REM sleep behaviour disorder (RBD)

What is REM Sleep Disorder?

REM sleep disorder is a neurological disorder which specifically affects the REM stage of sleep. In order to understand the condition we first need to  look at the nature of REM sleep.

REM (rapid eye movement) is a state of sleep that is characterized by intense brain activity and is the most common time for dreaming. It accounts for approximately 20% to 25% of an average night’s sleep and is characterized by irregular breathing, higher blood pressure  and of course, rapid movement of the eyes. These processes are quite normal during REM sleep, and indeed indicates a healthy sleep regime.

One of the other main features of REM sleep is that your brain effectively puts the body into a state of almost complete muscle atonia or paralysis. This is thought to be necessary to prevent you from acting out your dreams. If, on the other hand, your body responds to your dreams during REM sleep, and fails to remain immobile, then you may be suffering from REM sleep behavior disorder (RBH).

This can result in a number of undesirable and unpredictable behaviours including sleep talking, sleepwalking, yelling, punching, kicking, grabbing or even jumping.

Statistically, men are more likely to experience REM sleep behavior disorder than women, especially when they reach middle age. It’s also worth pointing out that the precise nature of this condition is unknown, though there is evidence to suggest that it can be triggered (amongst other things) by withdrawal from alcohol and certain types of drugs.

Symptoms of REM Behaviour Disorder

The most obvious signs that a person is suffering from REM sleep disorder is that he or she speaks, screams, kicks, walks or grabs objects during sleep. When awoken, they can usually recall the dream in almost perfect clarity. However, they will have almost no recollections of ever moving.

Episodes of REM sleep disorders can happen many  times in one night but in some cases they may only occur once or twice per week. RBD most commonly occurs during the morning hours of sleep, when REM sleep usually occurs.

Causes of RBD

As we’ve already mentioned, the precise cause of RBD is unknown. The condition however is associated with several degenerative neurological conditions, including Parkinson’s disease and dementia.

More than half of all RBD cases are of unknown causes, while the other half seems associated with alcohol and sedative hypnotic withdrawal. Withdrawal from the use of anti-depressants and other drugs that affect the nervous system can also contribute to REM sleep disorder.

Another important point is that RBD can often precede certain neurological illnesses, usually by several years. According to one  related study, approximately 38% of all patients diagnosed with REM sleep disorder eventually developed Parkinson’s disease around 12 to 13 years from the time RBD related symptoms began to appear.

It’s also worth pointing out that RBD symptoms afflict around 69% of people who suffer from multi-system atrophy, Parkinson’s disease and other neurological diseases. However, it’s important to remember that the relationship between such diseases and RBD is yet to be fully understood, and not all people who suffer from RBD will develop such neurological illnesses.

RBD Treatment

Although REM sleep behavior disorder is associated with various neurological illnesses, treating RBD will not necessarily prevent them. Likewise, treating a person who suffers from neurological illnesses may not necessarily result in the elimination of RBD.

Having said that, the most common treatment for RBD is Clonazepam, which eliminates the disorder approximately 90% of the time. However, in situations where Clonazepam fails to work effectively, the use of antidepressants or a melatonin supplement might help mitigate the symptoms of RBD. Aside from taking prescribed medications, it’s also important to find ways to cope when the symptoms first begin to manifest themselves. Even with the help of medication, there’s no telling when RBD symptoms might return.

Coping with RBD

In order to help keep yourself safe, you should make the following changes around your bedroom:

  • Keep away any sharp or potentially dangerous objects away from the bedroom.
  • Clear the floor of furniture or objects will help prevent unnecessary injury.
  • Surround the bed with cushions as a precaution against falling.
  • If the RBD symptoms are severe, consider sleeping on the floor.
  • Sleeping with padded bed rails should be used for people who violently flail their arms and legs about.
  • For couples, it may be prudent to sleep in different beds or even different rooms until the symptoms can be managed

Helpful Resources on RBD

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