Who Is At Risk Of Rem Sleep Behavior Disorder
According to the National Sleep Foundation, men are more likely to develop this condition than women. It can appear at any age, but it most commonly occurs after age 50.
You may be at higher risk of RBD if you have a neurological disorder, such as Parkinsons disease or multiple system atrophy. This disease is similar to Parkinsons, but it involves more widespread damage.
If you have RBD, youre at a higher risk of developing:
- Parkinsons disease, a brain disease that leads to tremors and eventually difficulty walking and moving
- narcolepsy, when you experience sleep attacks or uncontrollable bouts of falling asleep during the daytime
- periodic limb movement disorder, when you experience cramping or jerking of your legs during sleep
- sleep apnea, when you periodically stop breathing during sleep
Autonomic Dysfunction In Parkinsons Disease
The prevalence of autonomic symptoms in PD patients ranges from 14 to 80%. This variability could be mainly attributed to differences in diagnostic methodology and the autonomic disorder assessed across studies. Further, several studies enrolled heterogeneous populations, while others did not use validated questionnaires4646. McDonald C, Winge K, Burn DJ. Lower urinary tract symptoms in Parkinson’s disease: Prevalence, aetiology and management. Parkinsonism Relat Disord. 2017 Feb 35:8-16. https://doi.org/10.1016/j.parkreldis.2016.10.024.
Regarding the non-motor symptoms of PD, dysautonomia, including orthostatic hypotension, constipation, sialorrhea, as well as urinary and sexual dysfunction, frequently occurs at all disease stages. However, they are more common in more advanced PD stages and significantly worsen the quality of life and impair social life.
Sialorrhea is characterized by excessive salivation and the inability to retain saliva within the mouth. Consequently, the patient might drool or aspirate saliva, which could even result in aspiration pneumonia. The prevalence of sialorrhea in PD patients varies from 10 to 84%4949. Srivanitchapoom P, Pandey S, Hallett M. Drooling in Parkinson’s disease: a review. Parkinsonism Relat Disord. 2014 Nov 20:1109-18. https://doi.org/10.1016/j.parkreldis.2014.08.013 and is more frequent in case of ineffective medication.
What Do People With Rem Sleep Behavior Disorder Dream About
The vast majority of dreams that trigger episodes of the disorder are violent, research suggests, including attacks by unknown assailants or by animals like tigers, panthers, wolves, dogs, or bears. Most of the time the patient has not experienced similar events in real life. The patients often remember the content of their dreams when they awaken.
Read Also: Worksheets For Borderline Personality Disorder
Idiopathic Rapid Eye Movement Sleep Behavior Disorder
iRBD, which occurs without neurodegenerative disease, was first described in 1986, with similar phenomenological reports being presented in the 1970s. It is characterized by central nervous system dysfunction during sleep and wakefulness with cortical activity impairment, neuropsychological changes, and autonomic dysfunction1313. Fantini ML, Ferini-Strambi L, Montplaisir J. Idiopathic REM sleep behavior disorder: Toward a better nosologic definition. Neurology. 2005 Mar 64:780-6. https://doi.org/10.1212/01.WNL.0000152878.79429.00.
Evaluation Of Diurnal Aggressiveness
For the evaluation of diurnal aggressiveness, the Buss-Perry Aggression Questionnaire 17 was adopted. The BPAQ represents a revision of the Buss-Durkee Hostility Inventory ,18 which includes revisions of the response format and item content to improve clarity. Although, as with the Buss-Durkee scale, items for six a priori subscales were initially included in this measure, item-level factor analyses across three samples confirmed the presence of only four factors, involving physical aggression, verbal aggression, anger, and hostility. The BPAQ has been adopted in a previous study on aggressiveness in patients with RBD by Fantini et al.19 To the best of our knowledge, the BPAQ questionnaire has not been previously administered to patients with PD.
Recommended Reading: Binge Eating Disorder Signs And Symptoms
How Does Rem Sleep Behavior Disorder Affect A Persons Social Life
It can have a significant effect until a person seeks treatment. Embarrassment over episodes can impair social relationships, as individuals could avoid any situations in which others could discover their condition, such as vacation travel, overnight visits to friends, and sleeping with new sex partners. This avoidance can lead to painful social isolation.
