Have you ever had a particularly detailed dream where you wake up wondering if it was real? Or have you woken suddenly from a nightmare with a sensation of falling? Dreams can seem very real at times but, for some people, they become a reality.
Rapid eye movement (REM) sleep behavior disorder is a condition in which you physically act out your dreams. For most people, the body remains immobile during REM sleep but, for people with this disorder, they engage in both sounds and movements while they are dreaming.
This sleep disorder may not be life-threatening, but it can worsen over time and may affect your quality of life as well as your relationships. In this article, we’ll explore the topic of rapid eye movement sleep behavior disorder, providing an overview of what it is, what symptoms it causes, and how it is related to other sleep disorders. We’ll also provide information about diagnosis and treatment options.
What is Rapid Eye Movement Sleep Behavior Disorder?
When you go to bed at night, you drift off to sleep, and your brain goes through four distinct stages of sleep that cycle through until you wake in the morning. There are two different sleep states: non-rapid eye movement (NREM) and rapid eye movement (REM). The first three stages of sleep are NREM while the fourth is REM sleep.
Every night, your brain goes through the four stages of sleep several times. A complete cycle lasts between 90 and 110 minutes with each individual stage lasting for 5 to 15 minutes.
During the first stage of NREM sleep, you become drowsy, and your brain wave activity begins to slow down as your muscles relax. In the second stage of NREM sleep, your eyes move slowly while your brain waves continue to slow down.
You may experience sudden bursts of brain activity known as sleep spindles, but you won’t wake as easily as in the first stage. The third stage of NREM sleep is the most restorative stage of sleep, consisting of delta waves.
After passing through the first three stages of sleep, your brain enters REM sleep – this accounts for about 20% of your total sleeping time.
In this stage, your eyes move rapidly from side to side, and your brain waves become more active – this is the dreaming stage. Even though you are technically asleep, your brain is almost as active as it is while you are awake.
For a person with rapid eye movement sleep behavior disorder, the line between wakefulness and sleep is even more blurred.
Rapid eye movement sleep behavior disorder is a condition in which the sleeper acts out his or her dreams.
For most people, the body is paralyzed during REM sleep but, in people with this disorder, that paralysis is incomplete or completely absent. Someone with this disorder might talk, yell, punch, kick, flail, grab, sit up, or even jump out of bed.
What Are the Symptoms of Rapid Eye Movement Sleep Behavior Disorder?
The primary symptom associated with rapid eye movement sleep behavior disorder is dream-enacting behavior that comes during sleep. In most people, the REM stage of sleep is one in which arm and leg movements are minimized if not fully restricted. The body becomes increasingly more relaxed as you move through the first three stages of sleep until you are almost completely paralyzed during the REM stage. This is also when sleep paralysis occurs – the transition between sleeping and waking.
People with rapid eye movement sleep behavior disorder exhibit incomplete or absent paralysis that normally comes with REM sleep. As such, they actually act out their dreams with various movements and vocalizations.
Here are some of the most common symptoms of rapid eye movement sleep behavior disorder:
- Arm movements such as punching, flailing or grabbing
- Leg movement such as kicking
- Sitting up suddenly or jumping out of bed
- Talking, laughing, shouting, cursing, or yelling
All of these movements occur while you are dreaming and are in response to the dream you are having. In many cases, episodes of rapid eye movement sleep behavior disorder occur during particularly vivid or violent dreams.
You might dream, for example, that you are being chased or that you are defending yourself from an attacked. In these cases, you might wake up to find that you’ve physically left your bed in an attempt to escape or that you’re flailing against your bed partner, imagining that they are the assailant from your dream.
People who suffer from rapid eye movement sleep behavior disorder typically find that the symptoms come on gradually and that the disorder worsens over time.
At first, you may wake suddenly, but you will be alert and not disoriented – many people with the disorder find that they clearly remember their dreams upon waking. They may not, however, realize that they were acting out dream behavior unless there is a bed partner or family member there to witness it.
Rapid eye movement sleep behavior disorder is sometimes described as a parasomnia because it is characterized by involuntary and unwanted behaviors that occur during sleep.
It can be particularly problematic when the dreamer enacts a violent dream against a bed partner or if they leave the bed and put themselves in danger. Each episode can last anywhere from a few minutes to an entire REM sleep cycle, occurring as many as four times per night. These episodes don’t tend to happen during naps, and they generally don’t lead to daytime sleepiness.
What Causes Rapid Eye Movement Sleep Behavior Disorder?
The underlying cause of rapid eye movement sleep behavior disorder is a blurring of the line between the different sleep states.
As is true for other sleep disorders like narcolepsy and parasomnia, the brain may not make the transition from wakefulness to sleep and back to wakefulness as smoothly as it should. In a way, the characteristics of one sleep state carry over into the others.
Rapid eye movement sleep behavior disorder is commonly linked to other sleep disorders such as narcolepsy, periodic limb movement disorder, and sleep apnea. Though rapid eye movement sleep behavior disorder itself may not lead to excessive daytime sleepiness, any of these other sleep disorders can. This, combined with the interruption of sleep for bed partners or family members, can lead to a significant disturbance that may affect the patient’s quality of life.
The exact cause of rapid eye movement sleep behavior disorder is unclear.
