Symptoms and Signs of REM Sleep Behavior Disorder

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 12/3/2021

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,
  • arms 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.

What Is the Treatment for REM Sleep Behavior Disorder?

The treatment for REM sleep behavior involves a combination of lifestyle changes and medications. Patients should try to avoid things that may make sleep worse or falling asleep more difficult. Things to avoid that make REM sleep behavior disorder worse include:

  • Drinking alcohol 
  • Recreational drugs
  • Certain prescription medications 
    • Stimulants 
  • Exposure to blue light at night from devices such as cell phones, tablets, or e-readers
  • Loud noises
  • Light exposure 
    • Make the bedroom as dark as possible

Set a strict and regular sleep schedule when possible.

Some medications are used to treat REM sleep behavior disorder, such as:

Always consult a doctor before taking any prescription or over-the-counter (OTC) medication. They can best advise you on a treatment plan based on your medical history and symptoms.

Establishing a safe sleep environment is very important. Patients with REM sleep behavior disorder can be injured while acting out dreams or sleepwalking. Steps to take to keep patients safe include:

  • Put the bed and mattress on the floor 
  • Remove other furniture from the bedroom 
  • Remove sharp objects and weapons from the bedroom
  • Sleep in separate beds from a partner

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.