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:
Don’t Miss: Dsm 5 Bipolar I Disorder
Symptoms And Diagnostic Considerations
Rapid Eye Movement Sleep Behavior Disorder is a non-familial sleep disorder, characterized by the loss of the inherent muscle atonia observed during normal REM sleep. This phenomenon is often referred to as REM Sleep without Atonia . Whilst isolated RSWA is frequently an incidental finding in sleep studies, it forms the substrate of the dream enactment behavior which defines RBD. Here, individuals experience vivid dreams which they act out during sleep.
It is important to remember that dream enactment and limb movements during sleep can occur in the healthy population, often in the context of heightened emotional states . The same symptoms may also be experienced during withdrawal from sedatives or alcohol. In non-pathological dream enactment, individuals typically respond to dream content during the transition from REM sleep to the awake state and while maintaining REM atonia during much of the REM period. In contrast, RBD individuals will maintain REM sleep during and immediately after most of their dream enactments. As acute dream enactment is generally self-limiting, the chronicity of symptoms is a key distinguishing factor, and forms part of the diagnostic criteria for RBD .
Relationship Between Rapid Eye Movement Sleep Behavior Disorder And Autonomic Dysfunction In Parkinsons Disease
The various clinical presentations of PD, associations between motor and non-motor symptoms, and prognoses support the hypothesis that PD subtypes could be classified according to the predominant phenotype, severity, and prognosis markers. These findings substantiate the PD subclassification based on the predominant motor symptom and the presence of non-motor symptoms indicative of a more severe disease form. The coexistence of RBD and autonomic dysfunctions is associated with the phenotypic conversion to PD, non-motor symptoms , and faster progression of motor symptoms, collectively describing what previous studies have termed the malignant PD form1919. Zitser J, During EH, Chiaro G, Miglis MG. Autonomic impairment as a potential biomarker in idiopathic REM-sleep-behavior disorder. Auton Neurosci. 2019 Sep 220:102553. https://doi.org/10.1016/j.autneu.2019.05.005.
Therefore, assessing RBD and autonomic dysfunction from PD onset could contribute to patient management with respect to both pharmacological and non-pharmacological treatments. Further, it could allow managing patient expectations, especially in cases of greater severity and more reserved prognosis.
Also Check: Bipolar I Disorder Dsm 5
Additional Health Benefits And Uses
Sodium oxybate has been investigated for treatment of alcohol withdrawal, fibromyalgia, and rapid eye movement behavior disorder, among other conditions.113 Sleep-deprived normal subjects who took sodium oxybate before a 3-hour nap following a night of sleep deprivation slept a similar amount of time as the placebo group, but they also had a higher percentage of slow wave sleep during and longer MSLTs following the nap, reported less subjective sleepiness, and had faster reaction times on the psychomotor vigilance test.115 Findings such as these suggest that sodium oxybate may exert its effects by increasing slow wave sleep.
Nicolaas I. Bohnen, … Martijn L.T.M. Müller, in, 2018
Causes Of Rem Sleep Disorder
The exact cause of RBD is unknown, but it may happen along with degenerative neurological conditions such as Parkinson’s disease, multisystem atrophy , and diffuse Lewy body dementia. In 55% of people, the cause is unknown, and in 45%, itâs linked with alcohol or sedative-hypnotic withdrawal, tricyclic antidepressant , or serotonin reuptake inhibitor use or other types of antidepressants .
RBD often happens several years before the development of these neurodegenerative diseases. In one study, 38% of people diagnosed with RBD developed Parkinson’s disease within an average of 12 to 13 years after RBD symptoms began. Also, RBD is seen in 69% of those with Parkinson’s disease and multisystem atrophy. The relationship between RBD and Parkinson disease is complex not everyone with RBD will develop Parkinson’s disease.
Also Check: Does Schizoaffective Disorder Get Worse With Age
How Are Parasomnias Treated
Treatment starts with identifying and treating other sleep problems and any other health issues as well as reviewing medications that may trigger the parasomnia.
