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Rapid eye movement sleep behavior disorder

rapid eye movement sleep behavior disorder, rapid eye movement sleep behavior disorder screening questionnaire
Rapid eye movement sleep behavior disorder RBD is a sleep disorder more specifically a parasomnia that involves abnormal behavior during the sleep phase with rapid eye movement REM sleep It was first described in 1986

The major and arguably only abnormal feature of RBD is loss of muscle atonia ie, the loss of paralysis during otherwise intact REM sleep during which paralysis is not only normal but necessary REM sleep is the stage of sleep in which most vivid dreaming occurs The loss of motor inhibition leads to a wide spectrum of behavioral release during sleep This extends from simple limb twitches to more complex integrated movement, in which people appear to be unconsciously acting out their dreams These behaviors can be violent in nature and in some cases will result in injury to either the patient or their bed partner


  • 1 Symptoms
  • 2 Causes
    • 21 Idiopathic RBD causes
    • 22 Symptomatic RBD causes
    • 23 Physiological causes
  • 3 Diagnosis
  • 4 Treatment
  • 5 Epidemiology
  • 6 In animals
  • 7 See also
  • 8 References
  • 9 External links


RBD is characterized by the dreamer acting out his or her dreams These dreams often involve kicking, screaming, punching, grabbing, and even jumping out of bed When awakened, people can usually recall the dream they were having, which will match the actions they were performing, but they will not be aware that they were moving In a normal sleep cycle, REM sleep may be experienced at intervals of between 90 minutes and two hours every night, which means RBD episodes may occur up to four times a night In a rare case, they may only happen once a week or once a month1 Episodes occur more towards the morning hours because that is when REM sleep is more frequent The actions in an episode can result in injuries to oneself or one's bed partner People can also respond to other people while sleeping and not even know it This causes them to be aware of things while they are sleeping, which can result in sleep deprivation2


Rapid eye movement behavior disorder RBD occurs when there is a loss of normal voluntary muscle atonia during REM sleep resulting in motor behavior in response to dream content It can be caused by adverse reactions to certain drugs or during drug withdrawal; however, it is most often associated with the elderly and in those with neurodegenerative disorders such as Parkinson disease and other neurodegenerative diseases, for example multiple system atrophy and Lewy body dementia3

RBD is categorized as either idiopathic or symptomatic4

Idiopathic RBD causesedit

Idiopathic RBD is when the individual's sleep structure seems to be normal but there is a significant increase in the density of REM sleep as well as the percentage of slow wave sleep This category of RBD is more strongly linked to having a genetic component, as seen throughout familial gene patternscitation needed

Symptomatic RBD causesedit

Symptomatic RBD is the more characteristically seen disorder This category of RBD is strongly associated with neurodegenerative diseasescitation needed About 15% of Parkinson's patients also have RBD, 70% of multiple system atrophy patients also have RBD, and about 85% of Lewy body dementia patients also have RBD4 Other reported neurological associations include Shy–Drager syndrome, olivopontocerebellar atrophy, multiple sclerosis, vascular encephalopathies, Tourette's syndrome, and Guillain–Barré syndromecitation needed It is uncertain whether RBD precedes these neurodegenerative disorders, whether they coincide, or whether it follows these disorders However, Mayo Clinic researchers have characterized RBD as the strongest predictor of whether a male patient is developing Lewy body dementia5

Physiological causesedit

Research studies have alluded to physiological behavior of the body that accounts for what causes the symptoms of RBD Findings have found associations with central nervous system dysfunction and abnormal cortical activity during REM sleep including low beta waves in the occipital lobe as well as increased theta waves in the frontal and occipital lobescitation needed Magnetic resonance imaging MRI studies have suggested frontal lobe and pons dysfunctions in RBD patients because of the significantly lower blood flow in these portions of the brain as compared to non-RBD individuals4 Other electrophysiological findings include electromyogram EMG intensification in chin muscle tone most predominantly, as well as limb phasic twitching and prolonged excess activity of the extremities

RBD may also be caused by brainstem damage of the neural circuits which normally manage the phenomenon of REM sleep6


Because a number of parasomnias may be confused with RBD, it is necessary to conduct formal sleep studies such as polysomnography PSG performed at sleep centers that are experienced in evaluating parasomnias in order to establish a diagnosis7 In RBD, a single night of extensive monitoring of sleep, brain, and muscle activity will almost always reveal the lack of muscle paralysis during REM sleep, and it will also eliminate other causes of parasomnias8

