REM Sleep Behaviour Disorder Symptoms and Causes

Did you know that we humans spend one-third of our lives sleeping? Sleep is quite important for our well-being, in fact, if you don’t have a good night's sleep, it can reflect on you throughout your day’s activity.  

Sleep may sound simple, uncomplicated process, however, that’s not the case. It is quite a complex process, and one fascinating aspect of sleep is rapid eye movement (REM), a normal phase of our sleep. However, sometimes things go wrong leading to a condition called REM sleep behaviour disorder (RBD) wherein, this normal phase of our sleep gets disrupted.  

In this article, we will discuss everything you need to know about this condition. 

Overview of REM Sleep 

Rapid eye movement or REM is one of the phases our brain goes through during the sleep cycle. During this period, our body goes through several physiological changes, such as increased brain activity, eye movement, muscle relaxation, and quicker respiration. About 90 minutes into our sleep, we generally enter the REM sleep phase, and it occurs every 1.5 to 2 hours.

Symptoms of REM Sleep Behaviour Disorder 

The REM sleep phase makes our body more relaxed, however, RBD, on the other hand, makes us physically act to our dreams, leading to movement and behaviour. Here are some of the primary and associated symptoms of REM sleep behaviour disorder. 

Primary Symptoms 

Some of the primary symptoms include:  

Acting Out Dreams 

In our dreams we see strange things, however, the REM sleep phase helps us remain physically still, stopping us from acting out these dreams. But, with REM sleep behaviour disorder, people physically perform actions from their dreams, including movement and violent behaviours. 

Vocalisations During Sleep 

People with this condition often shout, talk, or make other sounds while asleep, mirroring the experience of their dreams. These vocalisations can be simple utterances or complex sentences. 

Sudden Limb Movements 

In REM sleep behaviour disorder, people even experience uncontrollable and forceful movements of their arms and legs, which are often a result of their response to their dream events. These movements can range from simple jerks to behaviours such as punching, kicking, and moving out of bed. 

Unintentional Injuries 

The condition makes one move and is involved in behaviours that can lead to unintended injuries, which may include bruises, cuts, or broken bones due to being out of bed or getting objects during sleep. Bed partners can also have the chance of getting injured. 

Associated Symptoms 

Some of the associated symptoms include: 

Sleep Disruption 

The symptoms, such as body movement and vocal outbursts of RBD, can greatly influence one’s sleep quality, not just for the individual but also their bed partner. This can also lead to other conditions, such as insomnia and daytime fatigue. 

Daytime Sleepiness 

Due to disturbed and non-restorative sleep, individuals with RBD frequently experience extreme daytime sleepiness, which can impact their everyday activities, concentration, and mood, consequently affecting their social, professional, and personal lives. 

Difficulty Awakening 

People who have sleeping difficulties may experience problems when it comes to waking up in the morning: they may need several alarms or someone else’s help to wake up from bed. Such a problem may dictate a stressful and hectic pace to a person’s morning, which in turn, may lead to chronic lateness or even truancy coming to work or school. 

Confusion Upon Waking 

Disturbed arousal is another symptom of RBD that can result in difficulty in focusing in the morning and in comprehending the environment and the events of the night. As a result, individuals may experience anxiety and confusion.  

Causes of REM Sleep Behaviour Disorder 

When we fall asleep and enter into the REM sleep phase, our body muscles experience temporary paralysation, helping us stay safe while dreaming. But for people with RBD, this phase doesn’t happen and due to this they unknowingly act out their dreams. The exact causes of RBD are not known, however, scientists believe the following conditions may cause RBD. 

Neurological Conditions 

RBD is known to be an initial sign of other neurodegenerative diseases like Parkinson’s disease, Lewy body dementia, and multiple system atrophy. These illnesses cause gradual dysfunction of the brain and the nervous system, which results in disruption of the sleep regulation process. 

Medication Effects 

Some drugs, including certain antidepressants, can disrupt normal sleep patterns and hence are known to have connections with RBD. In some instances, when these drugs are changed or stopped completely, the symptoms of RBD are reduced. 

Other Contributing Factors 

However, it is worth noting that there are other risk factors, though less common, associated with the development of RBD. These include substance abuse, especially alcohol and sedatives, head trauma, and some sleep disorders, but the nature of these factors and their connection with RBD is not always clear. 