What researchers do know is that there is a connection between rapid eye movement sleep behavior disorder and various degenerative neurological conditions such as multiple systems atrophy, Parkinson’s disease, and diffuse Lewy body dementia. In about 45% of cases, the condition is associated with withdrawal from alcohol or sedative-hypnotic medications or certain antidepressants. The exact nature of these relationships is still the subject of study.
This sleep disorder occurs most commonly in men, particularly after the age of 50. It is fairly uncommon in women and children, and it is thought to affect less than 1% of the population.
Rapid eye movement sleep behavior disorder affects the elderly at a higher rate and is most often seen in people with neurological conditions such as Parkinson’s disease and multiple system atrophy. In many cases, symptoms of this disorder present years or decades before these neurological conditions.
In addition to the correlation between this disorder and neurological conditions, there is also a link between rapid eye movement sleep behavior disorder and other sleep disorders.
For example, people with this condition have a higher risk for developing sleep apnea, narcolepsy, and periodic limb movement disorder. Other risk factors include withdrawal from drugs or alcohol, sleep deprivation, brainstem tumors, stroke, and the use of certain medications.
How is Rapid Eye Movement Sleep Behavior Disorder Diagnosed?
Though rapid eye movement sleep behavior disorder is not immediately life-threatening, there is some risk for sleep disturbance and potential injury if you leave your bed while still asleep.
If you sleep with a partner or live with family, your dream-enacting behavior might interfere with their sleep or even put them at risk for physical harm. Some people with this disorder also develop anxiety about the problem and isolate themselves from others. These things are enough for most people to seek treatment.
Something else you should consider if you’re thinking about ignoring the symptoms of rapid eye movement sleep behavior disorder is that people who have this condition have a higher risk for developing more serious cognitive, neurological, and emotional problems later in life.
The link between this disorder and neurological conditions like Parkinson’s has already been discussed, but some other connections have been identified for things like apathy, anxiety, attention deficits, and problems with executive functioning skills.
If you’re concerned about symptoms of rapid eye movement sleep behavior disorder, talk to your doctor.
Your primary care physician will likely be unqualified to make a clinical diagnosis of this uncommon condition, but they can refer you to a sleep specialist.
To make a diagnosis, you may need to undergo the following:
- A thorough review of your medical history
- A discussion of symptoms, including frequency and severity
- Physical and neurological exam to rule out other sleep disorders
- Discussion between your doctor and sleep partner
- Nocturnal sleep study (polysomnogram) performed in a sleep lab
Any or all of these things may be required to rule out underlying medical causes for your behavior and to confirm a diagnosis of rapid eye movement sleep behavior disorder.
In order to make a diagnosis, your sleep specialist will likely use the criteria from the International Classification of Sleep Disorders, Third Edition (ICSD-3).
Here are those criteria:
- Repeated times of arousal during sleep where the patient talks, makes noises or performs complex motor behaviors that often correlate with the content of the dream
- Patient recalls the dreams associated with these sounds and movements
- No confusion or disorientation if woken during an episode
- Polysomnogram results showing increased muscle activity during REM sleep
- Sleep disturbance not caused by another sleep disorder, mental health condition, or by medication or substance abuse
Because rapid eye movement sleep behavior disorder is closely linked to neurological diseases like Parkinson’s, a diagnosis of this condition may lead to further testing and treatment.
If you haven’t yet begun to exhibit symptoms of a neurologic disorder, treatment may be limited to safety measures to keep you safe and, possibly, medications to mitigate symptoms.
What Are the Treatment Options for Rapid Eye Movement Sleep Behavior Disorder?
Though rapid eye movement sleep behavior disorder is not a life-threatening condition, it does tend to worsen over time. If your symptoms progress, you could put yourself or your bed partner at risk. It is also important to remember that this condition is frequently linked to other sleep disorders as well as more serious neurological conditions. For all of these reasons, it is important to seek treatment for rapid eye movement sleep behavior disorder as early as possible.
When it comes to treatment of rapid eye movement sleep behavior disorder, there are two primary focuses: safety precautions and medications.
Bedroom safety precautions can help keep both the patient and the bed partner safe. These precautions might include things like moving objects away from the bedside and moving the bed away from the window. You could also place a large object like a dresser in front of the window or door. Another option is to place your mattress on the floor to reduce the risk of injury.
Medications for rapid eye movement sleep behavior disorder typically include clonazepam and melatonin, as well as certain antidepressants.
Clonazepam is a benzodiazepine that is effective in roughly 90% of cases for this disorder. It suppresses muscle activity and helps relax the body during sleep to prevent you from acting out your dreams. Melatonin is a hormone produced naturally in the body that helps reduce muscle tone to decrease movement during REM sleep.
Here are some other things you can do to manage rapid eye movement sleep behavior disorder:
- Stick to a regular sleep schedule to avoid sleep deprivation
- Seek treatment for any concurrent sleep disorders
- Avoid excessive use of alcohol or certain medications
- Undergo additional monitoring for neurologic symptoms
We all have strange dreams from time to time, but most people don’t act on them or even remember them in the morning.
For people with rapid eye movement sleep behavior disorder, however, the line between sleeping and waking becomes blurred which sometimes leads to dream-enacting behavior. If you or a bed partner exhibits symptoms of this disorder, seek medical care sooner rather than later.
Disclaimer: The information on this website is not intended to be used as a substitute for professional medical advice, clinical diagnosis, or treatment. Always seek the advice of your personal physician or another qualified health provider with any questions you may have regarding a medical condition.
