Rapid Eye Movement Sleep Behavior Disorder
REM sleep behavior disorder is a very common REM parasomnia. RBD is a failure for atonia to occur during REM sleep and therefore the RBD patient is not paralyzed and acts out during dreaming. This can result in the patient or sleeping partner being injured, as many times, the patient flails arms and legs around during a dream, even shouting and swearing . Remember, however, that the patient is asleep and unaware of this behavior. RBD has a clear demographic: 90% of RBD patients are male and over the age of 50. RBD is thought to be associated with impairments in the motor systems in the brain since they do not activate at the onset of REM with typical atonia. In fact, a large number of older male patients with RBD were reported to develop Parkinson’s disease, a degenerative neurological disease that affects the cortical motor systems . Thus RBD may be an early indicator of a predilection to Parkinsonian disease.
What Is Rapid Eye Movement Sleep What Parasomnias Happen During This Sleep Stage
Rapid eye movement sleep follows the three non-REM stages of the sleep cycle. During REM sleep, your eyes rapidly move under your eyelids and your heart rate, breathing and blood pressure are all increased. This is a time when vivid dreaming occurs. Your body cycles through and repeats non-REM and REM sleep about every 90 to 110 minutes.
Parasomnias happen during the latter part of the night. If awakened during the event, its likely youd be able to recall part or all of the dream.
Parasomnias that happen during REM sleep include:
Other parasomnias include:
New Pd Subtypes In Development
New classifications of patients with PD may improve both diagnostics and the accuracy of predicted outcomes.
A newly developed system of three subtypes focuses on the severity of key motor and non-motor symptoms and highlights RBD as a relevant non-motor marker.
Thomas Warner MD told Medscape Medical News recently that We have found that it is possible to accurately predict prognosis, disability, and survival of patients with Parkinson’s disease by classifying them into different clinical subtypes at the time of diagnosis.
Warner, senior author of a new study published in January 2019 at JAMA Neurology, defines these subtypes as:
People with PD who also have RBD will likely fall into subtype 2. However, this distinct symptom can help chart a clearer treatment path and prepare you for a more aggressive clinical approach.
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Myth #: Rbd Is Primarily A Psychiatric Condition
Fact: RBD is a neurological condition recognized by medical and mental health professionals.
People may mistakenly think that REM sleep behavior disorder is mainly a mental health issue because it has to do with disrupted sleep caused by dysfunction in the brain. The myth is likely reinforced by the conditions inclusion in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition by the American Psychiatric Association .
In actuality, the DSM-5 contains many physical health and mental health disorders, especially when physical health disorders connect to psychological symptoms like depression and anxiety. The DSM-5 lists many sleep-wake disorders including:
- Restless leg syndrome
- REM sleep behavior disorder
No one would likely consider narcolepsy and restless leg syndrome firstly as psychiatric conditions, so the same standards should apply to RBD. RBD is a neurological condition, not a psychiatric condition.
When a person is in REM sleep, the brain is supposed to shut down muscles to prevent movement. In REM sleep behavior disorder, these nerve pathways do not function properly, resulting in unwanted and unexpected movements.
Implications Of Idiopathic Rbd For Future Drug Trials In The Synucleinopathies
As noted above, RBD tends to precede the onset of parkinsonism or dementia in patients with MSA, PD, and DLB by years or decades.1, 17, 22, 63, 65, 81, 82, 84, 91, 92, 109, 114, 176, 177 Almost 40% of patients with iRBD in one series were subsequently found to have developed a parkinsonian disorder,114 and continued follow-up of this cohort has shown approximately 65% have now developed parkinsonism and/or cognitive impairment.29 RBD preceded dementia and/or parkinsonism in 67% of another series,84 and preceded the onset of cognitive impairment in autopsy-proven LBD by a median of 10 years.138 The prospectively-followed cohorts by Iranzo et al. and Postuma et al.are particularly important.26, 80 Therefore, iRBD may represent the harbinger of an evolving neurodegenerative disorder, which in most cases may be a synucleinopathy.1, 3, 24, 26, 76, 80, 84, 110, 117–119
List of potential biomarkers to study in patients with idiopathic RBD.
