REM sleep behavior disorder – symptoms and treatment

Henry Warren

Professional writer

If you suffer from REM sleep behavior disorder you will often violently act out your dreams.

Sufferers of REM sleep disorder may punch or kick in their sleep. They may talk or shout in their sleep or even get out of bed entirely!

All in all, whether you are a sufferer or the partner of a sufferer, you are probably going to notice the condition if it develops.

Here's the basics of REM-sleep behavior disorder, its symptoms and treatment:

What is REM sleep disorder?

REM-sleep behavior disorder is a type of sleep disorder in which you physically act out your dreams.

It is part of a group of sleep disorders called parasomnias. This type of disorder includes most of the very abnormal, unusual or undesirable behaviors which occur during sleep – things like sleep walking or sleep talking.

Rapid Eye Movement sleep behavior disorder – as you might expect – occurs during the REM stage of sleep. This usually accounts for around 20-25% of your sleeping time.

Normally during REM (Rapid Eye Movement) sleep – the sleeping phase in which dreams occur – your limbs will be in a state of temporary paralysis known as atonia. This is why you don't normally physically reproduce the actions you are taking in your dreams.

However, if you suffer from REM sleep disorder, this paralysis either does not occur or is more limited. This means a sufferer can vocalize their dreams, move about in bed – sometimes quite violently if their dream is a lively or unpleasant one – or even leave the bed or perform actions as if they were awake.

What are the different stages of sleep?

There are five different stages of sleep:

• NREM (Non-Rapid Eye Movement) – this is divided into four stages.
• REM – the fifth stage of sleep is Rapid Eye Movement sleep. Dreaming happens in this stage. It usually starts around 90 minutes into a person's sleep cycle.

Signs that a person is in REM sleep include:

• The eponymous rapid eye movements
• Irregular breathing
• Raised blood pressure
• High levels of electrical activity in the brain (similar to levels seen when awake)
• Atonia, the paralysis of your limbs (reduced or absent in REM sleep behavior disorder sufferers)

REM sleep behavior disorder – symptoms

REM sleep behavior disorder symptoms can include:

• Dream-enacting behaviors – physically, these might include kicking and punching, flailing around, sitting or jumping up in bed or even sleepwalking. They might also include talking or shouting, laughing, cursing or emotional outbursts.
• Dream recall – a common REM sleep disorder symptom is the ability to remember a dream clearly if you awaken during an episode.
• Vivid, violent dreams – unfortunately for someone who acts out their dreams (and often anyone who might be in the same bed) is that R.E.M. sleep behavior disorder sufferers often have very intense dreams.

The fact that the REM sleep phase occurs in a cyclical pattern means that most people experience around four per night. They tend to happen during the morning hours.

Episodes of REM sleep disorder behavior can happen during every phase in some cases. Equally, they may occur one per week or even once per month.

It is highly likely that if you are sharing a bed with someone and display any symptoms of REM sleep behavior disorder they will comment on it when you wake up.

What causes REM-sleep behavior disorder?

The biological cause of REM sleep disorder is that the nerve pathways in your brain which activate in your sleep to prevent your muscles from moving during “normal” REM sleep do not work correctly.

Common causes of REM-sleep behavior disorder and factors which you put you at a greater risk of developing the condition include:

• 1. Being over 50 and male – while women and those under 50 can develop the disorder – and, these days, seem to be doing so in increasing numbers – being over 50 years of age and male is common among sufferers.
• 2. Suffering from narcolepsy – this very rare long-term brain condition can lead to extreme daytime tiredness and a person falling asleep at random undesirable times. Having it can make developing REM sleep disorder more likely, particularly in younger people and women.
• 3. Suffering from certain degenerative neurological conditions – having a stroke or brain tumor or suffering from Parkinson's disease, multiple system atrophy or Lewy body dementia can increase your risk of developing the disorder.
• 4. Being on particular types of medication – several types of medication, including modern antidepressants, and the withdrawal from medication, drugs or alcohol are also risk factors.
• 5. Occupational and environmental factors – these include smoking, head injuries and working in farming or with pesticides.

REM sleep behavior disorder – treatment

REM sleep disorder may start slowly, but it will tend to get worse as time passes. This makes visiting your doctor and securing treatment an absolute priority for sufferers.

Luckily, REM sleep behavior disorder treatment usually has very positive outcomes. Treatment tends to involve:

• Medication – clonazepam is effective in 9 out of 10 cases. However, it is not suitable for people with dementia, obstructive sleep apnea or gait disorders. In these cases, melatonin or certain antidepressants might be suitable.
• Check-ups – after the initial visit to their doctor at which the disorder is diagnosed, sufferers should consider regular check-ups to check for Parkinson's disease.
• Developing sleeping strategies – taking sensible precautions such as moving the bed away from any windows, moving sharp objects or furniture away from the bed or even considering placing the mattress on the floor, surrounding the bed with cushions or moving the bed against a wall can help to manage the condition until treatment is effective.
• Improving sleeping habits – developing a a predictable timetable for your sleep cycle and avoiding recreational drugs and alcohol can help sufferers to manage the condition. There are numerous sleep tracking apps and devices to help you sleep on the market which are well worth checking out.

Your first step should always be to visit a healthcare professional though – whether that's a sleep specialist or your family doctor.

REM sleep behavior disorder can be very manageable and treatable. Yet it also isn't something you should suffer with in silence.

Henry Warren I am a professional writer and health & wellness enthusiast.