Understanding REM Sleep Behavior Disorder: Causes and Treatments

Approximately 17 types of sleep issues exist, ranging from teeth grinding and bed-wetting to more serious conditions like sleep paralysis. Many are linked to underlying health issues or early signs of neurological problems. This article focuses on REM sleep behavior disorder, which occurs when nerve pathways in the brain fail to inhibit muscle movements during REM sleep. Normally, muscle activity is temporarily paralyzed during REM, but in this disorder, movements like kicking or punching occur. These are often linked to vivid dreams.

Individuals over 50, or those with conditions such as Parkinson’s, Lewy body dementia, multiple system atrophy, or narcolepsy, are more prone to this disorder. Certain medications and degenerative diseases increase risk.

The International Classification of Sleep Disorders provides specific criteria for diagnosing various sleep conditions. For REM sleep behavior disorder, repeated episodes of arousals with movements, speech, or noises that relate to dreams are key indicators. Patients often remember their dreams and any associated behaviors. When awakened during these episodes, they remain alert and oriented. Polysomnography testing reveals increased muscle activity during REM sleep.

This condition is not caused by other sleep issues, mental health disorders, medications, or substance use. Safety is paramount—removing hazardous objects, decluttering the sleeping environment, and adding protective measures such as padding or window guards help prevent injuries.

Typically, treatment involves two main medications, both equally effective. However, one drug used for anxiety may cause side effects like dizziness, daytime sleepiness, and worsened sleep apnea. Alternatively, dietary supplements are being studied for their potential to reduce symptoms. Research continues to find improved treatment options.