Sleep is a time for rest for most of us. Our body recuperates from the stresses of the day when we sleep. But for those of us suffering from REM Sleep Behaviour Disorder, sleep can become a cause of stress.

When we are in the REM phase of our sleep, we have rapid eye movements, our breathing becomes irregular, our blood pressure goes up, and there is a loss of muscle tone(temporary paralysis). In REM Sleep Behaviour Disorder, the temporary paralysis that occurs is missing, so you act out your dreams.

Those suffering from this disorder will often have sudden arm and leg movement while they sleep and they also tend to talk, shout and scream. REM Sleep Behaviour Disorder is associated with other neurological ailments like Lewy body dementia and Parkinson’s Disease.

Symptoms of REM sleep behaviour disorder

The onset of the symptoms of this disorder is gradual, and they can get worse over time. For most cases, these episodes of dream enactment take place within 90 minutes of falling asleep. These are some common symptoms of this disorder:

  • One of the main symptoms of this disorder is sleep enacting. The patient will make sudden, often violent movement and can cause harm to himself and his sleeping partner.
  • The patient may awake from his dream and will be able to recall the dream vividly.
  • The patient of this disorder also talks, laughs, cries and even curses while sleeping.

You must consult your doctor immediately if you are experiencing any of these symptoms.

Causes

Though the exact cause of this disease is not known, it is associated with degenerative neurological conditions like Parkinson’s disease, multistem atrophy and diffuse Lewy body dementia and Shy-Drager syndrome.

In some cases, alcohol and sedative-hypnotic withdrawal can lead to this disorder. Use of tricyclic antidepressants, serotonin reuptake inhibitor and other types of antidepressants can also cause this disease.

According to one study, 38 percent of patients with REM Sleep Behaviour Disorder developed Parkinson’s after 12 to 13 years. However, not all patients with this disorder develop Parkinson’s.

Risks Factors

  • Men over 50 years are at a higher risk to develop this condition. Now even women under 50 are being diagnosed with this disorder.
  • If you have a neurodegenerative disorder, you are at a higher risk for developing this disorder.
  • Those people who have narcolepsy (a sleep disorder characterised by overwhelming drowsiness during daytime) can also develop symptoms of this disorder.
  • Occupational pesticide exposure or smoking or a previous head injury can also increase your risk for REM Sleep Behaviour Disorder.

Diagnosis and treatment

Consult your doctor for diagnosis of this disorder. Your doctor may ask the patient to take a neurological exam and also refer you to a neurologist. The doctor may also monitor the sleep pattern of the patient. Here are some of the tests that patients may have to take for proper diagnosis of REM Sleep Behaviour Disorder.

Neurological examination

Neurological examination check for the symptoms of Parkinson’s disease like hand tremors, slowness in movement and muscle stiffness.

Polysomnography

Specialists do these tests in a sleep study centre. This involves the patients going to sleep in the centre while the doctors monitor his parameters through the following:

  1. Electroencephalogram(EEG): To monitor the brain’s electrical activity.
  2. Electrocardiogram(ECG): To monitor the activity of the heart.
  3. Electromyogram(EMG): To monitor the movement of the muscles.
  4. Electrooculogram(EOG): To monitor eye movements.
  5. Respiratory movements are also monitored.

Continuous video recording is done to observe the behaviour of the patient during sleep. This is done to rule out other disorders like obstructive sleep apnea(OSA).

Imaging studies

Imaging studies like CT scan or MRI are not routine procedures for RBD. Doctors conduct these procedures for younger people with suspected RBD where there is no reason for this disorder like alcohol or medicine abuse.

The good news is that doctors can cure most cases of RBD with the use of medicines. Clonazepam is one of the most commonly used drugs for this disorder.

Use of this drug can cause specific side effects like memory loss, confusion, sleepiness and lack of balance. Doctors also prescribe melatonin as a supplement to get rid of the symptoms.

Precautions

It is essential to take these precautions to ensure patient safety while the treatment is going on.

  • Remove sharp and harmful items from the bedroom.
  • Clear the room of extra furniture that may harm the person if he falls out of bed.
  • Place the mattress on the floor.
  • Shift the person’s bed to the ground floor if possible.

Conclusion

REM Sleep Behaviour Disorder is not something that we should take lightly. Consult a specialist if you observe your partner acting out his dream. This disorder is treatable, but you must act quickly so that the consequences are a lot less harmful.