Rapid Eye Movement (REM) Sleep Behaviour Disorder (RBD)

This is a fact sheet about REM Sleep Behaviour Disorder. RBD is the absence of muscle paralysis during REM, leading to physically acting out your dreams which can be intense, vivid, sometimes violent

Woman sleeping in bed. Photo by Ivan Oboleninov
calendar icon
January 29, 2024
time, clock icon
min read


Things you should know:

  • REM Sleep Behaviour Disorder (RBD) causes a person to move unusually while asleep, like acting out a dream. Movements can be sudden, violent and possible dangerous to bed partners.
  • RBD mostly occurs in older people. In young people it is usually a side effect of medication.
  • There are ways to treat RBD that work well. At least 80% of people get better with treatment.
  • There are several problems that can cause RBD. A sleep specialist can help.

What is Rapid Eye Moment (REM) Sleep Behaviour Disorder (RBD)?

RBD happens when you sleep. It can lead to talking and shouting. It can make you move vigorously. You might have vivid, striking dreams as well. When this happens, people with RBD are seen to suddenly move or call out. They can look like they are acting out their dreams. The episode usually doesn't go on for long. Often you might be able to recall what your dream was about when you wake up.

RBD can be a danger to both people with it and their bed partners. This can be due to the person with RBD responding violently to an imagined attack or because of vigorous movement of their arms and legs.

What causes RBD?

There are several types of sleep that occur every night. One of these is called rapid eye movement, or REM sleep. This is the time when you have your most structured dreams. Normally in REM sleep, the muscles should relax totally. But if you have RBD, your brain sends the wrong signals to your body muscles, so they fail to relax during sleep. This means that when you have dreams you can act these out with bodily movement.

There are two forms of RBD. The first often occurs later in life (over 50 years of age) and more often in males. The cause is unknown. People with this form of RBD should be checked for the possibility of the development of neurological conditions such as Parkinson’s disease. The second form of RBD occurs as a side effect of medicines, such as a high dose of antidepressants.

RBD can be made worse if you also have another sleep problem, such as Obstructive Sleep Apnoea.

How is RBD diagnosed?

The first step is to work out if the RBD is the side effect of a medication or if there is another obvious cause for it.

If no readily identifiable cause can be found, you need to see a sleep specialist for further investigation. He/she will check if you have any other sleep problems contributing to the RBD, for example Obstructive Sleep Apnoea. Most of the time this assessment will involve an overnight sleep study. This is done in a hospital and includes a video recording.

How do you treat RBD?

This depends on the cause. If it appears to be due to a medication side effect, the drug responsible should be stopped if possible. If no specific cause is found there are drugs that can help, such as clonazepam which is generally effective in low doses. If you have been diagnosed with Obstructive Sleep Apnoea or another sleep disorder, then treatment of this may help the RBD.

Where and when should you seek help?

If you or your bed partner has symptoms of RBD then you should discuss this with your GP. He or she is likely to refer you to a sleep specialist, who might suggest an overnight sleep study.

Download a PDF of this Fact Sheet

Other useful links: