Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Repetitively falling asleep, sleeping, and waking up is a complicated process that can, in some cases, be a symptom of a sleep-related condition. Most people are familiar with insomnia or sleep apnea, but these aren’t the only sleep conditions. Another less common condition is called REM Sleep Behavior Disorder (RBD).
What is RBD?
REM is one of our most restorative sleep phases and is characterized by the rapid movement of the eyes and dreaming. RBD occurs during this phase. A person with RBD dreams and physically acts out these dreams while they’re still asleep.
For partners of those with RBD, this can be a worrying and terrifying experience. In most instances, those with RBD remember their dreams. Affected dreams are often quite vivid, and a person will often use pushing, kicking, jerking, talking, shouting, grabbing, or even punching during an episode. It’s not uncommon for someone with RBD to jump out of bed while sleeping and run from something dangerous in their dream.
The frequency of symptoms varies on a nightly basis. They can range from rare to very often, depending on the severity of the condition. RBD differs from sleepwalking because the person will remember the dream. These dreams can seem so real that those with the condition believe it happened in real life.
Symptoms of RBD
- Remembering careful details from your dreams
- Your partner tells you what you did in your sleep and it matches your dream
- Confusion if you’re awakened from a dream you’re acting out
- You are asleep at the time of the incident, unlike sleepwalking when your eyes may be open
- Daytime fatigue
How Common is RBD?
RBD is relatively rare compared to other sleep disorders, such as sleep apnea or insomnia. Studies have shown that 0.5-1% of the general population has this condition, with men over 50 years of age having a slightly higher risk.
Individuals suffering from neurological issues, such as Parkinson’s, may be more susceptible to RBD, as the condition is thought to occasionally precede the development of Parkinson’s and Alzheimer’s. Those regularly suffering from severe RBD may be more likely to develop narcolepsy or sleep apnea.
The reason why some people suffer from RBD and others don’t is still somewhat of a mystery. During a regular sleep cycle, the body enters non-REM and REM cycles. Symptoms of RBD are not evident in non-REM sleep phases. However, dreams occur during the REM sleep phase, and the more vivid the dreams, the higher the likelihood you’ll have of RBD.
The REM cycle occurs up to 5 times per night and usually begins around 90 minutes after falling asleep.
During this time, your brain is active, but your body is virtually paralyzed. For most people, this REM stage would not involve any bodily movement, but for someone with RBD, the chemical in the brain that keeps the body still during this time isn’t present or isn’t present in the right quantity.
This chemical imbalance is the cause of RBD and other sleep-related issues, such as sleepwalking. Therefore, due to this lower brain chemical, the body isn’t paralyzed as it should be, causing the person to move around and essentially act out their dream.
Diagnosis & Treatment
The good news is that RBD can be diagnosed by a doctor and treated with medications to reduce the symptoms.
Diagnosis involves referral to a sleep specialist who will administer sleep studies. During this time, a specialist will monitor the patient during the different sleep stages, and track heart rate, movements, body temperature, and breathing. Neurological referral may also be necessary in some cases.
Is RBD Curable?
With prescribed medications, such as Clonazepam and/or Melatonin, and a regular bedtime routine, the condition can be controlled; although; there is no cure. There may be some adverse side effects with the medications, such as balance issues, problems with concentration, or general sleepiness in the mornings.
Individuals regularly experiencing RBD should also have regular neurological check-ups. Studies have shown that the condition may be a warning sign for future neurological diseases, such as Parkinson’s.
While RBD cannot be cured completely, it can be managed and controlled with the use of medications and healthy sleep hygiene practices.
Personal relationships can suffer due to this chronic condition. That’s because a sleeping partner may be scared or troubled by the acting out of dreams. In some cases, the partners are hit or punched. However, once a diagnosis has been made and treatment has begun, most people notice a sharp decline in their symptoms and prevalence.
If you’re experiencing symptoms of RBD, don’t hesitate to talk to your doctor.
- Howell, H., Schenck, C. (2020, September) Rapid Eye Movement Sleep Behavior Disorder. Up to Date. https://www.uptodate.com/contents/rapid-eye-movement-sleep-behavior-disorder
- Makin, S. (2016, December 15). Why Sleep Disorders May Precede Parkinson’s and Alzheimer’s. Scientific American. https://www.scientificamerican.com/article/why-sleep-disorders-may-precede-parkinsons-and-alzheimers/
- How muscles are paralyzed during sleep: Finding may suggest new treatments for sleep disorders. (n.d.). ScienceDaily. https://www.sciencedaily.com/releases/2012/07/120711131030.htm