REM Sleep Behavior Disorder And Possible Resolutions

What is REM sleep behavior disorder? REM (rapid eye movement) sleep behavior disorder occurs when the normal paralysis that occurs during rapid eye movement sleep is no longer present.

Normally, this "voluntary muscle atonia" or temporary paralysis during sleep protects us from getting up and sleep walking, hurting ourselves and others, and so on. With REM sleep behavior disorder, though, this beneficial paralysis is not present.

How is REM sleep disorder diagnosed?

The patient has a history of sleep related disruptive, injurious, or potentially injurious behaviors, and has abnormal REM sleep behavior documented during previous monitoring. Epileptiform activity is also not present on an EEG as measured during sleep, in general, and other causes for the sleep disorder have been ruled out, such as medication use, mental disorder, physical or neurological disorder, or substance abuse.

What causes REM sleep behavior disorder?

The precise causes are not known, although thought that sleep regulating nuclei, particularly the pontine tegmentum, are involved. In addition, neurochemical systems may have complex interplay between them, such as between certain cholinergic, serotonergic, and noradrenergic systems not yet defined.

What happens during REM sleep behavior disorder exhibition?

Normally, skeletal muscles are temporarily paralyzed during REM sleep so that we in effect cannot get up and "act out" our dreams. For people who suffer from REM sleep behavior disorder, the suppression of normal motor activity is absent, such that they can then get up and act out their dreams, sometimes in injurious or even violent ways. In short, they can potentially be harmful both to themselves and other people in these instances. It is known that males suffer more frequently than do females from this disorder, and older people are more likely to suffer from it than are younger people. People who suffer from narcolepsy may also be more likely to suffer from this disorder.

Treatment

Treatment is individualized, but clonazepam has been shown to be particularly effective for those who suffer from this disorder, with up to 90% of patients experiencing significant to total relief. In addition, it has low occurrence of tolerance or abuse. Patients who take it often begin to experience relief within the first week and even within the first dose. Normal dose is half a milligram, with an increase to 1 to 2 mg if half a milligram is not effective.

The natural hormone melatonin has also been shown to be effective with REM sleep behavior disorder. Approximately 3 to 6 mg are usually taken, with most patients experiencing relief; in some cases, patients experienced adverse effects but this was alleviated with a decrease in dosage.

In less severe cases, medicines and chemicals may not be necessary. Simply changing one's sleep habits may be enough to assuage minor RBD. For example, sleeping on a comfortable memory foam mattress or memory foam topper can significantly reduce incidences of RBD as such sleeping surfaces limit movement and create a comfortable environment upon which to dream.