My husband have these episodes where he mumbles in his sleep coupled with arm twitches and I even remember waking up and seeing him swatting at something. I thought he was awake but when I asked him what the matter was, he didn’t respond. That’s when I knew he was still asleep. I was told it’s RBD and that it could get violent. Can you give me more info about this disorder? What should I do about it?
I think everyone has heard of sleep-talking, there was even a song of it but I can barely remember the exact lyrics, sleepwalking, and other sleep disorders. But did you know that there is another sleep phenomenon which almost led to the demise of a woman because her husband strangled her in his sleep? Yes, and this is an example of a REM sleep behavior disorder (RBD) in action.
REM sleep behavior disorder is actually the acting-out of a dream because of the absence of muscle atonia that normally occurs during the rapid eye movement (REM) stage of sleep. Normally, when we sleep, we go through a series of sleep stages before going into deep sleep or REM stage. This is where dreaming occurs. Our brain, in order to prevent us from potential injuries, sends out a signal to relax our skeletal muscles giving us that temporary paralysis while we sleep.
In REM sleep behavior disorder, the signals, somehow, are intercepted somewhere and it doesn’t reach the muscles. In effect, when the dreaming stage of sleep is attained, the body fails to assume the sleep behavior which is paralysis, and adapts the waking stage instead, which means acting out whatever it is that transpires in the dream. Actions such as mumbling, grunting, shouting, and even violent behaviors such as punching and, yes, strangling, has been documented.
This is a very rare, but very intriguing, disorder and it is thought to be the most studied among other REM sleep parasomnias. In the US, there are only about 0.5% reported cases of REM sleep behavior disorder out of the general population. It could be because most of the cases are reported, not to the doctor, but to family members and significant others.
REM sleep behavior disorder is known to affect men in their 60’s and beyond. In fact, according to research, around 80% – 90% of RBD cases occur in males. However, this disorder can also be found in females and younger generations but not as prevalent as it is in older men.
It is still not clear what causes this phenomenon but experts are looking into it. Possible causes would be tumors, brain injuries, and degenerative disorders. It has also been found that there is a significant link between REM sleep behavior disorder and degenerative disorders. It seems like those who had prior REM sleep behavior disorder has a greater chance of developing Parkinson’s disease. But this is still subject to confirmation.
The leading treatment that most RBD patient’s responds to is clonazepam. Clonazepam is a benzodiazepine derivative and have been known to be the best drug for suppressing the acting out of dreams, though some research shows that Clonazepam treatment on some users have been discontinued because of it’s side effects. The second most tried treatment is melatonin and have been effective on treating RBD on some patients. The reason behind the effectiveness of Melatonin on some cases still remains a mystery. Other drugs that have been studied but are not widely used because of their side effects are paroxetine, Rozerem, Seroquel and Xyrem.
Since experts are still on the process of finding out the truth about the causes of this disorder and treatment options still doesn’t work for some cases, safety measures are encouraged for those who have this REM sleep behavior disorder. Practices like putting extra pillows on the floor beside the bed, removing hard objects including nightstands and clocks, etc., even removing side tables from near the bed, would prevent injuries during episodes. Should you feel that you or anyone in the family is exhibiting these sleep behaviors, consulting a sleep doctor wouldn’t hurt.