What is REM Sleep Behavior Disorder?

Rapid eye movement (REM) sleep behavior disorder is a form of parasomnia characterized by abnormal movements or brain activity during sleep. In people with REM sleep behavior disorder, the vivid dreams experienced during the phase of sleep known as REM sleep are physically acted out. This can result in physical injuries to the sleeper, as well as people or pets present in the room. This type of sleep disorder is most commonly observed among older men although it can be seen in people of all ages.

In normal REM sleep, people are in a state of paralysis known as atonia while their brains are highly active. People often experience very vivid and intense dreams during this period of sleep. In this disorder, the body is not paralyzed, the brain may send signals to the muscles, and the sleeper can start physically acting out the events in the dream.

REM sleep behavior disorder goes far beyond sleepwalking. People may punch, kick, and engage in a variety of activities after leaping out of bed during REM sleep. The sleeper may mistake people in the room for adversaries and attack them, and can be severely injured by colliding with furniture or falling. Sometimes people become confused by their dreams and may mistake parts of their own bodies as elements in the dream, attacking their arms and legs and causing injuries.

People may not be aware that they have REM sleep behavior disorder unless they live with people who have observed unusual activities during sleep. For a diagnosis, a stay in a sleep clinic may be recommended. The patient will be monitored overnight to confirm that the behavior occurs during REM sleep and that it is not seizure activity, but is a genuine attempt to act out the events of the dream. A patient interview will also be conducted to learn more about the symptoms and to screen for underlying causes or untreated sleep disorders.

If a patient has an existing sleep disorder, treating that may address the REM sleep behavior disorder. Patients can also benefit from changing their sleep habits, establishing a sleep schedule and sticking to it, and clearing the bedroom to reduce the risk of injuries during episodes. A sleep specialist can evaluate an individual patient's situation and provide advice and assistance with treatment. It is important to conduct a thorough evaluation to rule out potential causes like psychological stress or underlying neurological disorders that might be contributing to REM sleep behavior disorder.