What Is REM Sleep Behavior Disorder?

Rapid eye movement (REM) sleep behavior disorder (RBD) 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. Unlike sleepwalking or night terrors, you can recall your dreams upon waking.

RBD occurs in less than one percent of the population, according to the National Sleep Foundation. It was once believed that this disorder mostly affected men, but new data suggests that it occurs in both men and women with similar frequency. RBD can be treated with medication. However, it often occurs with other sleep problems or conditions, which may require additional treatment. If diagnosed, you should be monitored by your doctor. REM sleep behavior disorder may indicate a neurodegenerative disease or may be induced by some medications.

During an episode of RBD, you may:

  • talk
  • shout
  • flail
  • grab
  • punch
  • kick
  • jump

After waking up, you’ll probably remember details from your dream. They will match behaviors you acted out while sleeping. For example, if you dream about someone chasing you, you might jump out of your bed to run away.

In most cases, your episodes of RBD will happen at least 90 minutes after you fall asleep. Other people will experience these episodes during the later portions of sleep. You may have as many as four episodes in a night. You can also experience less frequent episodes.

Sleepwalking is a different condition than RBD. You may experience similar movements while sleepwalking. However, it’s usually harder to wake up from a sleepwalking episode than an RBD episode. You’re more likely to be confused after waking up from sleepwalking. You’re also less likely to remember your dream. If you have your eyes open, walk around, leave the room, eat or drink, engage in sexual activity, or use the bathroom while sleeping, you’re probably sleepwalking.

When you sleep, your 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 90 minutes to two hours each night.

During typical 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. As a result, you can develop disorders such as sleepwalking, narcolepsy, or RBD.

In RBD, your muscles aren’t temporarily paralyzed like they should be. This allows your body to react to your dreams. You may begin with small actions, such as talking or twitching, and progress to larger movements, such as jumping or kicking. These actions can harm you or your bed partner.

According to the National Sleep Foundation, men are more likely to develop this condition than women. It can appear at any age, but it most commonly occurs after age 50.

You may be at higher risk of RBD if you have a neurological disorder, such as Parkinson’s disease or multiple system atrophy. This disease is similar to Parkinson’s, but it involves more widespread damage.

If you have RBD, you’re 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” or uncontrollable bouts of falling asleep during the daytime
  • periodic limb movement disorder, when you experience cramping or jerking of your legs during sleep
  • sleep apnea, when you periodically stop breathing during sleep

To diagnose this condition, you should talk with a sleep specialist. Your doctor will need to know your medical history and will perform a neurological exam. Your doctor may even refer you to a neurologist for more comprehensive testing.

Your doctor may monitor your sleep patterns by asking you to keep a sleep diary. They may also ask you to fill out the Epworth Sleepiness Scale. This scale can help them 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.

In most cases, this condition can be successfully managed with medication. Clonazepam (Klonopin) is the most frequently used medicine. Your doctor may also prescribe melatonin, a dietary supplement that can help eliminate symptoms. You should talk to your doctor to learn which medication is best for you.

You will likely need to take other precautions to protect yourself and your bed partner. For example:

  • Move objects away from your bedside.
  • Move your bed away from the window.
  • Maintain a standard bedtime.
  • Avoid certain medications and alcohol.
  • Treat any other sleep disorders.

This condition can often be treated successfully with medication. If you take clonazepam to treat RBD, you may experience side effects. For example, you may experience morning sleepiness, memory problems, confusion, or decreased balance. The drug can also make sleep apnea worse. If you notice side effects that are interfering with your daily life, speak with your doctor. Switching to melatonin might help relieve your symptoms of RBD, while causing fewer side effects.

You should also be checked regularly for neurological disorders, such as Parkinson’s disease. In some cases, RBD is the first warning sign of neurodegenerative disease.