What is REM Sleep Behavior Disorder?
People with REM Sleep
Behavior Disorder (RBD) tend to speak, shout and move
vigorously or violently during REM sleep. These episodes
of abnormal movements may result in injury to the patient
or a bed partner. If the patient awakens during these
episodes, the patient will report the dream with the
violent events that correspond with the observed
movements.
All muscles are paralyzed
during REM sleep, except those that mediate breathing and
movement of the eyes, fingers and toes. Electrical
activity and oxygen consumption of the brain continues to
the same degree as during wakefulness.
The diagnosis of RBD is
sometimes very apparent based on the patient’s history.
Other cases, it is difficult to distinguish the symptoms
from those of sleepwalking, sleep talking, seizures or
sleep terrors. It is helpful to do an overnight sleep
recording, known as a polysomnogram (PSG). The
Polysomnogram may record an episode of REM sleep behavior
disorder by recording one or more awakenings directly from
Stage REM sleep.
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What are the symptoms?
The main symptom of REM
sleep behavior disorder is dream-enacting behaviors,
sometimes violent, causing self-injury or injury to the
bed partner. The dream-enacting behaviors are usually
non-directed and may include punching, kicking, leaping,
or jumping from bed while still asleep. The person may be
awakened or may wake spontaneously during the attack and
vividly recall the dream that corresponds to the physical
activity.
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What Causes REM Sleep
Behavior Disorder?
That this time the cause
of REM Sleep Behavior Disorder is unknown, although the
disorder may be associated with other degenerative
neurological conditions such as Parkinson disease,
multisystem atrophy, diffuse Lewy body dementia, and Shy-Drager
syndrome. It is estimated that 55% of persons with the
disorder, the cause is unknown, and in 45%, the cause is
associated with alcohol or sedative-hypnotic withdrawal,
tricyclic antidepressant (such as imipramine), or
serotonin reuptake inhibitor use (such as fluoxetine,
sertraline, or paroxetine) or other types of
antidepressants (mirtazapine).
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How is it treated?
Medication can help to
treat REM Sleep Behavior Disorder such as Clonazepam (Klonopin).
Clonazepam helps to relieve symptoms in nearly 90% of
patients with little evidence of tolerance or abuse. There
is normally a response to the medication during the first
week, often on the first night. The initial dose is 0.5 mg
at bedtime, with some persons requiring a rapid increase
to 1 mg. After continued use over the years, symptoms may
resurface.
Several other
medications, such as tricyclic antidepressants, may be
effective for REM Sleep Behavior Disorder.. Though,
tricyclics are also known to increase REM Sleep Behavior
Disorder in some patients.
Persons with REM sleep
behavior disorder have a risk of injuring themselves and
their sleep partners, safety of the sleeping environment
is very important. Take the following precautions to make
the environment safe:
- Remove potentially
dangerous objects from the bedroom.
- Clear the floor of
furniture and objects that could injure the person if he
or she fell from bed.
- Place the mattress on
the floor, or place a cushion around the bed.
- Have the person sleep
in a bedroom on the ground floor if possible, especially
for people who leave the bed during an episode.
- The bedmate should
sleep in another bed until the symptoms resolve.
- A bed with padded
bedrails can be considered.
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