Facts About REM Sleep Behavior Disorder

A person sitting on a bed in a dark room


A man lying on a bed

REM sleep behavior disorder (RBD) is a sleep disorder that causes people to act out their dreams. This can include talking, walking, or even fighting. People with RBD often do not remember their dreams.

People with REM sleep behavior disorder may injure themselves or their bed partner. Bed partners of people with RBD often complain of being kicked, punched, and bitten during the night. There is also a strong correlation between RBD and severe depression. This is because dreams allow an outlet for emotional stress to be processed on a subconscious level. A person who has to repress these dreams may feel depressed because of the lack of emotional release.

Problems caused due to REM sleep behavior disorder:

A person lying on a bed

REM sleep behavior disorder occurs during rapid eye movement (REM) sleep when dreams are most active. During REM sleep, neurons throughout the brainstem are less active than during non-REM sleep. As a result, people with RBD cannot physically react to their dreams. They act them out instead. People who have RBD often display other symptoms during sleep as well, these include breathing problems and abnormal sleeping postures, which can be signs of other neurological disorders or side effects from medication.

People with REM behavior disorder tend to be older men who experience daytime drowsiness and trouble sleeping at night due to low levels of norepinephrine, a neurotransmitter that regulates arousal. Men are also more likely to experience RBD than women because of the difference in sex hormones between men and women.

Although REM sleep behavior disorder is not life-threatening, its effects on the quality of life can be severe, especially for people’s bed partners. Fortunately, treatments exist for this debilitating disorder.

Clinical syndrome:

REM Sleep Behavior Disorder (RBD) has been recognized as a clinical syndrome since 1986 by The American Academy of Sleep Medicine (AASM). It may be associated with narcolepsy; however, RBD can occur independently or secondary to other conditions such as Parkinson’s disease, restless legs syndrome (RLS), depression, dementia, drug side effects (e.g., benzodiazepine withdrawal), or addiction.

RBD is characterized by the acting out of intense, vivid dreams with violent thrashing and screaming during REM sleep. The disorder usually begins in midlife, affecting men more often than women. Most people diagnosed with RBD are between 50 and 70 years old, although it has been seen in much younger patients as well

Several distinct clinical syndromes can result due to disruptions in either normal sleep architecture or the neuronal circuits necessary for normal motor inhibition during REM sleep. These include narcolepsy-associated cataplexy (with or without other symptoms of narcolepsy), idiopathic RBD (iRBD, previously known as pure RBD), multiple system atrophy (MSA), and Parkinson’s disease plus RBD. Nocturia-associated RBD, another distinct clinical syndrome not linked to other disorders, also exists.

Role of dopamine replacement therapy:

Role of dopamine replacement therapy in REM sleep behavior disorder: While the etiology of IBD is unknown, it has been hypothesized that dopaminergic neuronal degeneration contributes to the pathophysiology of this disorder. Dopamine agonists may be beneficial for the treatment of RBD as these medications can facilitate inhibition by providing additional inhibitory input to the brainstem nuclei responsible for motor atonia during REM sleep. Although a study failed to demonstrate a significant effect on nocturnal movements with pramipexole use in patients with probable iRBD, a subsequent small open-label study demonstrated a significant reduction in sleep disruption and increased sleep time after treatment with levodopa/carbidopa (Sinemet) at 1.25 or 3.75 mg three times daily for 12 weeks, as well as improvements on the Clinical Global Impression of Change (CGIC) scale and Epworth Sleepiness Scale (ESS).

Other medications used to treat RBD include quetiapine, clonazepam, melatonin agonists, and antihistamines; however, it should be noted that these agents may worsen symptoms due to central nervous system penetration and their potential side effects. Despite limited data, dopamine receptor antagonists such as haloperidol and pimozide may also prove efficacious in treating RBD, although concerns regarding elevated death rates and neuroleptic malignant syndrome limit their widespread use.


REM Sleep Behavior Disorder is a condition characterized by the acting out of intense, vivid dreams with violent thrashing and screaming during REM sleep. In this article, we’ve provided an overview of what RBD is as well as some treatment options to improve the quality of life for those living with the disorder. If you or someone you know experiences these symptoms nightly, it may be time to seek medical attention from your physician or a neurologist specializing in sleep disorders.

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