Abbreviations: Cog=cognitive/neuropsychological testing, Aut=autonomic studies, MRI=magnetic resonance imaging, MRS=magnetic resonance spectroscopy, DaT=DaTSCAN, PET=positron emission tomography of the brain using various ligands, MIBG=Cardiac I-metaiodobenzylguanidine imaging.
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The 5 Top Sleep Disorders And How Weighted Blankets Help
From insomnia to narcolepsy, weve got the run-down on the five most common sleep disorders and the natural strategies that can help you reclaim your sleep.
The top 5 most common sleep disorders are insomnia, RLS, sleep apnea, narcolepsy, and REM sleep behavior disorder.
Many sleep disorders require the help of a sleep professional, but there are natural ways to improve our sleep and catch our Zzzs.
Weighted blankets can help improve sleep quality and reduce the symptoms of these disorders.
Did you know?50-70 million U.S. adults are impacted by sleep disorders.
Sleep disorders are a common issue in America, leading to millions of restless nights and tired days. As people who care deeply about the quality of sleep, the Bearaby team wanted to take a closer look at some of the top sleep disorders that are wreaking havoc on our quality of life.
From insomnia to narcolepsy, weve got the run-down on the five most common sleep disorders and the natural strategies that can help you reclaim your sleep.
What Are Risk Factors For Rem Sleep Behavior Disorder
RBD most often occurs in men. It can appear at any age. But it most often emerges after men are 50 years old. It is uncommon in women and children. Less than 1% of people have it. It appears more often in the elderly. RBD is also seen more often in people with some neurologic disorders. It occurs at a higher rate in people who have one of the following conditions:
- Parkinson disease
- Multiple system atrophy
- Lewy Body Dementia
People found to have RBD may develop Parkinson disease many years later. Those with RBD should watch for symptoms of Parkinson, such as tremors.
People with RBD are at higher risk for the following sleep disorders:
- Periodic limb movement disorder
- Sleep apnea
RBD can also be related to other factors that increase the intensity of REM sleep. These include the following:
- Alcohol withdrawal
A genetic link for RBD has not yet been identified.
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Knowing The Truth About Rem Sleep Behavior Disorder Can Clear Up Misconceptions About The Disorder Learn Five Common Rem Sleep Disorder Myths And The Truth Behind Them
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Rapid eye movement sleep behavior disorder, often referred to as RBD, is a condition with the ability to severely disturb a persons sleep pattern. Despite the facts about the condition being widely available, there are still misunderstandings about the diagnosis.
Misunderstandings can lead to REM sleep behavior disorder myths, so there must be an emphasis on the truth to end the rumors. By knowing the truths behind the myths, people and their loved ones can seek the best treatment available.
Myth #: Rbd Affects Everyone In The Same Way
Fact: Each episode of RBD is a unique experience.
Each person with REM sleep behavior disorder responds differently. It is the content of the dream that drives the RBD events, so certain types of dreams will produce certain actions.
If a person with only a mild case of RBD is dreaming about a meeting an old friend, they may mutter a few words under their breath during the episode. The symptoms will only be short in and low in intensity.
If a person who is highly influenced by RBD is having a dream about a physical altercation with a real or imagined enemy, they could exhibit a severe range of REM sleep behavior disorder effects. In this example, the person could:
- Yell or swear
- Leap out of bed
- Act aggressively or violently
RBD episodes are dangerous for the person with the condition as well as anyone who shares their bed. They could hurt themselves or others based on the content of the dreams they are enacting.
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How To Diagnose Rem Sleep Behavior Disorder
RBD is a disorder that can get worse over time. This can put you or your bed partner in danger. RBD also tends to be linked to other medical problems. You should seek a sleep doctors advice if you suspect that you might have RBD.