Diagnosis of REM Sleep Behaviour Disorder 

There are multiple methods professionals use to determine if a person has REM sleep behaviour disorder or not. Some of the techniques they use include:  

Sleep Study (Polysomnography) 

Polysomnography is a multi-parameter in-lab sleep study wherein the test records various functions of your body while you sleep. For example, your heart rate, brain wave activity, eye movement, breathing rate and airflow, and muscle movements. The test is usually conducted during the night; however, it can be done during the daytime if the circumstance demands it. 

Patient and Bed Partner Reports 

Diagnosis of RBD often starts with detailed reports from the patient’s bed partner. These accounts include descriptions of dream enactment behaviours such as talking, shouting, or physical movements during sleep. Bed partners offer critical observations of these activities, which the patient might not be aware of and can help professionals identify patterns and severity of symptoms. 

Medical History Review 

Medical professionals often examine the patient’s past and present health conditions, what type of medications they’re using, how long they have been using, and if there are neurological or psychiatric conditions. They also look for underlying conditions that may be contributing to RBD, for example, neurodegenerative diseases like Parkinson’s. 

Treatment and Management 

Now let’s understand what are some of the effective treatments for REM sleep behaviour disorder and strategies to manage it.  

Medications 

Though there are no specific medications approved for REM sleep behaviour disorder, medications such as melatonin, clonazepam, and pramipexole can help one manage its symptoms. Professionals often prescribe these medications to improve symptoms. 

Behavioural Strategies 

Some behavioural interventions are effective when used along with taking medicine. Sleep hygiene practices, such as maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and avoiding stimulants before sleep, can improve overall sleep quality. Stress management techniques like meditation or yoga may also be helpful. 

Safety Precautions and Lifestyle Adjustments 

Prioritising safety is crucial for individuals with RBD. Creating a safe sleep environment involves removing sharp, glass, or heavy objects from the bedroom, using bed rails, placing mattresses on the floor next to the bed, and potentially sleeping in a separate room. Regular exercise, a balanced diet, and avoiding excessive alcohol and caffeine can contribute to better sleep and overall health. 

Living with REM Sleep Behaviour Disorder 

Coping with RBD can be challenging, but with appropriate management, it's possible to improve sleep quality and reduce daytime symptoms. Here are a few strategies to consider: 

Daily Life Adjustments 

The most crucial approach in handling RBD involves reducing the chances of getting injured at night, therefore, eliminating potential dangers in the bedroom. Establishing consistent sleep routines, practicing relaxation techniques, exercising regularly, eating a balanced diet, and considering sleep aids may also help.  

Support and Resources 

It is important to stay in touch with support groups as they can be a source of useful information and positive support Seeking the help of healthcare professionals – sleep doctors and neurologists – is important for diagnosis, treatment, and further management Using the available materials, including online communities and informational literature, can be helpful as well. 

Mindful Strategies to Overcome REM Sleep Behaviour Disorder with MindTalk 

Cadabam’s MindTalk deals with REM Sleep Behaviour Disorder in a comprehensive manner. Our therapists provide tailored support through cognitive-behavioural therapy, stress-reduction approaches, and sleep hygiene principles. 

By understanding the root causes and developing coping mechanisms, individuals can significantly improve not only their sleep quality but also their overall well-being. Our supportive environment promotes a safe space for patients to share their experiences and work towards a better night's sleep. 

FAQs 

What is the cause of REM Behaviour disorder? 

The exact cause of REM Behaviour Disorder is still unknown. There are theories linking it to factors such as neurodegenerative diseases, medication, and factors such as substance use, but a definitive cause has not been established. 

What causes excessive REM sleep? 

Excessive REM sleep can be caused by sleep disorders, such as narcolepsy, or disrupted sleep patterns. It may also be linked to stress, depression, or medication effects. Consult a healthcare professional for a precise diagnosis and treatment. 

How do I stop REM sleep disorder? 

Consult a healthcare professional for a diagnosis. Treatment may involve medications like melatonin or clonazepam and lifestyle changes such as a safe sleep environment, stress management, and avoiding alcohol. Regular follow-ups are crucial for effective management. 

Can REM sleep disorder be caused by stress? 

Yes, stress can contribute to REM sleep disorder. Stress can disrupt sleep patterns and potentially trigger or exacerbate symptoms of REM sleep behaviour disorder, which involves acting out dreams during REM sleep.