Rapid Eye Movement (REM) Sleep Behavior Disorder: Tests, Treatment

During REM or rapid eye movement sleep, a person doesn’t usually move. About twenty percent of our sleep is used up in REM in the second phase of the sleep at night. It is also the normal time of dreaming.

Rapid Eye Movement (REM) Sleep Behavior Disorder

The on-set of REM disorder in regard to sleep is not gradual, but a sudden happening. It might occur sometimes or several times during the night. Additionally, the disorder might get worsened with the passing of time. The cause of this disorder has been inferred as the association of other neurological disorders, sometimes multiple disorders. Of them ParkinsonLewy Body Dementia are very significant.

Tests to Diagnose Rapid Eye Movement (REM) Sleep Behavior Disorder

The doctor will take your case under consideration by reviewing your personal health background as well as the symptoms. The reviewing or evaluation might include the following tests like:

  • Physical and Neurological Tests: The consulting physician will confirm about the REM disorder or other kinds of disorders after you go through the tests relating to neurology and physiology. Sometimes there are number of other sleep disorders that are very similar to the REM sleep behavior disorder. Even, it might exist together with other disorders of sleep, such as narcolepsy or obstructive sleep apnea.
  • Polysomnogram or Study of Sleep during Night:Doctors may take you into sleep laboratory to keep track and evaluate the condition of your sleep over night. The patient who is kept under monitoring needs to sleep at the right position so that following parameters can be monitored.
    • EEG or Electroencephalogram: monitors the electrical movements of the brain
    • ECG or Electrocardiogram: observe the Electrical movements of the heart
    • Eelectromyogram: Monitors the movements of the muscles
    • Electrooculogram: Monitors the movements of the eye
    • Respiratory movements test.

These different parameters are observed during the different stages of sleep through which a patient is made to pass through. The attributive patterns of sleep from the Electrodes are kept recorded both during sleep and in awaking condition. An uninterrupted recording of both the visual and audio is done to track the sleep behavior.

The people suffering from RBD exhibit a boosting of the muscle tone that is related with the electroencephalogram pattern of REM sleep. The test is called polysomnogram. On the other hand, in case of people with no sleep disorder, the electroencephalogram type of REM sleep there is no connection with the atonia or muscle tone. Besides, the video recording also shows the movement of the body that coincides with the electroencephalogram (EEG) pattern of Sleep disorders.

Diagnostic Criteria for RBD

Doctors will make sure whether you are suffering from REM sleep behavior disorder or not by following the below criterions and find out the similarities with your problem.

  • You arise frequently during sleep and do some peculiar noises and some motor activities like kicking, punching, or movement of running which are very often parallel to the content of the dreams very often.
  • If you ever wake up at some point of time during the sleep episode, you become alert and not puzzled or bewildered.
  • A sleep inspection proves that your muscle activity increased during the REM sleep
  • Doctors make sure that your sleep troubles are not triggered by other disorders (mental) or any medications or substance abuse.

Treatment Options for Rapid Eye Movement (REM) Sleep Behavior Disorder

The neurologist may seek advice from a sleep specialist for the right diagnosis and the handling of RBD which is treated by following the symptoms and applying different medications. Though, the response to treatment and the medications varies for different cases; therefore, all the related medications should be put to test before making any case of RBD as incurable. The dealing with REM sleep behavior disorder with medication includes physical safeguards and medications.

Physical Security

As a part of the management of safeguarding yourself, the sleep experts might suggest some alteration in the sleep setting in order to make it safer. These are:

  • Padding of floor close to the bed
  • Eliminating the risky or unsafe things like, sharp items or weapons etc.
  • Putting barriers on the bed side
  • Moving away the furniture from near the bed
  • Safeguarding the glass windows

Medications for RBD

Possible options for treatment to cure REM sleep behavior disorder comprises of:

Melatonin Therapy: This is nothing but a dietary supplement therapy. It helps to either minimize or remove the symptoms. Melatonin can be as useful as clonazepam. Except some feeling of wooziness in the morning it is usually well-tolerated because of its few side effects.

  • This therapy can trim down REM sleep behavior without any muscle damage.
  • 3–12 mg of Melatonin seems to be effectual in regard to minimizing the symptoms of clinical RBD sleep behavior disorder.
  • Minimal negative effect may support melatonin as initial therapy in RBD over Clonazepam.

