REM Behavior Disorder

What is RBD?

The often agitated acting out of dreams–which should not be possible in normal individuals. Why not? Because normal individuals become paralyzed in REM sleep–the sleep stage during which our most vividly recalled dreams tend to occur.

This condition, REM Sleep Behavior Disorder (RBD) is a neurologic, not a psychiatric disorder. Because patients with this disorder tend to experience violent dreams, it can result in serious injuries as well as deaths. For example, many afflicted individuals dream that they are struggling with an intruder and in the process, attack their bed partner. It is not uncommon for these patients to put their fists through drywall or to lunge face-first into the floor or furniture.

What causes RBD?

  • It has been described most frequently in men over age 60, some of whom also demonstrate other disorders of the brain such as later development of Parkinson’s disease. Hence, in many instances, it appears to be a degenerative disorder related to aging.
  • Virtually identical attacks sometimes can be triggered by sleep apnea. It is important to look for sleep apnea with overnight monitoring before initiating treatment whenever possible, because some medications that help RBD can diminish breathing efforts during sleep.
  • RBD also can occur in younger individuals and women, some of whom will be found to have narcolepsy!
  • Drugs such as antidepressants and sleeping pills can also be factors in triggering this condition.

Can RBD be treated?

  • Treatment is available and in fact, treatment is often crucial since this disorder can prove to be very dangerous.
  • Aggravating factors should be addressed whenever possible and sleep apnea, if present should be controlled.
  • If the behaviors continue despite efforts to eliminate aggravating factors and if sleep apnea is not causing the attacks, medications will usually be helpful.
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