sleeping alone
• Placing cushioning on the floor next to the bed
• Removing potential weapons from the bedroom
• Moving furniture with sharp edges away from the bed
• Locking windows and doors

Essentially, people with RBD need a safe environment to sleep, and their family members also need to be able to sleep soundly without fear for their, or their loved one's, safety. Research also indicates that sleep equipment may be beneficial for those with RBD, especially if they have a coexisting sleep disorder.

Anyone who believes they may have REM Sleep Behavior Disorder or any other form of sleep disorder should seek advice from their physician.

References:

1. National Library of Medicine: Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
2. National Heart, Lung, and Blood Institute: What Are Sleep Deprivation and Deficiency?
3. American Psychological Association: More sleep would make us happier, healthier and safer
4. PRB.org: Poor Sleep has Social Causes and Consequences
5. Cleveland Clinic: Sleep Disorders
6. National Library of Medicine: Sleep in the Aging Population
7. Doernbecher Children's Hospital: Pediatric Sleep Disorders
8. Health.com: Sleep
9. American Psychological Association: Diagnosing and treating sleep disorders
10. CDC.gov: Key Sleep Disorders
11. WebMD: Insomnia
12. American Academy of Sleep Medicine: Adult sleepwalking is serious condition that impacts health-related quality of life
13. National Cancer Institute: non-REM sleep
14. Medical News Today: What is REM sleep?
15. National Library of Medicine: Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
16. National Library of Medicine: Unraveling the Mechanisms of REM Sleep Atonia
17. National Library of Medicine: Antidepressants and REM Sleep Behavior Disorder: Isolated Side Effect or Neurodegenerative Signal?
18. National Library of Medicine: Alcohol consumption and probable rapid eye movement sleep behavior disorder
19. WebMD: REM Sleep Behavior Disorder
20. National Library of Medicine: Gender differences in REM sleep behavior disorder: a clinical and polysomnographic study in China
21. National Library of Medicine: REM Sleep Behaviour Disorder in Older Individuals: Epidemiology, Pathophysiology, and Management
22. Cleveland Clinic: REM Sleep Behavior Disorder (RBD)
23. British Journal of General Practice: REM sleep behaviour disorder: the importance of early identification in primary care
24. ScienceDirect: Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series
25. National Library of Medicine:Idiopathic REM sleep behavior disorder as a long-term predictor of neurodegenerative disorders
26. National Library of Medicine: Melatonin Therapy for REM Sleep Behavior Disorder: A Critical Review of Evidence
27. Journal of Clinical Sleep Medicine: Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline
28. National Library of Medicine: Prevalence of obstructive sleep apnoea in REM behaviour disorder: response to continuous positive airway pressure therapy