REM Sleep Behavior Disorder

We’ve all heard dogs bark in their dreams. We’ve seen their feet twitch and can imagine them dreaming about chasing a cat. Like dogs, normal sleepers may talk in their sleep on occasion or even thrash around. REM Sleep Behavior Disorder (RBD), however, presents as active and often aggressive or violent behaviors while the sleeper engages in REM deep sleep. The disorder can therefore represent a danger to the sleeper as well as anyone the sleeper comes in contact with.

Normal sleepers cycle through light and deep sleep stages throughout the night. Sleepwalking, talking, and other nightly disturbances often occur during non-REM deep sleep, during which time it is difficult to awaken the sleeper. While it may be necessary to protect a sleepwalker from hazards, sleepwalkers rarely hurt others.

During REM deep sleep the brain experiences electrical activity and the eyes, rapid eye movement (REM). According to Sleep, Dreams and REM Behavior Disorder by Mahalia Cohen, “The majority of the Dreaming that occurs during a sleep cycle occurs during the REM or paradoxical sleep state.” During this stage of deep sleep brain activity mimics that of a wide-awake person but the body experiences paralysis. “To imagine this paralysis during dreams not occurring is a frightful image, since in many cases dreams are violent and active,” Cohen says. Those who suffer RBD may frequently harm themselves or anyone they come in contact with through no fault of their own.

Persons suffering from REM Sleep Behavior Disorder have been known to frighten and maim those closest to them as they act out their frightening and often violent dreams. In an effort to protect themselves and others from harm some sufferers bind themselves to the bed. Talking, yelling, hitting, kicking, sitting up, or jumping out of bed during REM deep sleep may indicate RBD.

Before devising a treatment plan a diagnosis may require an overnight stay at a sleep center. Sleep Medicine suggests, “A full evaluation is needed as REM Sleep Behavior Disorder may be caused by certain medications and has been also linked to Parkinson’s disease.” Physicians at the center will take the history and perform a physical examination but clinical history alone cannot complete the process.

Northwestern Memorial Hospital explains the diagnostic polysomnogram, an overnight test that records brain and body function. There are now available apparatus for home study but nothing can match the overnight stay at a sleep center.

After a diagnosis has been made, a treatment plan may include medication to suppress REM as well as the activities associated with the disorder.

Even though it seems logical that the inability to paralyze the body during sleep creates the disorder, the specific cause of the disorder is unknown. Washington University Sleep Medicine Center says, “This particular disorder can be an inherited trait, but tends to present in males more often than females. Sometimes medications such as antidepressants, can cause REM behavior disorder.”

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