General management strategies for both Non-REM and REM sleep disorders are to:
- Follow good sleep hygiene habits .
- Maintain your regular sleep-wake schedule. Have a consistent bed time and wake up time.
- Limit, or dont use, alcohol or recreational drugs.
- Take all prescribed medications as directed by your healthcare provider.
Other treatments for non-REM sleep disorders:
- Medication is not usually prescribed for non-REM parasomnias. However, when they are used, benzodiazepines are the medications of choice for parasomnias that are long lasting or potentially harmful. Tricyclic antidepressants are also sometimes tried. Psychological approaches are also considered.
Other treatments for REM sleep disorders:
- Clonazepam and melatonin are the medications commonly used to manage REM sleep disorders.
Your healthcare provider will discuss the best treatment options medications and/or psychologic approaches for your specific type of parasomnia considering your unique health history and medical issues.
Another discussion you and your healthcare provider will have are suggestions to keep your sleeping environment safe. Tips include:
Rbd And Neurodegenerative Disorders
A simplified model of the interaction of motor function in Parkinsons Disease and REM atonia. During wake in PD , dysfunctional BG input to premotor and primary motor cortex impairs motor function. During RBD in PD, lesions to the SLD and/or VMM result in disinhibition of descending motor commands, resulting in motor behavior that in some aspects is improved over waking behavior. This may be due to PreMo and PMC bypass of dysfunctional BG modulation during REM sleep , or a specific reduction in dysfunctional PreMo influence on PMC motor commands due to different putative topographies of BG loops with PreMo and PMC .
Also Check: What Causes Bipolar Disorder To Get Worse
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.
Pearls And Other Issues
After ten years from diagnosis, there is a high risk with rapid eye movement behavior disorder for developing alpha-synucleinopathy pathology.
There are currently no guidelines on counseling and management regarding potential phenoconversion of RBD to alpha-synucleinopathy. The approach may include a discussion with the patient to understand this risk. The patient should be recommended to seek consultation from their primary care provider, sleep specialist, and/or neurologist if associated symptoms manifest, such as memory issues, constipation, gait abnormalities, orthostatic hypotension, or neurological deficits.
Prodromal alpha-synucleinopathy is possible in younger patients less than 50 years old, but nondegenerative disorders should be considered, including autoimmunity, narcolepsy, and REM-suppressing medication use.
There is a lack of controlled, randomized, double-blind studies for RBD treatment. However, injury prevention is critical in the management of RBD. Clonazepam is highly effective in treating RBD to reduce injury risks.
Low risk for adverse reaction favors melatonin over clonazepam as initial pharmacological therapy for RBD.
Also Check: Oppositional Defiant Disorder Strategies For Teachers
From Rapid Eye Movement Sleep Behavior Disorder To Parkinsons Disease: Possible Predictive Markers Of Conversion
- Liche ZhouLiche ZhouDepartment of Neurology & Institute of Neurology, Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Lin ZhuLin ZhuDepartment of Neurology & Institute of Neurology, Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Jun Liu*Jun LiuDepartment of Neurology & Institute of Neurology, Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
ACS Chem. Neurosci.
Article Views are the COUNTER-compliant sum of full text article downloads since November 2008 across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.
Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.
The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated.
Rapid Eye Movement Sleep Behavior Disorder In Parkinsons Disease
Table 2Table 3
Based on the PD model proposed by Braak et al.4141. Braak H, Del Tredici K, Rüb U, de Vos RA, Jansen Steur EN, Braak E. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging. Mar-Apr 2003 24:197-211. https://doi.org/10.1016/s0197-458000065-9, pre-symptomatic PD stages are characterized by the deposition of Lewy bodies in the dorsal pons, bulb, and olfactory nucleus. This explains why RBD precedes PD motor symptoms in some cases nevertheless, it does not explain why many PD patients do not present RBD. Histopathological changes have been reported in patients with iRBD who did not clinically present neurological disorders. These changes included the presence of Lewy bodies in the brainstem in one patient and decreased monoaminergic neurons in the locus coeruleus and substantia nigra in another2020. Schenck CH, Boeve BF, Mahowald MW. Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series. Sleep Med. 2013 Aug 14:744-8. https://doi.org/10.1016/j.sleep.2012.10.009.
