REM Sleep Behaviour Disorder

REM Sleep Behaviour Disorder (RBD) is a sleep disorder where you act or shout out in vivid dreams.

RBD is often a prodromal symptom of Parkinson’s & can be managed with medication.

Connection between RBD & Parkinson’s

REM Sleep Behaviour Disorder (RBD) is a sleep disorder characterised by the acting out of vivid, often unpleasant dreams with vocal sounds and/or complex motor behaviours during REM (rapid eye movement) sleep. Normally during REM sleep, your body’s muscles are relaxed and inactive (atonia), but in RBD, this atonia is incomplete or absent, allowing you to physically act out your dreams.

RBD is strongly linked to Parkinson’s disease (PD) and other neurodegenerative disorders, particularly those that affect the brain’s dopamine-producing neurons. While RBD can occur in isolation, research indicates that it is often an early marker of PD or other neurodegenerative diseases, sometimes appearing years before the full onset of PD symptoms (Postuma et al., 2015). As PD progresses, the motor symptoms of the disease (such as tremor and rigidity) become more pronounced, but the damage to areas of the brain controlling movement and sleep regulation is already underway, which is where RBD becomes relevant.

Prevalence of RBD in Parkinson’s

Studies show that around 50-60% of people with Parkinson’s disease will develop RBD at some point (Postuma et al., 2015). This statistic underlines the significant overlap between these two conditions.
Up to 80% of individuals diagnosed with idiopathic RBD (without a current diagnosis of PD) may eventually develop PD or a related neurodegenerative disorder over the course of several years (Schreeder et al., 2019).

What is REM Sleep Behaviour Disorder (RBD)?

REM Sleep Behaviour Disorder (RBD) is a sleep disorder in which a person acts out their dreams during the Rapid Eye Movement (REM) phase of sleep. Normally, during REM sleep, the body experiences temporary paralysis to prevent acting out dreams, but in individuals with RBD, this paralysis is absent or incomplete. This can lead to violent movements such as kicking, punching, or jumping out of bed. The disorder can be dangerous to both the person with RBD and their bed partner, with cases of self-injury or injury to others being documented.

Key Statistics

Association between RBD and neurodegeneration: RBD is frequently an early warning sign of PD or other neurodegenerative diseases, with its onset occurring in the years before a formal PD diagnosis (Postuma et al., 2015).
RBD’s impact on quality of life: Individuals with both PD and RBD may experience significant disruptions in their sleep quality, which can exacerbate other PD symptoms, such as cognitive decline, mood disorders, and motor difficulties (Schreeder et al., 2019).
Risk of injury: People with RBD may engage in vigorous and sometimes violent movements during sleep, which can result in injuries to themselves or their bed partners (Postuma et al., 2015).
Medication efficacy: The most commonly used treatments for RBD in individuals with PD are clonazepam and melatonin, which have shown effectiveness in reducing the frequency and severity of RBD episodes (Czernicki et al., 2021).

Treatment options for RBD

RBD is treatable with medications, and the main treatment is often a class of drugs called benzodiazepines, such as clonazepam. These medications help reduce muscle activity and suppress the movements associated with RBD during sleep. Additionally, melatonin, a hormone that regulates sleep-wake cycles, has shown promise in treating RBD (Czernicki et al., 2021). It is important for people with Parkinson’s to manage their RBD symptoms, as untreated episodes can lead to physical harm for themselves or their bed partner.

Always seek professional medical advice before starting any new treatment.

Infosheet under review

References:

Czernicki, S., Millan, M. J., & Delobel, P. (2021). The role of melatonin in the treatment of REM sleep behaviour disorder. Journal of Sleep Research, 30(3), e13238. https://doi.org/10.1111/jsr.13238

Postuma, R. B., Gagnon, J. F., & Montplaisir, J. Y. (2015). REM sleep behaviour disorder in Parkinson’s disease: A review. Parkinsonism & Related Disorders, 21(2), 89-95. https://doi.org/10.1016/j.parkreldis.2014.11.019

Schreeder, M. T., Rittman, T., & Grosset, D. (2019). REM sleep behaviour disorder and Parkinson’s disease: A meta-analysis of the prevalence and risk factors. European Journal of Neurology, 26(5), 742-748. https://doi.org/10.1111/ene.13991