Rapid eye movement (REM) sleep behavior disorder occurs when a person unknowingly, physically acts out their vivid, often bad dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep.

People don’t normally move during REM sleep, which is a normal stage of sleep that occurs many times during the night.

About 20% of a person’s sleep is REM sleep, the usual time when dreaming occurs, primarily during the second half of the night.

REM sleep behavior disorder may be linked to neurological conditions, such as:

• Lewy body dementia
• Parkinson’s disease
• Multiple system atrophy

The onset of REM sleep behavior disorder can be gradual or sudden, and it can worsen over time. Episodes of the disorder occur occasionally or several times a night.

Symptoms of REM sleep behavior disorder include:

• Movements, such as kicking, punching, arm flailing, or jumping from bed, in response to action-filled or violent dreams, such as being chased or fighting off an attack
• Noises, such as talking, laughing, shouting, emotional outcries, or even cursing
• Being able to recall the dream if awoken during the episode

Usually, the nerve pathways in the brain that prevent muscles from moving are active during normal REM sleep, which results in temporary paralysis of the body. However, in REM sleep behavior disorder, the nerve pathways no longer work, causing a person to physically act out their dreams.

There are several risk factors associated with the development of REM sleep behavior disorder, including:

• Having a certain type of neurodegenerative disorder
• Taking certain medications
• Having narcolepsy
• Being male and over 50 years old

Additionally, recent evidence indicates there may also be several specific environmental or personal risk factors for REM sleep behavior disorder, including:

• Occupational pesticide exposure
• Farming
• Smoking
• A previous head injury

REM sleep behavior disorder can cause various complications, including:

• Injury to yourself or your sleeping partner
• Distress to your sleeping partner or other people living in your home
• Social isolation for fear that others may become aware of your sleep disruption

To diagnose REM sleep behavior disorder, a healthcare provider reviews your medical history and symptoms. The evaluation can include:

• Physical and neurological exam
• Nocturnal sleep study
• Talking with your sleeping partner

A healthcare provider uses the symptom criteria in the International Classification of Sleep Disorders, Third Edition (ICSD-3). The criteria include:

• You have repeated times of arousal during sleep where you talk, make noises, or perform complex motor behaviors, such as punching, kicking, or running movements, that often relate to the content of your dreams
• You recall dreams associated with these movements or sounds
• If you awaken during an episode, you are alert and not confused or disoriented
• A sleep study shows you have an increase in muscle activity during REM sleep
• Your sleep disturbance is not caused by another disturbance, a mental health disorder, medication, or substance abuse

REM sleep behavior disorder can be the first indication of the development of a neurodegenerative disease, such as Parkinson’s disease, multiple system atrophy, or dementia with Lewy bodies.

Treatment for REM sleep behavior disorder may include physical safeguards and medications.

Physical safeguards make it safer for you and your bed partner.

Medications such as melatonin and clonazepam can be prescribed to help treat REM sleep behavior disorder.

If you are experiencing any symptoms of REM sleep behavior disorder, you can consult with a neurologist at Jamaica Hospital Medical Center. To schedule an appointment, please call (718) 206-7246.

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