REM Sleep Behavior Disorder

 REM sleep behavior disorder is catageorized as a parasomnia, for although it occurs as part of the sleep process, it's not necessarily associated with disrupted sleep, or with excessive sleepiness. It involves the enactment of vivid dreams, it is living the dream to its full extent, whether it be a particularly violent one or a peaceful dream.

The dream enactment occurs during rapid eye movement sleep, it may involve shouting, screaming, sobbing, kicking, punching, jumping out of bed, or any number of other physical activities which take place in the dream. During normal REM sleep the sleeper is in an atonic state or sleep paralysis, however, in REM sleep behavior disorder the normally dormant neurotransmitter acetycholine is not blocked and the voluntary muscles become tonic.

There may be more than one episode of REM behavior disorder throughout the night, the first one occurring about 90 minutes after falling asleep, with up to 4 more episodes until waking. However, this is not necessarily the general rule, some may experience one a night, or one a month, the disorder does not manifest during naps. The dreamer does not experience sleepiness during the day as a result of their violent dreams, it's usually their partner who has this problem. 

The person with this disorder has no memory of having such active dreams during the night, and if the person lives alone it may be almost impossible to be aware of the problem. Those who have long suffering bed partners are bound to be informed of their problem, and therefore measures will be taken to treat it. The dreamer may remain unconvinced of their violent dreams, until presented with the evidence of the damage they have caused to their bed partner, with their wildy flailying limbs.

REM sleep behavior disorder is usually found in older males and may indicate the possiblity of a neurological problem at a later stage, or else it may be part of an already existing health problem. Although this disorder can appear at any age, sometimes as early as 50 years, it most often occurs in elderly males who have Parkinson's disease, or Multiple system atrophy. It does occur in a very small percentage of females, and has been known to occur in childhood.

Cause of REM Sleep Behavior Disorder

 In a recent study, Nightingale et al suggested that 36% of persons with narcolepsy experience symptoms of REM behavior disorder, because of this researchers consider there may be  a strong association of REM behavior disorder with HLA class II genes.

RBD may be idiopathic, or it may occur in association with various neurological conditions, such as brainstem neoplasm, multiple sclerosis affecting the brainstem, olivopontocerebellar atrophy (OPCA), DLB disease, Alzheimer dementia, progressive supranuclear palsy (PSP), or Shy-Drager syndrome (multiple system atrophy).

Other factors may be involved in this disorder such as, alcohol withdrawl, sleep deprivation, brainstem tumors,  stroke, medications, or psychiatric disease.

Treatment of REM behavior disorder

REM behavior disorder is treated with medications according to the manifestating symptoms, and the underlying disease state. Clonazepam is frequently prescribed, however, at exactly what cost to the already compromised health of the person with the disorder is hard to predict. Varied drugs will be tried in an effort to contain the problem. 

An important consideration is environmental safety, both for the patient and the bed partner. Potentially  dangerous objects should be removed from the bedroom, lamps or any other objects which could cause injury should be removed from the bedroom . The bed should be moved away from the window, and  cushions should be put around the bed, and most importantly the bed partner should move to another room until the condition is under control.

A German study done by Dieter Kunz, M.D., and colleagues, of Charité Hospital in Berlin has found that melatonin reduces the symptoms of REM sleep behavior disorder, and it some cases has caused complete cessation of the disorder.   

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