You May Like: Are You Born With Bipolar Disorder
Association With Other Nonmotor Manifestations
In PD, anosmia, REM behavior disorder, cognitive dysfunction, and OH all have been associated with cardiac sympathetic denervation . Almost all patients with PD have at least some olfactory dysfunction, and a substantial minority have absent sense of smellanosmia. Olfactory function can be quantified by the University of Pennsylvania Smell Identification Test . Among patients with alpha-synucleinopathies such as PD, UPSIT scores are correlated positively with myocardial noradrenergic innervation as assessed by cardiac sympathetic neuroimaging .
Several sleep disorders are associated with PD however, REM behavior disorder stands out. In REM behavior disorder, the patients act out their dreams and thrash about in bed. Polysomnography shows absence of the atonia that normally accompanies REM sleep. Patients with REM behavior disorder can injure themselves or their bedmates while the patients are asleep. REM behavior disorder patients have substantial myocardial noradrenergic denervation as indicated by cardiac sympathetic neuroimaging. Indeed, heart/mediastinum ratios of 123I-MIBG-derived radioactivity have been reported to be even more severely decreased in REM behavior disorder than in PD .
Mechanisms for the linkage between nonmotor manifestations and neuroimaging evidence for cardiac sympathetic denervation remain unknown. A hypothesis for the future is that they are linked because they all involve NE depletion.
Ulrich Voderholzer, Christian Guilleminault, in, 2012
Rem Sleep Behavior Disorder
Like wakefulness, normal REM sleep features corticohippocampal activation, but unlike wakefulness, postural muscles have sustained, or tonic, atonia to prevent movement. Smaller muscles, including cranial muscles such as those regulating eye movements, show phasic activity bursts that emerge through the tonic atonia. This phasic activity can be concurrently seen in the cortex, thalamus, and the pons. In RBD, motor commands supercede the tonic atonia of REM sleep, resulting in motor behaviors. These motor commands can originate from primary and premotor cortices, with input from the basal ganglia, or from brainstem or spinal cord motor generators . In humans, these motor commands range from twitches to dream mentation-linked actions that mimic wakefulness. However, motor behavior in RBD can be jerky compared to wakefulness , and dream content can become skewed toward violent, defensive nightmares , perhaps as a result of the motor behaviors themselves .
You May Like: Schizoaffective Disorder Bipolar Type Icd 10
Deterrence And Patient Education
Patients with rapid eye movement behavior disorder and their sleeping partners are prone to injuries during their sleep that can result in serious harm. The sleeping partner could target a violent dream enactment behavior leading to the patient being arrested on charges of domestic assault. Therapeutic management should include injury risk mitigation discussions with the patient and their sleeping partner.
It is ethically important to disclose potential risks for the development of neurodegenerative disease to patients diagnosed with RBD. An open discussion with family members offers an opportunity for improved understanding and avoiding misinformation about the disease process. It is recommended to counsel patients that Parkinson disease and other neurodegenerative disorders can be treatable. The prompt diagnosis of RBD may provide an early therapeutic window for neuroprotective therapies. The International Rapid Eye Movement Sleep Behavior Disorder Study Group is conducting ongoing collaborative studies for symptomatic and neuroprotective treatment.
How Is Rem Sleep Behavior Disorder Treated
In most cases, this condition can be successfully managed with medication. Clonazepam is the most frequently used medicine. Your doctor may also prescribe melatonin, a dietary supplement that can help eliminate symptoms. You should talk to your doctor to learn which medication is best for you.
You will likely need to take other precautions to protect yourself and your bed partner. For example:
- Move objects away from your bedside.
- Move your bed away from the window.
- Maintain a standard bedtime.
- Avoid certain medications and alcohol.
- Treat any other sleep disorders.
Recommended Reading: Symptoms Of Nonverbal Learning Disorder