Rapid Eye Movement Sleep Behavior Disorder

Definition

Rapid eye movement sleep behavior disorder, also called REM sleep behavior disorder, is a condition in which an individual exhibits vocalizations and/or complex motor behaviors (running, punching, jumping) while they are in a REM state of sleep. These behaviors typically reflect the content of action-filled or violent dreams in which a person is being attacked or trying to escape a dangerous situation; their behavior is therefore called “dream enacting behavior.”

To receive a diagnosis of REM sleep behavior disorder, the sleep behavior must cause significant distress or impairment in some important area of functioning, including injury to self or the bed partner during sleep. Approximately .38 to .5 percent of the general population have REM sleep behavior disorder, and it is most commonly seen among men who are older than 50 years of age. 

Symptoms

The muscles of the body usually become temporarily paralyzed during REM sleep. People who have REM sleep behavior disorder do not experience this paralysis, but rather will act out behaviors that reflect the content of their dreams.

The behaviors seen in REM sleep behavior disorder usually start more than 90 minutes after a person has fallen asleep, once they are in a state of REM sleep. The vocal sounds are typically loud, emotional, and can include profanity. The physical behavior includes running, punching, hitting, jumping out of bed, and kicking, which can be frustrating as well as dangerous for the person or their bed partner. Once the person wakes up, they are awake and alert and they can usually remember the content of their dreams. 

Causes

The cause of most cases of REM sleep behavior disorder is unknown. In some cases, prescription medications such as some anti-depressants and beta-blockers can result in REM sleep behavior disorder. It is not known, however, whether these medications cause symptoms or whether the medications trigger an underlying predisposition to develop REM sleep behavior disorder. REM sleep behavior disorder is also present in approximately 30 percent of people who have narcolepsy. 

Treatments

Treatment for REM sleep behavior disorder includes medication and making changes in the sleep environment to protect yourself and your bed partner. Medications such as melatonin and klonopin have both been shown to improve symptoms, but as with any medication, should be taken as prescribed and monitored carefully for side effects. Changes in the sleep environment to promote safety include the following:

  • Padding the floor around the bed with a mattress or pillows
  • Padding corners of nearby furniture
  • Window protection
  • Removing dangerous objects, such as guns or sharp objects, from bedroom area
  • Sleeping in a separate room from the bed partner until symptoms are under control

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Aurora, R. N., Zak, R. S., Maganti, R. K., Auerbach, S. H., Casey, K. R., Chowdhuri, S., ... & Standards of Practice Committee. (2010). Best practice guide for the treatment of REM sleep behavior disorder (RBD). Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 6(1), 85.

Last reviewed 03/06/2018