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Sleep Disorders 101: REM Behavior Disorder

When most people fall asleep at night and start to dream, the action takes place inside their mind.  However, for people who have REM Behavior Disorder (RBD), this is not always the case.  People with this parasomnia may do all sorts of activities while they are physically asleep because they are in effect, acting out their dreams.

During normal sleep, humans experience two different stages; rapid eye movement sleep (REM) sleep and non-rapid eye movement sleep (N-REM) sleep.  The difference between these two stages is important to understand in order to comprehend why people with RBD experience their dreams both physically and mentally.  When we are in REM sleep, our brains are as active as they are when we are awake and the results of an EEG show similar activity levels between REM sleep and wakefulness.  This means that as far as our brain is concerned, being awake and being in REM sleep are essentially the same.  The real difference is that when we are in REM sleep, our bodies experience a temporary state of paralysis, called sleep paralysis that keeps our bodies from acting on the things that are going on inside our minds.

In people with RBD, this sleep paralysis function doesn’t seem to work properly or work consistently.  This leads to a wide range of actions and activities during sleep including talking, screaming, jumping out of bed, kicking, and hitting.  The best way to explain this anomaly is that people with RBD are in effect acting out their dreams while they are asleep.  These active dreamers will often remember their dream but won’t realize they were moving around or taking actions.  They may also interact with other people and stimuli while sleeping which indicates a level of ongoing awareness of what is going on around them that may impact their overall sleep quality.

Diagnosis, Cause, and Treatment

RBD is most often diagnosed when another person witnesses the behavior and the person with the condition seeks medical help because they are worried that they may endanger themselves or others with their unconscious behavior.   RBD can look very similar to other sleep disorders like sleepwalking and night terrors which are actually related to other stages of sleep.  Because it can look like other disorders, it is important to participate in a sleep study or polysomnography in order to obtain an accurate diagnosis.

RBD can be caused by certain medication and may be experienced by people who are going through withdrawal from using drugs.  It is most commonly seen in elderly people and those with diagnosed neurological disorders that involve degeneration like Parkinson’s disease.

RBD is generally treated with medication and can be controlled this way in 90% of cases.  The medication used in treatment is dependent on the symptoms experienced and any underlying condition that is contributing to the disorder.  Those with RBD also need to create a safe, secure sleeping environment free of dangerous objects and designed to limit the danger of hurting themselves or others.

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