A Comprehensive Guide to REM sleep behaviour disorder

A Comprehensive Guide to REM sleep behaviour disorder

REM sleep behaviour disorder (RBD) is a parasomnia in which an individual dreams that they are acting out their dreams. 

It is normal not to move in REM sleep. It is a normal phase of sleep that can often occur throughout the night. 

The average period of dreaming is most often in the second part of the evening. The time in bed will be during REM sleep accounts for 20%. 

The first signs of REM sleep disorder usually occur gradually and may worsen as time passes. 

REM sleep disorder could be a sign of other neurological disorders like Lewy body dementia (also known as dementia with Lewy bodies), Parkinson's disease, or multiple system atrophy.

REM sleep behaviour disorder (RBD) is a parasomnia condition that causes people to act out their dreams. Here’s what you need to know about this condition and how to treat it.

What happens during REM Sleep?

The fourth phase of your sleep is REM sleep. In REM times, brain activity is accelerated up to levels comparable to when you're awake, which is why REM is often associated with the most vivid dreams. 

When heart rate and breathing rise in REM sleep, most of your muscles are numb, which lets you experience vivid imagination.

Your eyes fly and move quickly under your eyelids during this sleeping time. During REM sleep, you experience increased brain activity and your pulse speed increases, and you may have dreams. 

The REM sleep phase begins after you've slept for about 90 minutes. The initial cycle typically takes about 10 minutes, and with each cycle, the time can get longer to an hour during the final period before you are awake.

The importance of REM sleep to your sleep cycle is that it stimulates the regions within your brain crucial to learning, making, or keeping memories. Research conducted by the National Institute of Neurological Disorders and Stroke found that depriving animals of REM sleep dramatically reduced their lifespan from two to three years to a mere five weeks. 

Rats that were not deprived of all sleep cycles lasted just three weeks. The significance of REM sleep, specifically, is due to the reality that the brain develops critical neural connections during this stage of sleep, which are essential to overall well-being and overall health (Sleep walking).

REM Sleep

REM sleep behaviour disorder causes

The precise causes of RBD are not known. However, it could result from degenerative neurological disorders like Parkinson's disease and multisystem atrophy (also called Shy-Drager syndrome), and widespread Lewy body degeneration. For 55% of patients, the cause is not known. 

In 45%, it is associated with alcohol or sedative-hypnotic withdrawal tricyclic antidepressants (such as imipramine) or serotonin-reuptake inhibitors (such as sertraline, fluoxetine, or paroxetine) or different types of antidepressants (mirtazapine).

RBD usually occurs many years before the onset of these neurodegenerative disorders. In one study, 38% of those diagnosed with RBD were diagnosed with Parkinson's disease in 12-13 years following RBD symptoms. 

Additionally, RBD is seen in 69% of people with Parkinson's disease or multisystem atrophy. The connection between RBD and Parkinson's disease is complicated; not all people with RBD will have Parkinson's disease.

Symptoms and Signs of REM

With REM sleep disorder, instead of the usual paralysis of your legs and arms (atonia) in REM sleeping, it is possible to play out your dreams.

The beginning of the disorder can be gradual or abrupt, and the episodes can occur at times or even several times throughout the night (Night terrors). The condition usually gets worse as time passes.

Signs and symptoms of REM sleep disorder could be:

  • Moving, like kicking or punching, arms flailing or jumping out of bed as a response to actions-filled nightmares, or even violent ones like being chased by a thief or protecting yourself from attack
  • The sounds that are made, for example, shouting, laughing, talking, emotional outcries, or cursing
  • The ability to recall the dream should you awake during the dream.

Risk Factors and Possible Complications

Risk factors

Factors that can contribute to the formation of REM sleep disorder comprise:

  • Males over 50 However, more women are receiving diagnoses of the condition, precisely those younger than 50. young adults and children may develop the disorder when it is associated with narcolepsy treatment with antidepressants or brain tumours
  • Being a particular kind of neurodegenerative disorder like Parkinson's disease or multiple system atrophy. dementia or stroke with Lewy bodies
  • Narcolepsy is a chronic sleep disorder and is characterized by excessive daytime tiredness.
  • Certain medications are taken, especially newer antidepressants and the consumption or withdrawal of alcohol or drugs.

Recent research suggests that there could be various particular risk factors, either personal or environmental. 

Factors that contribute to a REM sleep disorder could be a factor, such as exposure to occupational pesticides or farming, smoking, or having suffered a head injury previously.

Risk factors

Complications

Complications resulting from a REM sleep disorder can include:

  • Do not be a nuisance to your partner in bed or other guests within your home
  • Social isolation is the fear that other people will become aware of your sleeping disturbance
  • Injuries to yourself or your sleeping partner

Diagnosis and Treatment

Diagnosis

To identify REM sleep-related disorder, your doctor will review your medical history and the symptoms you are experiencing. Your examination may consist of:

  • The physical and the neurological examination. Your doctor analyzes the neurological and physical and assesses your condition for REM sleep behaviour disorder and various sleep-related disorders. 

