You are probably familiar with insomnia or narcolepsy. But, REM sleep behavior disorder (RBD) is less well-known. People with RBD act out their dreams — often in a very dramatic fashion. This chronic parasomnia is quite rare and affects less than one percent of the population. RBD occurs most often in late-middle-aged men. Learn more about this sleep disorder and how to get better sleep with RBD.
What is REM Sleep Behavior Disorder?
Rapid eye movement (REM) sleep is the stage of sleep during which you dream. Normally, during this phase of sleep, our muscles become paralyzed, so we don’t act out our dreams. This paralysis keeps you still even as your brain acts out fantastical dream scenarios. But in RBD, the brain doesn’t properly paralyze the muscles. As a result, people with RBD act out their dreams. They may:
- Kick
- Punch
- Jump or leap from bed
- Talk
- Laugh
- Shout
- Thrash around
- Dance
These behaviors occur in response to dreams. A person with RBD may injure themselves by kicking a wall or jumping out of bed. They may accidentally injure their bed partners, as well. One patient with RBD pulled out a gun and fired it at imaginary attackers who were in his dreams. There are two main types of RBD.
- Isolated (Idiopathic) RBD - There isn’t an underlying cause with this type of RBD. However, it may be an early sign of a neurological condition such as Parkinson’s disease, multiple system atrophy, or Lewy body dementia, according to the Cleveland Clinic.
- Secondary (Symptomatic) RBD - This type of RBD is caused by an underlying cause, such as narcolepsy, medication, alcohol withdrawal, or another condition.
REM Sleep Behavior Disorder Vs. Sleepwalking
Sleepwalking takes place during the deep stage of sleep (NREM 3). RBD occurs during the REM stage of sleep. People who sleepwalk frequently walk around or leave the room, and their eyes are typically open. These behaviors rarely occur with RBD. Instead, people with RBD act out their dreams, often while still in their bed. With RBD, the person will vividly remember their dream, whereas people who sleepwalk rarely remember what they were dreaming about.
Causes
The exact cause of RBD is unknown. In some cases, REM sleep behavior disorder is triggered by a tumor, stroke, or certain medications. However, in many cases, RBD may signal serious underlying health disorders, including:
- Parkinson’s Disease
- Obstructive sleep apnea (OSA)
- Post-traumatic stress disorder (PTSD)
- Lewy body dementia
- Narcolepsy
REM sleep behavior disorder could be a foreshadowing of the development of a very serious disorder. According to experts, about 80 percent of people who have RBD go on to develop a neurodegenerative disease, such as Parkinson’s disease.
How RBD Affects Sleep Quality
REM sleep behavior disorder can cause frequent sleep disruptions, and lead to a lower quality of sleep. RBD causes sleep problems, not only for the person suffering from the disorder but for their partners, as well. It is estimated that up to 90 percent of partners of people with RBD have sleep problems.
Improving Sleep Quality With REM Sleep Behavior Disorder
It’s very important to manage RBD to prevent it from interfering with your sleep, as well as to prevent injuries.
See Your Physician
If you have the symptoms of RBD, it’s important to see your physician to undergo a sleep study (polysomnography), as well as look for underlying causes of the disorder. Your doctor may also prescribe medication to help with RBD. A benzodiazepine, clonazepam (Klonopin), is most often prescribed for RBD. This drug suppresses muscle activity during sleep. It helps in up to 90 percent of cases.
Consider Lifestyle Changes
The following lifestyle changes can help if you have RBD. You may have to try one or more of these to see what works for you.
Safety Measures
People with RBD are at risk of injuring themselves and their sleep partners. Therefore, sleep environment safety is very important. These safety measures can help keep you and bed partners safe during RBD episodes.
- Sleep on the ground floor, if possible. That way, you won’t hurt yourself on the stairs if you leave your bedroom during an episode.
- Remove glass objects and sharp corners away from the bed. Examples include bedside tables and dressers.
Instead of a bed, consider placing your mattress directly on the floor. That way, you will not be injured if you fall out of bed. - Make sure the floor is clean. Remove all clutter near the bed, so you won’t be injured if you get out of bed during a dream.
- Install alarms on windows and doors. This will wake you or others in your household up if you open a window or door.
- Sleep by yourself until episodes are under control. Or place a pillow between you and your partner.
- Put away weapons. Don’t keep guns near your bed. They should be kept safely locked away.
Sleep Hygiene Changes
When it comes to RBD, making a few simple sleep hygiene changes can help. The following sleep hygiene changes have been shown to reduce RBD episodes.
- Don’t drink alcohol. Alcohol can trigger RBD episodes.
- Practice good sleep hygiene. The more sleep-deprived a person is, the more likely they are to suffer from RBD episodes. Therefore, make sure you follow a consistent sleep schedule. You can use Pillow to automatically track your sleep. Set up a relaxing bedtime routine. Your routine might include reading a book, drinking a warm decaffeinated tea, or journaling.
- Consider taking an immediate-release melatonin supplement. Melatonin has been found to be very effective in controlling RBD episodes and it is well-tolerated.
The Bottom Line: Improving Sleep Quality With RBD
REM sleep behavior disorder is a rare parasomnia that can wreak havoc on your sleep. Not only that, but it can cause you to injure yourself and others. Fortunately, taking the simple precautions outlined above can help keep you and others safe while you sleep — and help you get better sleep.
Remember: It’s always a good idea to talk to your doctor if you have symptoms of REM sleep behavior disorder as this condition can be a symptom of a serious underlying disorder, such as Parkinson’s disease or dementia.
