REM sleep behavior disorder (RBD) is a non-motor and sleep-specific disorder associated with Parkinson’s. Typically, the body shuts off muscle activity during REM sleep. With RBD, muscle activity and dream enactment occur during REM sleep.
A person with RBD acts out vivid dreams in different ways that may range from talking to jumping from bed to kicking a sleep partner. Bed partners report violent responses by the person with RBD, involving being punched, bitten or kicked, while the person acting out the dream is unaware of this behavior.
People with RBD report experiencing vivid dreams and that the disorder gets in the way of having a restful night of sleep. The frequency of RBD can range from one night per month to several times per night. While RBD can occur on its own, between one-third and one-half of people with Parkinson’s report RBD as a symptom.
RBD can be an early indicator of Parkinson’s
Research shows that up to 80% of people with RBD will develop a neurodegenerative disorder within ten years. As research into preventative measures increases, this may be an important early marker to increase the efficacy of a Parkinson’s vaccine.
Restful sleep is important in general, but it is especially important for the quality of life of people living with Parkinson’s.
RBD can seriously impact bed partners as well. Often, bed partners are the first to notice the RBD symptoms, as they can be violent and dangerous for the bed partner. The person with RBD may be unaware of the violence occurring during sleep, and may feel embarrassed when the bed partner explains the situation.
If you or your loved one is experiencing RBD, discuss with your doctor. There are possible medications that can help as well as adaptations and modifications to beds and bedrooms to enhance the safety for the person with Parkinson’s as well as the partner.
Treatment and Management
Treatment aims to decrease the frequency and severity of vocalizations, motor activity and nightmares. The three most common medical treatments include clonazepam (often sold under the brand name of Klonopin), melatonin and carbidopa levodopa (Sinemet®).
Adjusting the sleeping space may also provide a solution for both the person with RBD and the bed partner. Some couples living with Parkinson’s and RBD find that getting separate beds is the most effective way to combat RBD. Separate mattresses or a protective barrier between partners often provides a safer sleeping space to promote more restful sleep for both partners.
Tips for Care Partners
The following tips can help you and your partner manage RBD:
- Talk with your partner. It is essential to maintain an open dialogue about sleep symptoms that your partner may not be aware of. Since RBD can be physically dangerous, it is especially important to find the right management options for both of you.
- Go to doctor’s appointments. You may notice new symptoms, worsening symptoms, or improvement of symptoms that your partner with Parkinson’s does not notice. Since RBD can be potentially dangerous to you or your partner, it is critical to talk with your doctor about the best options for your specific situation.
- A 2010 study found that out of 242 people living with Parkinson’s, between 31.8% and 65.2% had undeclared non–motor symptoms. This research highlights the importance of knowing about non-motor symptoms so that both people with Parkinson’s and their care partners know what to talk with physicians about.
- Find the right solution for you. Since RBD can be physically harmful to you and your partner, discover a right solution that works for both of you. It may be necessary to get separate beds or other alternative solutions to improve the situation for you and your partner.