A REM sleep disorder can exhibit symptoms similar to those seen in other sleep disorders or can be a co-occurring disorder in conjunction with sleep-related disorders, such as obstructive sleep apnea or Narcolepsy.

  • You are engaging in conversation with your sleep partner. Your doctor may ask your partner to sleep if they have ever witnessed you play out your dreams during sleep, for example, striking, flailing your arms, shouting, or screaming. 

Your doctor could request that your partner take a survey about your sleeping habits.

  • A sleep study at night (polysomnogram). Doctors might recommend an overnight stay in a sleep lab. 

In this test, sensors will monitor your lung, heart, and brain activity and breathing patterns, leg and arm movements, vocalizations, and blood oxygen levels as you rest. 

Usually, you'll be recorded to capture your behaviour throughout REM sleep periods.

Diagnostic methods

Sleep medicine doctors typically refer to the International Classification of Sleep Disorders 3rd Edition (ICSD-3) symptoms to determine REM sleep disorder. 

To diagnose a REM sleep disorder, the following criteria must be met: following:

  • You've experienced repeated instances of awakening during sleep. You talk, make sounds, or engage in complex motor actions like striking, kicking, or running activities often related to your dreams.
  • You may recall your dreams relating to these movements or sounds.
  • If you wake up during the episode, you're awake and alert and not confused or confused.
  • The sleep analysis (polysomnogram) indicates that you experience more muscle activity in REM sleep.
  • Your sleep disorder isn't due to a different sleep disorder, mental health condition, substance abuse, or medication.

REM sleep disorder could be the initial sign that you are suffering from an underlying neurodegenerative disorder like Parkinson's disease multi-system atrophy or Alzheimer's disease, characterized by Lewy bodies. 

If you are diagnosed with a REM sleep disorder, you must consult your physician.

Treatment

Treatment for RBD can be beneficial. The treatment usually requires prescription medication and changing the way you sleep.

Medication

Many drugs have proved efficient in the case that is a result of RBD depending on the symptoms present.

The low dose of clonazepam belonging to the class of benzodiazepine drugs may help around 90% of those suffering from RBD. 

These medications reduce the activity of muscles and help relax the body during sleep.

If clonazepam does not work, certain antidepressants or melatonin can help calm disruptive behaviour during sleep.

People suffering from gait disorders, dementia, and obstructive sleep apnea must exercise care when taking Clonazepam. Always follow the directions from a doctor or healthcare professional.

Treatment

Lifestyle Changes

There are several measures to improve the quality of sleep for RBD sufferers, for example, using a regular sleep-wake pattern to prevent sleep lack and abstaining from alcohol.

The following tips can help ensure that a person with the disease and their sleeping companion are safe:

  • Place an existing mattress on the floor, then place cushions around the bed or put the bed against the wall.
  • You might want to consider installing padded bed rails.
  • If a person suffering from RBD awakes late at night, they should be sleeping on the floor as much as feasible.
  • Be sure to keep sharp objects and furniture away from your mattress.
  • Take away any potentially hazardous objects from the area.
  • Place the bed away from the windows.
  • Bed partners should share an individual room or the bed until RBD effects are in control.

A person suffering from RBD should be screened regularly for Parkinson's disease.

Outlook

The motions that are involved in RBD could become more violent with time. The treatment for RBD is essential because it will help prevent injuries at night.

If the examination doesn't reveal the root cause, medications can be used to manage symptoms, and there is usually no problem.

If an underlying neurological disorder causes symptoms, the outcome will be based on the extent of the condition.

Frequently Asked Questions

How common is REM sleep behaviour disorder?

REM sleep behaviour disorder is a rare sleep disorder that affects less than 1% of people. It is found in approximately 2% of older adults but more than 7% in adults over 60 years.

Which disorders are associated with REM sleep behaviour disorder?

Lewy Body Dementia, Multiple System Atrophy, and Parkinson's Disease are some of the closely related REM Sleep behaviour disorders.

Conclusion

A REM sleep disorder (RBD) is characterized by violent behaviours (screaming and striking and vivid dreams) in REM sleep. 

The prevalence ranges from 1 to about 2% of the overall population and is particularly prevalent for men and people over 60. 

Over the past decade, RBD has been suggested as a possible cause of neurodegenerative diseases.

The sleep facility will be able to identify the problem. Treatment may include medication and lifestyle changes to decrease the chance of injury in the sleep time (Sleep talking).

A person with this illness may find it frightening. However, the symptoms can be managed dependent on the severity of any underlying issues.


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