Doctor's Notes on REM Sleep Behavior Disorder
During REM sleep, rapid eye movements occur, breathing becomes more irregular, blood pressure rises, and there is loss of muscle tone (relative paralysis), but the brain is highly active, and REM sleep is usually associated with dreaming. In REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent, and is characterized by a person acting out dreams that are vivid, intense, and sometimes violent.
The main symptom of REM sleep behavior disorder is dream-enacting behaviors that may be violent and cause injury to the person to the bed partner. Dream-enacting behaviors include talking, yelling, punching, kicking, sitting, jumping from bed, leaping, arm flailing, and grabbing. A common complaint includes a sleep-related injury. If a person wakes during the attack they can usually vividly recall the dream that corresponds to the physical activity.
REM Sleep Behavior Disorder Symptoms
The main symptom of REM sleep behavior disorder is dream-enacting behaviors, sometimes violent, causing self-injury or injury to the bed partner.
The dream-enacting behaviors are usually nondirected and may include punching, kicking, leaping, or jumping from bed while still asleep.
The person may be awakened or may wake spontaneously during the attack and vividly recall the dream that corresponds to the physical activity.
REM Sleep Behavior Disorder Causes
The exact cause of REM sleep behavior disorder (RBD) is unknown, although the disorder may occur in association with various degenerative neurological conditions such as Parkinson disease, multisystem atrophy, diffuse Lewy body dementia, and Shy-Drager syndrome. In a majority of persons the cause is unknown, and in the other half, the cause is associated with alcohol or sedative-hypnotic withdrawal, tricyclic antidepressant (such as imipramine), or serotonin reuptake inhibitor use (such as fluoxetine, sertraline, or paroxetine) or other types of antidepressants (mirtazapine).
RBD often precedes the development of these neurodegenerative diseases by several years. In one study, 38% of patients diagnosed with RBD subsequently developed Parkinson disease within an average time of 12-13 years from the onset of RBD symptoms. The prevalence of RBD is increased in persons with Parkinson disease and in multisystem atrophy where it is observed in 69% of these patients. The relationship between RBD and Parkinson disease is complex; however, not all persons with RBD develop Parkinson disease.
Scientists used to think that people were physically and mentally inactive during sleep. But now they know that's not the case. All night long, your body and brain do quite a bit of work that's key for your health. There are two main types of sleep that we cycle in and out of when we rest -- REM (rapid eye movement) and non-REM sleep.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.