Summary
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 possibly dangerous to bed partners.
- Some other sleep disorders can have similar symptoms – a sleep study is needed to diagnose RBD.
- RBD mostly occurs in older people, often alongside a neurological condition (such as Parkinson’s disease or dementia with Lewy bodies). In young people it is usually a side effect of medication.
- There are ways to treat RBD that work well.
- Some people with RBD have an increased risk of developing a neurological condition. A neurologist can help investigate.
- There are several problems that can cause RBD. A sleep specialist can help.
What is 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 the content of their dream, often resulting in 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 is recognised more often in males. The cause isunknown. People with this form of RBD should be checked for the possibility of the development of neurological conditions, as it can occur before or alongside a diagnosed neurological condition, such as narcolepsy or Parkinson’s disease. The second form can be 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. This is something your general practitioner (GP), will be able to assess.
If no readily identifiable cause can be found, you need to see a sleep specialist for further investigation. They will check if you have any other sleep problems contributing to 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 medications that can be trialed, such as melatonin o clonazepam, which are generally affective in low doses. If you have been diagnosed with Obstructive Sleep Apnoea or another sleep disorder then treatment of this may help the RBD.
Bedroom safety should be prioritised if you have RBD. Moving furniture away from the bed, placing pillows or a mattress on the floor, sleeping in a sleeping bag, or sleeping in separate beds, may all help to minimise injuries.
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.