Parasomnias
REM Sleep Behavior Disorder
Acting out vivid, often violent dreams during REM sleep because normal muscle paralysis is lost. It can be an early sign of Parkinson's disease.
Overview
During REM sleep, the body is normally paralysed so you do not act out your dreams. In REM sleep behavior disorder (RBD), this paralysis is incomplete, so people punch, kick, shout or leap out of bed while dreaming. Dreams are often action-filled or involve being chased or attacked, and injuries to the person or bed partner can occur.
RBD most often starts after age 50. Isolated RBD, meaning RBD without another neurological condition, is now recognised as a strong early marker of synucleinopathies such as Parkinson's disease, dementia with Lewy bodies and multiple system atrophy. A large international study found that about 74% of people with isolated RBD developed one of these conditions within 12 years.
This is important to know but does not mean the outcome is fixed for any individual. A diagnosis allows safety measures, treatment and regular neurological follow-up.
A population study in Switzerland found polysomnography-confirmed RBD in about 1% of adults.
Common symptoms
- Talking, shouting or swearing in sleep
- Punching, kicking or flailing during dreams
- Falling or jumping out of bed
- Vivid, action-packed or threatening dreams
- Injuries to yourself or a bed partner
- Episodes later in the night when REM sleep is more common
- Waking up alert and able to recall the dream
Causes and risk factors
- Age over 50 and male sex in clinical samples
- Neurodegenerative conditions such as Parkinson's disease and dementia with Lewy bodies
- Narcolepsy
- Certain antidepressants
- Alcohol or sedative withdrawal
- Brainstem lesions in rare cases
How it is diagnosed
RBD requires an in-lab polysomnogram with video. The study must show REM sleep without atonia, meaning muscle activity during REM sleep when the body should be still, plus a history of dream enactment or recorded behaviours during REM sleep. The study also rules out mimics such as sleep apnea, which can cause similar movements.
After diagnosis, clinicians often check for other early signs of neurodegeneration, such as changes in smell, constipation, mood or movement, and arrange ongoing neurological follow-up.
Treatment options
Bedroom safety
Removing sharp objects, padding the floor, moving the bed away from windows and sleeping separately if needed.
Melatonin
Commonly used and suggested as an option in AASM guidance.
Clonazepam
A prescription option used by specialists, with caution in older adults and people with sleep apnea or memory problems.
Medication review
Adjusting antidepressants that may worsen RBD.
Treating sleep apnea
When present, which can reduce episodes and mimics.
Neurological follow-up
Regular review and, where available, research studies.
What you can do yourself
- Make the bedroom safe for you and your partner
- Avoid alcohol
- Keep a regular sleep schedule
- Record episodes on video to show your clinician
- Stay physically active and attend follow-up appointments
When to see a doctor
- You act out dreams or a partner reports violent movements during sleep
- You or a partner have been injured
- You also notice loss of smell, tremor, constipation or memory changes
- Symptoms began after starting an antidepressant
Frequently asked questions
Does RBD mean I will get Parkinson's disease?
Isolated RBD substantially increases the risk of Parkinson's disease, dementia with Lewy bodies or multiple system atrophy over time, but it is not certain for any one person and the timeline varies. Regular follow-up allows early detection and access to research studies.
How is RBD different from sleepwalking?
RBD occurs during REM sleep, usually later in the night, often in older adults, and the person can recall the dream. Sleepwalking occurs in deep non-REM sleep, usually early in the night, and the person rarely remembers it.
Can medicines cause RBD?
Some antidepressants can trigger or worsen RBD. Your clinician may review your medicines, but do not stop any medicine without guidance.
How can I keep my partner safe?
Remove sharp or breakable objects from around the bed, pad hard surfaces, lower the mattress, and consider sleeping in separate beds until symptoms are controlled.
Sources
This page is general information, not a diagnosis or medical advice. Read our medical disclaimer.