The doctor will ask you about your medical history. Your family history may also provide important details. The doctor should do a full exam. This should include a neurologic exam. You may be asked to complete a sleep diary. This will monitor your progress before and after treatment. You may be asked to rate your sleep with a simple questionnaire. This will help show how your sleep is affecting your daily life. Be sure to inform the doctor of any past or present use of any of the following:
Also, tell the doctor if you have ever had any other sleep disorder. You may also need to see a neurologist.
Tests may be needed if your medical exam shows something abnormal. People with RBD are at risk for other sleep disorders. As a result, you will likely need a sleep study. This study is called polysomnography. It charts your brain waves, heartbeat, and breathing as you sleep. It also records how your arms and legs move. This shows if there are other disorders that are related to your sleep problems. Examples of these disorders include sleep apnea and periodic limb movement disorder. The best sleep study will also record your sleep on video. This will show if you get out of bed and do anything unusual during the night.
Exams And Tests For Rem Sleep Disorder
The neurologic examination is often normal. However, symptoms and signs of Parkinson’s disease, such as hand tremor at rest, slowness in movement, and muscle stiffness that may suggest an underlying neurologic cause of REM sleep behavior disorder , should be considered.
Polysomnographic video recording is the single most important diagnostic test in persons with RBD. This test is usually conducted in a sleep study center. The person undergoing testing is required to sleep at the center while the following parameters are monitored:
- Electrical activity of the brain
- Electrical activity of the heart
- Movements of the muscles
- Eye movements
- Respiratory movements
These parameters are monitored as the person passes through the various sleep stages. Characteristic patterns from the electrodes are recorded while the person is awake and during sleep. Continuous video recording is done to observe behaviors during sleep. It is important to rule out other causes of REM sleep disturbance including conditions such as obstructive sleep apnea . OSA can cause a person to have restless sleep but the sleep should not be violent. Another condition was noted first on laboratory sleep study in REM without atonia which may be a mild form or precursor to RBD in some patients.
Additionally, the video recording shows body movements coinciding with the EEG pattern of REM sleep.
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Causes Of Sleep Apnea
Sleep apnea can be either obstructive or central. In obstructive sleep apnea, the relaxation of the throat and tongue muscles cause a blockage in the throat that prevents proper breathing.
Carrying excess weight, having a narrow throat, or suffering chronic nasal congestion can lead to obstructive sleep apnea. It is most common in older males.
With central sleep apnea, the problem stems from the brain, which fails to send the proper signals to initiate regular breathing. This problem is typically more common in older males with heart disorders, history of stroke, or who are taking narcolepsy medications.
Natural Ways to Overcome Sleep Apnea
- Maintain a healthy weight.
- Exercise and yoga can help strengthen your heart and prevent sleep apnea.
- Try sleeping on your side rather than on your back.
- Avoid alcohol and smoking which worsen sleep apnea.
Clinical Implications Of Rbd
Theoretical model of rapid eye movement sleep behavior disorder and its relationship with different clinical manifestations of synucleinopathies. Idiopathic RBD may remain as an isolated syndrome with or without additional cognitive, autonomic, or motor âsoft signsâ that may or may not evolve toward more definitive, clinically overt, âfull-blownâ synucleinopathy subtypes of dementia with Lewy bodies , multiple system atrophy , Parkinson disease , or PD with dementia . Patients with parkinsonism and dementia are considered to have PDD if cognitive decline occurs longer than 1 year after the emergence of parkinsonism and DLB if patients present with cognitive decline less than 1 year after the emergence of parkinsonism. Patients with PD and patients without RBD may represent different clinical phenotypes, given different and more severe motor signs, cognitive impairments, and autonomic signs in those with PD compared with those without PD. MCI = mild cognitive impairment PAF = pure automatic failure. Reproduced from Sleep Med,93 with permission from Elsevier, Inc.
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What Are The Risk Factors Associated With Rem Sleep Behavior Disorder
RBD most often occurs in men. It can appear at any age but it most often emerges in men who are over 50 years old. It is uncommon in women and children. but appears more often in the elderly. RBD is also seen more often in people with some neurologic disorders.