Recently, due to the limited access to PSG, attempts have been made to identify RBD from clinical interview as well as questionnaires9 Postuma et al have validated a single-question screening tool for RBD RBD1Q that could be easily applied in general practice to the patient and their bed partner10 A positive answer to the RBDQ1, ‘Have you ever been told or suspected yourself, that you seem to act out your dreams while asleep for example, punching, flailing your arms in the air, making running movement etc’ should encourage the medical practitioner to consider the diagnosis of RBD as it offers good sensitivity 94% and specificity 87% Other questionnaires, such as the Rapid Eye Movement REM sleep Behavior Disorder Screening Questionnaire RBDSQ11 or the REM Sleep Behavior Questionnaires – Hong-Kong12 are available for more detailed characterisation


RBD is treatable Medications are prescribed for RBD based on symptoms Low doses of clonazepam is most effective with a 90% success rate How this drug works to restore REM atonia is unclear: It is thought to suppress muscle activity, rather than directly restoring atonia Melatonin is also effective and can also be prescribed as a more natural alternative13 For those with Parkinson's and RBD, Levodopa is a popular choice Pramipexole is another drug which can be an effective treatment option14 Recent evidence has shown melatonin and clonazepam to be comparably effective in treatment of RBD with patients who received melatonin treatment reporting fewer side effects13 In addition, patients with neurodegenerative diseases such as Parkinson's disease reported more favorable outcomes with melatonin treatmentcitation needed

In addition to medication, it is wise to secure the sleeper's environment in preparation for episodes by removing potentially dangerous objects from the bedroom and either place a cushion round the bed or moving the mattress to the floor for added protection against injuries21516 Some extreme sufferers sleep in a sleeping bag zipped up to their neck, and wear mittens so they can't unzip it until they awake in the morning1718

Patients are advised to maintain a normal sleep schedule, avoid sleep deprivation, and keep track of any sleepiness they may have Treatment includes regulating neurologic symptoms and treating any other sleep disorders that might interfere with sleep Sleep deprivation, alcohol, certain medications, and other sleep disorders can all increase RBD and should be avoided if possible19


The most comprehensive assessment so far has estimated RBD prevalence to be about 05% in individuals aged 15 to 10020 It is far more common in males: most studies report that only about a tenth of sufferers are female This may partially be due to a referral bias, as violent activity carried out by men is more likely to result in harm and injury and is more likely to be reported than injury to male bed partners by women, or it may reflect a true difference in prevalence as a result of genetic or androgenic factors The mean age of onset is estimated to be about 60 years21

Various conditions are very similar to RBD in that sufferers exhibit excessive sleep movement and potentially violent behavior Such disorders include sleepwalking and sleep terrors, which are associated with other stages of sleep, nocturnal seizures and obstructive sleep apnea which can induce arousals from REM sleep associated with complex behaviors Because of the similarities between the conditions, polysomnography plays an important role in confirming RBD diagnosis

It is now apparent that RBD appears in association with a variety of different conditions Narcolepsy has been reported as a related disorder Both RBD and narcolepsy involve dissociation of sleep states probably arising from a disruption of sleep control mechanisms RBD has also been reported following cerebrovascular accident and neurinoma tumor, indicating that damage to the brain stem area may precipitate RBD RBD is usually chronic However, it may be acute and sudden in onset if associated with drug treatment or withdrawal particularly with alcohol withdrawal 60% of RBD is idiopathic This includes RBD that is found in association with conditions such as Parkinson's disease and dementia with Lewy bodies, where it is often seen to precede the onset of neurodegenerative disease Monoamine oxidase inhibitors, tricyclic antidepressants, Selective serotonin reuptake inhibitors, and noradrenergic antagonists can induce or aggravate RBD symptoms and should be avoided in patients with RBD

