Rapid Eye Movement Sleep Behavior Disorder

Authors: Pimlapas Smitthapipat, Pisira Leelasa-nguan, Phattarathida Thitathanakit

Editors: Hargun Champi, Aiyada Ieumwananonthachai

“Rapid eye movement (REM)” is the final stage in the sleep cycle, which contributes most to the ability to learn. Normally during this stage, the brain would be active and have vivid dreams while the body stays asleep. However, people with REM Sleep Behavior Disorder (RBD) physically act out their dreams, which are typically nightmares. 

Cause and symptoms 

The symptoms of Rapid Eye Movement sleep behavior disorder (RBD) includes movements —  kicking, punching, or jumping from the sleeping site —  in response to the patient’s dreams, which are typically unpleasant and/or violent. Patients may also talk, laugh, shout, or scream in a difficult-to-understand or impolite language. According to the records from Cleveland Clinic Organization, about 8 in 10 people with REM experience sleep-related injuries. Surprisingly, the patients are usually able to recall their dreams if they are woken during the dream. 

The first cycle begins around 90 minutes after the patient falls asleep and lasts around 10 minutes. However, each following cycle gets longer and longer.

REM is usually caused when the nerve brainstems called “Pons”  paralyze the body during sleep and no longer work, allowing the body to physically act out during dreams. Damaged Pons are also associated with Parkinson’s disease, Lewy body dementia, and Multiple System Atrophy (MSA) and patients who are diagnosed with REM are also diagnosed with one of the above. 

REM is mostly found in people over the age of 50 (most patients are around the age of 61) and is rarely found in children, teenagers, and adults. Elderly men are more likely to develop this disease than women.

Risk factors

There are several factors to account for the development of REM sleep behavior disorder including: age, gender, lifestyle, environment, and medical history. 

Typically, male patients who are over 50 years old would be more susceptible to this disorder, but there are more reports of females and youth developing this disorder in recent years. People with a background history of having narcolepsy or neurodegenerative disorders, for instance Parkinson’s disease, dementia, multiple system atrophy, or stroke, are also at a higher risk. The chances of developing REM sleep disorder increases if the person is experiencing PTSD or taking antidepressants, or drugs and alcohol. Studies suggest that an unhealthy and unclean environment may lead to REM sleep behavior disorder. Said environments include active association with smoking, pesticide exposure, and carbon monoxide poisoning. 

Treatments

There are two types of treatment for REM sleep behavior disorder, which involves safeguards and medication. The first type, physical safeguards, refers to changes in the patient’s sleeping environment that doctors may recommend to make them feel safer when sleeping. This can be done by easy cleaning and arrangement of objects around the bed such as making a barrier on the side of the bed or removing dangerous objects, such as sharp objects or weapons.

As for medication, two types of medicine can be prescribed from the doctor as treatment. First is melatonin, which may reduce or eliminate symptoms from REM sleep behavior disorder as it is well-tolerated to side effects. Secondly, Clonazepam or Klonopin is prescribed to help with anxiety, since it shows a decrease in symptoms. However, it comes with side effects such as urging patients to also sleep during daytime and sleep apnea.

Conclusion 

The Rapid Eye Movement (REM) sleep behavior disorder is a sleeping disorder in which the patients act out physical and verbal movements in response to their dreams, which are typically unpleasant and/or violent. REM is usually caused when the nerve brainstems called “Pons” that paralyze the body during sleep no longer work, and is mostly found in people over the age of 50. There are two types of treatment for REM sleep behavior disorder: safeguards and medication. The first requires the patient to change their sleeping environment to make them feel safer while sleeping, and the latter requires the usage of medications that relieve stress which decreases the symptoms of REM.

Works Cited

REM Sleep Behavior Disorder - Diagnosis and Treatment - Mayo Clinic. www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/diagnosis-treatment/drc-20352925.

“REM Sleep Behavior Disorder (RBD).” Cleveland Clinic, 7 June 2024, my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd.

“REM Sleep Behavior Disorder - Symptoms and Causes.” Mayo Clinic, www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/symptoms-causes/syc-20352920#:~:text=With%20REM%20sleep%20behavior%20disorder,you%20awaken%20during%20the%20episode.

Images Sources:

Arnett, Alyx. “AASM Updates Guideline for Managing REM Sleep Behavior Disorder.” Sleep Review, 10 Feb. 2023, sleepreviewmag.com/sleep-disorders/parasomnias/rem-parasomnias/aasm-updates-guideline-rem-sleep-behavior-disorder.

Sleepsia. “REM Sleep Behavior Disorder (RBD).” Sleepsia, www.sleepsia.com/blogs/bamboo-pillow/rem-sleep-behavior-disorder.