REM Behavioral Disorder

Mr Jones” is in his 70s. His wife is concerned about his kicking and screaming at night when they are asleep. This has been going on for the past 3 years, but getting worse lately. He kicks and flails his arms and legs, making gestures with his hands and talking angry. He wakes up out of these events, remembering a vivid dream, typically of being chased by a murderer or his wife is being attacked and he is in the process of defending her.

Mr Jones is suffering from REM Behavior Disorder, abbreviated as RBD. This disorder occurs during REM sleep, a sleep stage associated with active visual and emotional dreaming. Normally, there is muscle inhibition that causes muscle paralysis (also called atonia). This is important so that we don’t act our our dreams because as you an imaging, it can cause injury to ourselves or others. Individuals with RBD have a dysfunction of muscle paralysis. Therefore they might exhibit a spectrum from mild muscle twitches to more complex behaviors such as screaming, punching and falling out of bed. When they are awakened during these events, they recall an unpleasant dream that might match the physical actions.

RBD can be disruptive to the sleep quality and may lead to daytime sleep deprivation, depending on the severity and frequency. It is typically seen in men and in the elderly. It is also associated with brain disorders such as Parkinson’s disease or certain types of dementia (Lewy body dementia). RBD can be worsened by certain medications or the withdrawal of others.

Treatment of RBD

  • RBD can be treated successfully. Medications such as clonazepam and melatonin are good options.
  • A sleep study or polysomnogram might be needed.
  • If you suspect you have RBD, you need to see a sleep specialist and a neurologist to get appropriate diagnosis and treatment. The specialist needs to ensure that your symptoms are indeed RBD and not another possibility such as nighttime seizures.
  • If you suspect you have another sleep disorder such as sleep apnea, you want to treat it since sleep apnea can worsen the RBD symptoms.