People found to have RBD may develop Parkinsons disease many years later. Those diagnosed with RBD should watch for symptoms of Parkinsons such as tremor. People with RBD are at higher risk for other sleep disorders like narcolepsy, periodic limb movement disorder and sleep apnea.
How Are Parasomnias In Children Treated
Non-REM parasomnias are most common during childhood and normally end during adolescence. Usually all thats needed is calming reassurance from the parents that everything is okay. Medications are rarely needed, but if they are, theyre typically only prescribed for three to six weeks. Medications typically tried include benzodiazepines or anti-anxiety drugs.
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Treatments For Rem Behavior Disorder
If alcohol or medication use is the likely cause of the episodes, a simple switch in medications, and/or abstaining from alcohol should quickly clear up the number of episodes of RBD. In cases of withdrawal symptoms, it may be necessary for the bed partner to sleep in a separate bed or room until the symptoms regress, and episodes of RBD tail off.
The most common treatment for chronic RBD is clonazapam, an anti-convulsant drug. This drug suppresses muscle activity, and largely prevents any actions from taking place. Additional precaution should be taking regarding bedroom safety for those with chronic RBD. Keeping objects away from the subjects side of the bed, such as night tables, lamps, clocks, etc. is a good step. An additional step could be to put a protective device over the subjects hands, both to prevent damage to them, and to limit damage from them to other things, including a bed partner.
Rem Sleep Behavior Disorder And Co
There is a significant correlation between REM sleep behavior disorder and several neurodegenerative disorders. REM sleep behavior disorder often occurs first, with the neurodegenerative disorders developing several years later. REM sleep behavior disorder and Parkinsons disease have a complex relationship. One study found that 38% of individuals diagnosed with REM sleep behavior disorder developed Parkinsons disease on average of 1213 years after the onset of REM sleep behavior disorder symptoms. REM sleep behavior disorder is also found in approximately 69% of people with Parkinsons disease and multisystem atrophy.
People with REM sleep behavior disorder may also be at higher risk for developing narcolepsy, periodic limb movement disorder and sleep apnea, which are often co-occurring conditions. The prevalence of narcolepsy and REM sleep behavior disorder has been estimated to be as high as 36%.
The complex motor behaviors associated with REM sleep behavior disorder can also occur in other sleep disorders, such as sleep apnea. These behaviors occur when REM sleep is interrupted by disordered breathing, but resolve when the disordered breathing is effectively treated. This phenomenon has been termed as pseudo-RBD.
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Analyses In Patients With Rbd Plus Parkinsonism And/or Dementia
The major clinical syndromes and histopathologic disorders which cause dementia and/or parkinsonism are shown in Figure 4. As shown in this figure, numerous cases of RBD have been reported in association with certain neurodegenerative disorders, but not reported to date in association with most others. RBD is frequently associated with clinically-diagnosed Parkinson’s disease,3, 9, 20–23, 25, 26, 40, 43, 47, 63–80 dementia with Lewy bodies,3, 17, 26, 27, 41, 80–87 and multiple system atrophy.9, 10, 20, 22, 25, 26, 88–98 Pure autonomic failure has also been reported.20, 99 RBD was identified in several members of a kindred with a parkin mutation,100 and Lewy body disease pathology has been reported in a different large kindred with parkin mutations.101 Many of the cases described in the reports noted above have had postmortem examination, and all such cases have had Lewy body disease or MSA confirmed at autopsy.
The clinical syndromes and histopathologic disorders associated with each proteinopathy in the major neurodegenerative disorders which cause dementia and/or parkinsonism. Those syndromes and disorders which are commonly associated with REM sleep behavior disorder are shown in red, and those which have been rarely associated with RBD are shown in blue. Those syndromes and disorders associated with RBD in which at least 1 pathologically-verified case has been identified are in italics. Those in black print have not been reported in association with RBD.