Clonazepam (Klonopin): This traditional choice of treatment and medication is often used to take care of anxiety. It reduces the symptoms effectively. It has some apparent side effect, such as daytime drowsiness, reduced balance and aggravation of sleep apnea.

Pramipexole: It is also considered to be good for treating RBD, though the studies of efficacy have proved different other results. There is little proof that support that the use of paroxetine can treat RBD sleep behavior disorders. Some studies however recommended that these drugs may actually stimulate or make worse RBD.

Anti-depressant Therapy: For some patients of RBD medications, like tricyclic antidepressants, might be effective for a few RBD patients. However, tricyclics are also known essentially as impulsive RBD. The newer antidepressants particularly mirtazapine and venlafaxine are very common aggravators of RBD.

Levodopa: It is very useful for patients suffering from RBD. It is forerunner of Parkinson disease. Doctors carry on study and investigation of other treatment for REM sleep behavior disorder. Consult with your doctor to determine the most suitable healing option for your sleep disorder.

Long-Term Monitoring

Because RBD has a strong connection with neurodegenerative disorders, among them some are very frequently found in the people. These are Dementia, Parkinson, and Multiple System Atrophy. The neurologist should aim at exploring the cause and the possibility of RBD among these neurological diseases.

Alternative Treatment for Rapid Eye Movement (REM) Sleep Behavior Disorder

Specialized Alarm System:

The specialized alarm system has been devised for preventing the patients from the injury throughout episodes of RBD by awakening the patient gently. As reported by the patients with sleep disorders injury, the technique has been stated to be fruitful for patients who are quite unresponsive to other medications. This is also preferred to extended time of medication that bring for the negative effect such as, cognitive injury, daytime lethargy falls and aggravation of sleep apnea.

The alarm technique is practicable because of the fact during the period of REM sleep, the sounds are converted in a mode that appears to natural like the sound in wakeful state. Consequently, it is easy to awaken the RBD patients and are very often receptive to the verbal communication. At the same time it involves the dream ratification. It uses the application of pressure pad sensation, or a cord that fastens to the bed with magnet linked to alarm.

The other end part of the cord is clipped to the bed sheet of the patients. When activated by the movement that breaks that contact of the magnet, like the patient coming about or trying to go away out of the bed, the system of alarm become active with prerecorded previous voice that speaks softly and comforting the patient. The minor or major injuries related to sleep had been done away with in course of 36 months of investigation. But, after a few months, some interference had been necessary. It indicated the all-inclusive improvement of REM sleep phase. The patients using the system inform no much worries in regard to sleep.

Treatment for RBD in Children

Children can also suffer with REM sleep behavior disorder. The loss of ability to move the body usually takes place throughout REM sleep. It is partial or deficient, letting the child to perform their dreams. RBD is described as acting out the vivid, violent and intense dreams. It is frequently found in the boys. But in general, it is not usual diagnosis that is found in children.

  • The Common Symptoms: Yelling, Talking, Kicking, Punching, sitting, jumping out of bed, waving of arms, and the clutching while asleep.
  • Consequences of RBD: Injuries most often leads to bruises and injuries fractures or lacerations. It might very often involve the bed partner or other individual. The sleep-related violent behavior most often is like the child’s personality during the awakening state. Daytime violence and forceful activity of dream might also occur.
  • Treatment: Tricyclic antidepressants, Medication clonazepam, Tricyclic Antidepressants, Melatonin Anti-epileptics have been proved to be the best treatment for the disorders.


There a few complications that are caused by REM sleep behavior disorder. These are:

  • Inflicting injury to oneself or the other sleeping partner.
  • Anguishing the sleeping partner, or the people existing at home.

Lifestyle Modifications for Patients with Rapid Eye Movement (REM) Sleep Behavior Disorder

As the people with the sleep disorder prone to injure themselves and also the sleeping partners, the safety of environment during the sleep is very important. These include the following:

  • Keep away the unsafe objects out of the bedroom.
  • Make floor of the bedroom free of furniture and the other objects which might injure victim in case he or she fall out of the bed.
  • Cover the floor with mattress, or pad around the bed.
  • Choose to make the person sleep on the Ground floor bedroom if possible. It is particularly for those people who are used to come out of the bed at the time of the episode.
  • The bed partner should sleep on the other bed till the symptoms disappear.
  • The bed of the patients must be railed with padded border to ensure the safety from the injuries.
Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 29, 2022

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