In animalsedit

RBD has also been diagnosed in animals, specifically, dogs22

See alsoedit

  • Sleepwalk with Me


  1. ^ Schutte-Rodin, Sharon "REM Sleep Behavior Disorder" yoursleepaasmnetorg American Academy of Sleep Medicine Retrieved 1 October 2011 
  2. ^ a b "REM Sleep Behavior Disorder" Mayo Clinic Retrieved 2010-01-02 
  3. ^ Gugger, JJ; Wagner, ML Nov 2007 "Rapid eye movement sleep behaviour disorder" Ann Pharmacother 41 11: 1833–41 doi:101345/aph1H587 PMID 17925503 
  4. ^ a b c Paparrigopoulos, T J 2005 REM sleep behaviour disorder: Clinical profiles and pathophysiology International Review of Psychiatry, 174, 293-300
  5. ^ Celmer, Lynn 2013-03-22 "Acting out dreams linked to developing dementia" sleepeducationorg Retrieved 2016-09-07 
  6. ^ Carlson, N R 2013 Chapter 9 sleep and biological rhythms Physiology of behavior 11th ed, pp 290-321 Boston: Pearson
  7. ^ Schenck, CH; Mahowald, MW Mar 15, 2002 "REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP" Sleep 25 2: 120–38 PMID 11902423 
  8. ^ "REM Behavior Disorder and Sleep" 
  9. ^ Coeytaux, A; Wong, K; Grunstein, R; Lewis, SJ Nov 2013 "REM sleep behaviour disorder - More than just a parasomnia" Australian family physician 42 11: 785–8 PMID 24217098 
  10. ^ Postuma RB, Arnulf I, Hogl B, Iranzo A, Miyamoto T, Dauvilliers Y, Oertel W, Ju YE, Puligheddu M, Jennum P, Pelletier A, Wolfson C, Leu-Semenescu S, Frauscher B, Miyamoto M, Cochen De Cock V, Unger MM, Stiasny-Kolster K, Fantini ML, Montplaisir JY Jun 2012 "A single-question screen for rapid eye movement sleep behavior disorder: a multicenter validation study" Movement disorders : official journal of the Movement Disorder Society 27 7: 913–6 doi:101002/mds25037 PMC 4043389  PMID 22729987 
  11. ^ Stiasny-Kolster, K; Mayer, G; Schäfer, S; Möller, JC; Heinzel-Gutenbrunner, M; Oertel, WH Dec 2007 "The REM sleep behavior disorder screening questionnaire--a new diagnostic instrument" Movement disorders : official journal of the Movement Disorder Society 22 16: 2386–93 doi:101002/mds21740 PMID 17894337 
  12. ^ Li, SX; Wing, YK; Lam, SP; Zhang, J; Yu, MW; Ho, CK; Tsoh, J; Mok, V Jan 2010 "Validation of a new REM sleep behavior disorder questionnaire RBDQ-HK" Sleep medicine 11 1: 43–8 doi:101016/jsleep200906008 PMID 19945912 
  13. ^ a b McCarter, SJ; et al March 2013 "Treatment Outcomes in REM Sleep Behavior Disorder" Sleep Medicine 14 3: 237–242 doi:101016/jsleep201209018 PMC 3617579  PMID 23352028 
  14. ^ Paparrigopoulos, TJ Aug 2005 "REM sleep behaviour disorder: clinical profiles and pathophysiology" Int Rev Psychiatry 17 4: 293–300 doi:101080/09540260500104540 PMID 16194802 
  15. ^ Ferini-Strambi, L; Zucconi, M Sep 2000 "REM sleep behaviour disorder" Clin Neurophysiol 111 Suppl 2: S136–40 doi:101016/S1388-24570000414-4 PMID 10996567 
  16. ^ Boeve, BF; Silber, MH; Ferman, TJ Sep 2004 "REM sleep behaviour disorder in Parkinson's disease and dementia with Lewy bodies" J Geriatr Psychiatry Neurol 17 3: 146–57 doi:101177/0891988704267465 PMID 15312278 
  17. ^ Birbiglia, Mike; Glass, Ira 2008-08-08 "Fear of Sleep" This American Life Retrieved 2016-09-07 
  18. ^ American Academy of Sleep Medicine 2012-01-26 "Sleepwalk with Me: Comedian's sleep disorder experience comes to film" sleepeducationorg Retrieved 2016-09-07 
  19. ^ Schutte-Rodin, Sharon "REM Sleep Behavior Disorder" yoursleepaasmnetorg American Academy of Sleep Medicine Retrieved 1 October 2011 
  20. ^ Ohayon, MM; et al 1997 "Violent behaviour during sleep" Journal of Clinical Psychiatry 58: 369–76 doi:104088/jcpv58n0808 
  21. ^ Olson, EJ; et al 2000 "Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases" Brain 123: 331–39 doi:101093/brain/1232331 PMID 10648440 
  22. ^ Carey, Sarah 2001-02-13 "Dog with Rare Sleeping Disorder Sent Home After Unique Diagnosis at UF's Veterinary Medical Teaching Hospital" University of Florida Retrieved 2010-01-02 

External linksedit

  • McCarter, Stuart J; et al 2013 "Treatment outcomes in REM sleep behavior disorder" Sleep Medicine 14 3: 237–242 doi:101016/jsleep201209018 ISSN 1389-9457 PMC 3617579  PMID 23352028 
  • English BBC article 25122008: Canadian research on links between RBD and Parkinson's Disease

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