REM Sleep Behavior Disorder (RBD)

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REM Sleep Behavior Disorder OVERVIEW:
There are two different states of normal sleep. The first is non-rapid eye movement (NREM) and the second is rapid eye movement (REM). REM sleep is characterized by rapid eye movement, irregular breathing, rising blood pressure and a paralysis of the muscles.

During this time, there is an increase in the amount of activity that occurs in the brain that is similar to the activity experienced when a person is awake. People spend about 20% of their time in REM sleep.

An individual suffering from REM sleep behavior disorder will not experience the muscle paralysis that takes place during the normal REM cycle. This will cause the person to act out their dreams, which can result in intense and sometimes violent actions. This condition occurs mostly in middle-aged men.

SYMPTOMS:
Those most common symptoms of RBD are:

  • Enacting dreams, which may result in self-injury or the injury of a partner
  • Intense yelling, punching, grabbing, kicking, and leaping out of bed while asleep
  • Sufferers who are wakened during an episode will typically remember their dream vividly and may still be in an agitated state that reflects the activity occurring in the dream

CAUSES:
The cause of REM sleep behavior disorder is currently unknown. However, it is commonly associated with certain neurological degenerative conditions including:

  • Parkinson’s Disease
  • Atrophy
  • Dementia
  • Shy-Drager Syndrome

However, 55% of those affected with REM sleep behavior disorder have no actual cause that is connected to their episodes. Of those where a cause is diagnosed, 45% can be attributed to withdrawals from sedatives, selective serotonin reuptake inhibitors and certain antidepressants.

REM sleep behavior disorder is usually diagnosed a few years before a neurodegenerative disorder is discovered in an individual. About 38% of these who receive the diagnosis will develop Parkinson’s disease within a span of 12 to 13 years. Multisystem atrophy has a higher occurrence with 69% of patients experiencing the disorder. However, not all patients who have RBD experience additional diagnoses.

TREATMENT:
Before a treatment program is started, your physician will generally prescribe a couple of tests. Hand tremor and muscle rigidity tests will be done to determine if there is a neurological disorder present that needs to be treated.

In addition to these tests, a polysomnography will also be performed. This will monitor:

  • Brain activity during sleep
  • Activity of the heart
  • Muscle movements during sleep
  • Eye movements
  • Respiration

Based on the results that are obtained, the specialist may make some recommendations for your treatment. Usually, the doctor will have you improve the safety of your sleeping area by:

  • Removing objects from the floor
  • Removing any furniture that might present a potential danger
  • Placing a cushion on the side of the bed

Depending on the frequency and severity of the condition, certain medications can be prescribed. The most common is clonazepam, which is given to patients at a dosage of .5 mg that is increased slowly to 1.0 mg over the first week. This treatment is successful in a majority of RBD patients, who experience instant results with improved sleeping.

Melatonin has also proven to be effective and is a more natural alternative.

Medication options showing positive results in patients with REM sleep behavior disorder and Parkinson’s are levodopa and pramipexole.

Consult your doctor to see what treatment will be best for you.




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