What are the other Names for this Condition? (Also known as/Synonyms)

• Dream-Enacting Behavior
• Rapid Eye Movement (REM) Sleep Behavior Disorder

What is REM Sleep Behavior Disorder? (Definition/Background Information)

• Rapid Eye Movement (REM) Sleep Behavior Disorder is a disorder in which individuals act out the dreams that they are experiencing. This abnormal behavior occurs during sleep
• The types of behavior occurring while sleeping may include:
  • Talking, yelling, or screaming
  • Physically acting out the dreams, possibly resulting in violent action
• The disorder is caused by an abnormal transmission of signals from the brain to the muscles during sleep. The abnormal transmission occurs most often due to injured nerves or neural pathways
• Rapid eye movement (REM) is a phase of sleep cycle that generally occurs within 90 minutes of sleep. Sleep cycles are generally classified as REM and non-REM depending on the type of brain waves generated during sleep
• REM Sleep Behavior Disorder is mostly observed in male adults over 50 years old. Certain neurological disorders such as Parkinson’s disease, multiple sclerosis, or sleep apnea may be associated with the disorder
• The disorder is treated with medications which are generally found to be very effective. The prognosis of REM Sleep Behavior Disorder with suitable treatment is excellent

Who gets REM Sleep Behavior Disorder? (Age and Sex Distribution)

• REM Sleep Behavior Disorder is most commonly seen in adult men over the age of 50 years
• Although, women (over or under the age of 50) and children/adolescents may also be affected
• Typically in younger individuals, the disorder may manifest alongside other more serious neurological conditions
• No racial and ethnic preference is observed

What are the Risk Factors for REM Sleep Behavior Disorder? (Predisposing Factors)

There are a number of factors that make an individual susceptible to developing REM Sleep Behavior Disorder.

• The disorder is commonly seen in individuals with certain brain conditions. Some of the common disorders and conditions seen alongside REM Sleep Behavior Disorder include:
  • Parkinson’s disease
  • Multiple sclerosis
  • Ischemic stroke
  • Multiple system atrophy
  • Sleep apnea
  • Narcolepsy
• It is also seen in individuals who are taking certain types of medications

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of REM Sleep Behavior Disorder? (Etiology)

• The cause of Rapid Eye Movement Sleep Behavior Disorder is abnormal signal transmission due to injured nerve pathways connecting the brain to the muscles. The injured nerve pathways can occur due to certain neurodegenerative disorder or health condition
• In some cases, the cause of injured nerve pathways cannot be identified due to lack of associated underlying disorders such as Parkinson’s disease, multiple sclerosis, ischemic stroke, multiple system atrophy, sleep apnea, and narcolepsy. In such cases, the disorder is known as Idiopathic REM Sleep Behavior Disorder

Normally, the muscles of the body are relaxed and inactive in REM (rapid eye movement) sleep. In REM Sleep Behavior Disorder, the muscles are instead active. Importantly, the disorder is a medical condition rather than a psychiatric condition. Its presentation is not correlated with other behavioral disorders.

What are the Signs and Symptoms of REM Sleep Behavior Disorder?

REM Sleep Behavior Disorder is characterized by vivid, violent dreams. Individuals with the condition have been known to act out these dreams, often harming themselves and others in the process.

• Most individuals start dreaming around 90 minutes after they fall asleep. This stage of sleep is known as REM sleep; the period when individuals with the disorder start to become active
• As these individuals are performing or enacting whatever actions are taking place in their dreams, the observed behavior can be wide-ranging and include (but not limited to) the following:
  • Making abnormal noises including shouting, yelling, or grunting
  • Getting out of bed
  • Running
  • Kicking
  • Punching
• In addition, individuals with REM Sleep Behavior Disorder have reported clear recall of their dreams

How is REM Sleep Behavior Disorder Diagnosed?

The diagnosis of REM Sleep Behavior Disorder usually involves a detailed physical and mental examination by a healthcare professional as well as a sleep study. In addition, the individual’s past pertinent medical history is carefully reviewed.

• The neurological examination may focus on the symptoms and look at key areas such as:
  • Has the individual demonstrated multiple episodes of activity without consciousness throughout the night?
  • Can the individual remember the dreams and the actions that they may have performed?
  • Upon awakening from the dream, is the individual awake and alert to what is happening?
• Sleep studies are commonly performed. During the study, certain parameters such as heart rate, breathing rate, brain activity, and movements in the extremities while sleeping are measured.
• Individuals with REM Sleep Behavior Disorder may also be videotaped during a controlled sleep study to observe the pattern of their behavior

Note: Individuals with REM Sleep Behavior Disorder differ from individuals that are sleepwalkers, because they (the former) are not confused when woken up from their dreams.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of REM Sleep Behavior Disorder?

• The main complication of REM Sleep Behavior Disorder is self-injury or the affected individual harming others, as a result of their dreams. Injury may occur to babies or children sleeping with them
• The disorder may also be an indicator of future neurodegenerative disease development

How is REM Sleep Behavior Disorder Treated?

• REM Sleep Behavior Disorder is commonly treated with medications
  • Certain medications have been shown to be extremely effective in managing the condition
  • The medication helps control or stop the abnormal movements while dreaming 
• Since there are sudden movements of the arms and legs, any object or furniture should be removed to minimize self-injury or injury to others
• It is also recommended that individuals who have been diagnosed with the condition should refrain from having small babies and children around them while sleeping

How can REM Sleep Behavior Disorder be Prevented?

REM Sleep Behavior Disorder is known to be more common in individuals who do not get consistent, productive sleep. Therefore, maintaining good sleeping habits will decrease the risk of developing the condition. Such measures may include:

• Avoiding sleep deprivation
• Not using alcohol in excess
• Undertaking proper treatment of other sleep disorders
• Undertaking suitable checkups and treatment for any underlying neurological conditions

What is the Prognosis for REM Sleep Behavior Disorder? (Outcomes/Resolutions)

• The prognosis for REM Sleep Behavior Disorder is generally good, as treatment with medications dramatically improves the symptoms
• The disorder oftentimes is present with other neurological conditions; so individuals experiencing episodes may have other conditions (sometimes unidentified)
• The prognosis also depends upon the severity of the associated underlying disorders (if any). In some cases, no associated underlying disorders are identified (Idiopathic REM Sleep Behavior Disorder)

Additional and Relevant Useful Information for REM Sleep Behavior Disorder:

REM Sleep Behavior Disorder is part of a larger group of diseases known as parasomnias. Parasomnias describe conditions in which abnormal behavior of the nervous system is observed during sleep.