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What is REM Sleep Behavior Disorder?


What is REM Sleep Behavior Disorder?

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 nonmotor 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.

5 Comments on “What is REM Sleep Behavior Disorder?

    • Jill Kershner

      January 25, 2017 at 9:37 am Reply

      We were in Brazil when I dreamed I was rescuing people drowning by leaping off of a pier. So I leaped out of bed, head first, and hit a bamboo bed post. Every where we went people gave my husband dirty looks because it looked like he had socked me in the eye as my entire face turned black and blue. Fortunately I did not leap out a window as they were all open with no screens. I now take clonazepam (.5 mg) which allows me to sleep without endangering myself or my husband. I still talk in my sleep most nights, but he says he enjoys the chatter and my giggles.

    • Donna Miller

      July 16, 2017 at 9:25 pm Reply

      Like Jill K. who commented above, I also take clonazepam to help with REM sleep behavior. We call it my “Don’t hit D medicine.” I often threaten not to take it before I go to bed if my husband has been teasing and tormenting me as he loves to do! He could do without me punching out bad guys in my dreams, but loves when I laugh during my dreams. He never knows what is so funny, but enjoys hearing the laughter. I’d say Jill and I both have great husbands – ones who enjoy being woken up in the middle of the night just to hear their sleeping wives giggle.

      • Alex Reinhardt

        July 27, 2017 at 2:34 pm Reply

        Giggles are always better than punches! It’s good to hear that you’ve found relief while taking Clonazepam; while it works for most people experiencing REM sleep behavior disorder, others have sought out healthier sleep patterns coupled with a separate bed as their solution. Thanks for commenting!

    • Devin

      August 7, 2017 at 9:55 am Reply

      How frequent would these episodes be to raise concern? I have had 3 episodes in the last 9 months for example.
      I feel like I move frequently in my sleep sometimes, but not every night and definitely not an episode of acting out my dreams.

      • Alex Reinhardt

        August 28, 2017 at 11:22 am Reply

        Thanks for your question, Devin. Make sure to discuss these episodes with your doctor. There are some solutions out there that can prevent future episodes but keeping a log of your sleep and the frequency of episodes will help your doctor develop a plan for you. It’s important to note any change in frequency, especially if you experience episodes more and more as time goes on. In the meantime, you can begin building healthy sleep habits by following 9 Easy Tips for a Better Night’s Sleep.

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