Have you ever kicked, jumped up, punched, flailed, shouted, or leapt out of bed while you were still asleep? Has your bed partner ever expressed concern about your unusual behaviors while you were sleeping? Do these actions match vivid dreams that you could clearly recall? Have any of these activities during your sleep ever resulted in an injury to you or your bed partner? If your answer to the first question and at least one of the ones that follow is yes, then you might have REM sleep behavior disorder, also known as RBD.
Rapid eye movement behavior disorder is an uncommon sleep disorder first described in 1986. REM Sleep Behavior Disorder or RBD, proved to be an early warning sign of a serious neurodegenerative disease for most patients. In the 20 years of studying RBD, Mark Mahowald and Carlos Schenck, working at the Minnesota Regional Sleep Disorders Center in the Hennepin County Medical Center, have found that 70 percent of otherwise healthy patients with the sleep disorder have gone on to develop Parkinson's disease or a related disease, usually within a period of 10 to 15 years of the onset of RBD.
The main symptom of this sleep disorder is the loss of muscle control while in the REM (rapid eye movement) stage of sleep. Normal sleep is made up of a series of REM dream episodes which occur about every 1 ˝ to 2 hours a night. An RBD episode usually first appear at least 1 ˝ hours after a person falls asleep. They may continue to happen until waking up in the morning. Active RBD events might appear as many as four times per night, or could also occur as rarely as once per week or per month. RBD does not normally appear during a nap. There are also other sleep conditions which go along with the RBD sleep disorder, like sleepwalking, narcolepsy and night terrors. The symptoms are different in each individual with regard to frequency and intensity.
While there is no known cause for RBD, it is characterized by brain activity patterns which resemble those of wakefulness and which have been documented with polysomnography and other sleep tests. Most dreaming occurs to a person during REM sleep, and a characteristic of REM sleep is a general state of atonia, or sleep muscle paralysis. While the brain is very active during REM sleep, the body usually is still.
People who suffer from rapid eye movement behavior disorder will act out dramatic and/or violent dreams during the REM stage of sleep. Another feature of RBD is shouting and grunting. RBD seems similar to other sleep disorders that involve motor activity, like sleepwalking or periodic limb movement disorder. Diagnosis and treatment will utilize elements like polysomnography, drug therapy, and the exclusion of potentially serious neurological disorders.
While RBD usually occurs in men 60 years old or older, it can also show u[ in younger people and in women. Parkinson's disease affects as many women as it does men, but this isn't true of RBD. Incidents of REM behavior disorder are often described anecdotally only to family members and not physicians, so statistics of incidence are very inexact.
The basic cause for sleep paralysis during REM happens in the brainstem, the part of the brain that connects the spinal cord with the cerebral hemispheres, and includes the pons, midbrain, and the medulla oblongata. While doctors do not totally understand this complex processes, it has been shown that the brainstem undergoes changes in REM sleep which results in paralysis of the body's voluntary muscles. Certain neurotransmitters, like acetylcholine (Ach), become dormant and do not naturally transmit motor activity to ensure restful, inactive sleep during the most electrically active stage of sleep. In this context, sleep paralysis describes a normal state of sleep, unlike sleep paralysis experienced in narcolepsy, which affects people while they are trying to stay awake.
In RBD, neurotransmitters are not blocked, and the voluntary muscles can be rigid and extremely tense during episodes, allowing a sleeping person to move during REM. Often, sleepers curl up slightly, while flexing their limbs and chin. The combination of heightened cerebral activity and the ability for muscular movement results in physically acting out dreams that involve excited and sometimes violent maneuvers.
People suffering RBD do not remember any of this activity, unless they fall out of bed, bump into the furniture, or injure themselves and wake up. But they can usually remember and give details of the dreams they had during an episode.
Dreams that involve physical or violent activity—like fighting, dancing, running, chasing, attacking, being attacked, and running from an assailant—are more likely to trigger RBD activity. Sleepers with RBD sometimes injure their bed partners. Some people have been known to leave the bed, run into a wall, run through a window, or run down the stairs. But RBD activity is usually confined to the bed and the surrounding area. Episodes tend to get worse over time. Early episodes may involve mild activity. Later episodes can be more violent. RBD is often ignored for years.
Due to the fact that REM sleep behavior disorder (RBD) may occur in association with neurodegenerative disorders, such as Parkinson disease, multiple system atrophy, and dementia, be sure to consult a neurologist to rule out these conditions. RBD symptoms may be the first manifestations of these disorders, so having a careful follow-up is needed, and those with RBD should watch for symptoms of Parkinson’s such as tremor, although not all persons who exhibited RBD go on to develop Parkinson disease.
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