REM Sleep Behavior Disorder

Written by Cindie Slightham | Published on August 15, 2012
Medically Reviewed by George Krucik, MD

What is REM Sleep Behavior Disorder?

Rapid eye movement (REM) sleep behavior disorder is a condition in which you act out your dreams while you sleep. These dreams are often very vivid and can involve a wide range of movements. The difference between this condition and sleepwalking or night terrors is that you can recall your dreams upon waking.

REM sleep behavior disorder occurs in less than one percent of the population and is most often diagnosed in men. It can be treated with medication, although it is usually an indication of other sleep or behavioral problems—which may require other treatment. If diagnosed, you should be monitored by your doctor because you may have higher risk of developing Parkinson’s disease.

What Causes REM Sleep Behavior Disorder?

When we sleep, our body goes through stages of both non-REM and REM sleep. REM sleep is associated with dreams and is a critical component of your sleep cycle. It occurs for roughly one and a half to two hours each night.

During REM sleep, your muscles are temporarily paralyzed while your brain is actively dreaming. In some cases, the chemical that causes your body to remain still and your brain to remain active doesn’t function properly, and you can develop disorders such as sleepwalking, narcolepsy, or REM sleep behavior disorder.

In REM sleep behavior disorder, the temporary muscle paralysis does not occur, which allows your body to react to your dreams. It may begin with small actions, such as talking, twitching, or jerking, but will eventually lead to large movements, such as walking, jumping, or kicking. These actions can harm the sleeper or their bed partner.

Who is at Risk for REM Sleep Behavior Disorder?

Men are more likely to develop this condition than women. It can appear at any age, but commonly occurs after age 50.

You may be at higher risk if you have a neurological disorder like Parkinson’s disease or multiple system atrophy (a disease similar to Parkinson’s but with more widespread damage).

If you have REM sleep behavior disorder, you are at a higher risk of developing:

  • Parkinson’s disease (a brain disease that leads to tremors and eventually difficulty walking and moving)
  • narcolepsy (when you experience “sleep attacks” during the daytime)
  • periodic limb movement disorder (a sleep disorder where you experience cramping or jerking of the legs)
  • sleep apnea (when you periodically stop breathing during sleep)

Diagnosing REM Sleep Behavior Disorder

To diagnose this condition, you should talk with a sleep specialist. The doctor will need to know your medical history and will perform a neurological exam.

Your doctor may monitor your sleep patterns by asking you to keep a sleep diary. He or she may also ask you to fill out the Epworth Sleepiness Scale. This scale can determine how your sleep patterns are interfering with your daily life.

You may be asked to perform an overnight sleep study. In this case, you will sleep in a laboratory attached to a heart rate, brain wave, and breathing monitor. These monitors will record your sleep stages, how you move throughout the night, and if you have any other disorders that may be affecting your sleep.

How is REM Sleep Behavior Disorder Treated?

This condition can be successfully managed with medication. Clonazepam (Klonopin) is the most frequently used medicine. You should talk to your healthcare provider to determine which medication will work best for you.

You will likely need to take other precautions to protect yourself and your bed partner, including:

  • moving objects away from the bedside and moving the bed away from the window
  • maintaining a standard bedtime
  • avoiding certain medications and alcohol
  • treating any other sleep disorders

Long-Term Outlook

This condition can often be treated successfully with medication. You should be checked regularly for neurological disorders, such as Parkinson’s disease.

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