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Sleep Disorders: REM Sleep Behavior

REM sleep behavior disorder is a condition in which a person acts out their dreams while sleeping. This can involve sudden movements and outbursts of talking or yelling. In some cases, it can lead to injury and can be violent at times.

Each night, your body goes through 2 different types of sleep. These are called "rapid eye movement" (REM) sleep and "non-REM" sleep. You cycle through each type several times during the night. During REM sleep, your eyes often twitch but your body normally doesn’t move. REM sleep is when most dreaming happens. In people with REM sleep behavior disorder, the body does not stay still the way it normally does during REM sleep.

REM sleep behavior disorder is different from sleepwalking, which is when a person walks or talks in their sleep. Sleepwalking is more common in children than adults, and most people grow out of it. People with REM sleep behavior disorder usually start having symptoms when they are older, often in their 60s or 70s. The disorder starts gradually and gets worse over time. It is often related to other medical conditions.

What are the signs and symptoms?

The main symptom is acting out your dreams while sleeping. Some people might punch or kick during sleep and not even realize it. Sometimes a person’s bed partner is the one who notices these actions first. Most of these episodes last for less than a minute. A person might also talk or yell in your sleep. Very active episodes might wake up the person, but they might also sleep through milder ones.

People with REM sleep behavior disorder tend to have the most symptoms during the second half of the night. That's because the body goes through more REM sleep during the second half of the night. The dreams people act out can be often scary or unpleasant. Acting out your dreams can cause injury such as falling out of bed or hitting something. It can also be dangerous for your sleep partner if you make rough or violent movements.

What are the risk factors and triggers?

REM sleep behavior disorder is caused by changes in the brain. These changes can be related to:

  • Neurologic disease such as Parkinson’s disease, which is a brain disorder that affects movement, learning, and memory
  • Dementia with Lewy bodies, another brain disorder that causes memory problems
  • Other medical conditions that affect the brain, such as a stroke or tumor
  • Narcolepsy, which is a sleep disorder that makes you feel sleepy all the time and fall asleep suddenly
  • Certain medicines, such as those used to treat depression

If your healthcare provider thinks you are at risk for one of these disorders, he or she will talk to you about what this means. In many cases, there are treatments that can help.

How is it diagnosed?

If your healthcare provider suspects you have REM sleep behavior disorder, he or she will send you for a sleep study. You are connected to different devices that monitor your heart rate, breathing, snoring, and other body functions. The results of the test can tell your provider if you have REM sleep behavior disorder or another sleep disorder.

What is the treatment?

If you have frequent or dangerous episodes during sleep, your doctor might suggest medicine. Medicines used to treat REM sleep behavior disorder include:

  • Melatonin – Melatonin is a hormone that is naturally made by a gland in the brain. Taking extra melatonin at bedtime can help your body to stay still during REM sleep. You can buy melatonin pills in a store or pharmacy without a prescription. This might involve starting at a low dose and then increasing it slowly until your symptoms improve.
  • Clonazepam – Clonazepam (brand name: Klonopin) is a drug used to treat anxiety. It can help treat REM sleep behavior disorder in some cases. Many healthcare providers prefer to try treatment with melatonin first, since it has fewer side effects than clonazepam.

If your healthcare provider thinks an antidepressant medicine is causing your sleep symptoms, stopping or switching the medicine can help or fix the problem.

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