Summary about Disease
REM Sleep Behavior Disorder (RBD) is a parasomnia in which you physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM (rapid eye movement) sleep. Normally, during REM sleep, your brain paralyzes your muscles to prevent you from acting out your dreams. In RBD, this paralysis is incomplete or absent. It can be associated with other neurological conditions, such as Parkinson's disease, Lewy body dementia, and multiple system atrophy. It can be dangerous to both the individual and their bed partner.
Symptoms
Talking, yelling, or shouting during sleep.
Making movements associated with dreams, such as punching, kicking, flailing, or leaping out of bed.
Remembering the dream content when awakened during an episode. Dreams are often vivid, action-filled, and violent, involving being chased, fighting, or defending oneself.
Potential for injury to oneself or the bed partner due to physical activity during sleep.
Daytime sleepiness is possible, but not as common as in other sleep disorders.
Causes
Neurodegenerative diseases: Often associated with Parkinson's disease, Lewy body dementia, multiple system atrophy, and progressive supranuclear palsy.
Medications: Certain antidepressants (e.g., SSRIs, SNRIs, tricyclic antidepressants) can trigger or worsen RBD.
Alcohol or drug withdrawal: Withdrawal from alcohol or sedatives can sometimes induce RBD.
Narcolepsy: RBD can sometimes occur in association with narcolepsy.
Brainstem lesions: Rarely, damage to specific areas of the brainstem can cause RBD.
Idiopathic: In many cases, the cause of RBD is unknown (idiopathic RBD). These cases often progress to a neurodegenerative disorder.
Medicine Used
Melatonin: This is often the first-line treatment due to its relative safety and efficacy in reducing dream enactment behaviors. Dosage varies significantly from person to person.
Clonazepam: A benzodiazepine that can be effective in reducing RBD symptoms, but it has potential side effects such as daytime sedation, dizziness, and dependence.
Other medications may be prescribed in specific cases or to manage underlying conditions.
Is Communicable
No, REM Sleep Behavior Disorder is not a communicable disease. It is not caused by an infection or any transmissible agent.
Precautions
Create a safe sleep environment: Remove sharp or dangerous objects from the bedroom. Pad the floor around the bed.
Lower the bed: Consider lowering the bed or placing a mattress on the floor.
Protect the bed partner: The bed partner should sleep in a separate bed or room if necessary to prevent injury.
Avoid alcohol and sedatives: These substances can worsen RBD symptoms.
Review medications: Discuss any medications with a doctor to see if they could be contributing to RBD.
Regular Neurological Follow-up: Important, especially if diagnosed with idiopathic RBD.
How long does an outbreak last?
RBD is not an "outbreak" in the sense of an infectious disease. It is a chronic condition. While individual episodes of dream enactment are brief (seconds to minutes), the underlying disorder is typically long-lasting, often lifelong. The frequency and severity of episodes can vary over time, but the disorder itself doesn't simply "go away" without treatment.
How is it diagnosed?
Polysomnography (Sleep Study): This is the gold standard for diagnosis. It involves monitoring brain waves (EEG), eye movements (EOG), muscle activity (EMG), heart rate, and breathing during sleep. RBD is diagnosed when REM sleep is present without the normal muscle paralysis (atonia).
Clinical History: A detailed interview about sleep behaviors, dream content, and any potential risk factors. Information from a bed partner is crucial.
Neurological Examination: To assess for any underlying neurological conditions.
Neuroimaging (MRI or CT scan): May be performed to rule out structural brain abnormalities.
DaTscan: May be considered if a parkinsonian disorder is suspected.
Timeline of Symptoms
Onset: Can be gradual or sudden. Often begins in middle age or later.
Early Stages: Episodes may be infrequent and mild, with subtle movements or vocalizations during sleep.
Progression: Over time, episodes tend to become more frequent and severe, with more violent movements and a higher risk of injury.
Association with Neurodegenerative Diseases: If RBD is idiopathic, signs and symptoms of Parkinson's disease, Lewy body dementia, or multiple system atrophy may develop years or even decades later.
Important Considerations
Safety is Paramount: Protecting the individual and bed partner from injury is the top priority.
Underlying Conditions: It's crucial to identify and manage any underlying neurological conditions or medications that may be contributing to RBD.
Regular Monitoring: Regular follow-up with a neurologist or sleep specialist is essential to monitor the progression of the disorder and adjust treatment as needed.
Risk of Injury: People with RBD are at high risk of injuries.
Neurodegenerative Risk: High conversion rate to neurological conditions such as Parkinson's Disease and Lewy Body Dementia.