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REM sleep behavior disorder

Rapid eye movement (REM) sleep behavior disorder is a sleep disorder in which you physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep — sometimes called dream-enacting behavior.

You normally don't move during REM sleep, a normal stage of sleep that occurs many times during the night. About 20 percent of your sleep is spent in REM sleep, the usual time for dreaming, which occurs primarily during the second half of the night.

The onset of REM sleep behavior disorder is often sudden, and episodes may occur occasionally or several times a night. The disorder can get worse with time.

REM sleep behavior disorder often may be associated with other neurological conditions, such as Lewy body dementia (also called dementia with Lewy bodies), Parkinson's disease or multiple system atrophy.

Symptoms Causes Risk factors Complications

With REM sleep behavior disorder, instead of experiencing the normal temporary paralysis of your arms and legs (atonia) during REM sleep, you physically act out your dreams.

Symptoms of REM sleep behavior disorder may include:

  • Movement, such as kicking, punching, arm flailing or jumping from bed in response to the content of action-filled or violent dreams, such as being chased or defending yourself from an attack
  • Noises, such as talking, laughing, shouting, emotional outcries or even profanity
  • Being able to recall the dream if you are woken up during the episode

Nerve pathways in the brain that prevent muscles from moving are active during normal REM or dreaming sleep, resulting in temporary paralysis of your body. In REM sleep behavior disorder, these pathways no longer work and you may physically act out your dreams.

Factors associated with the development of REM sleep behavior disorder include:

  • Being male and over 50 years old — however, more women are now being diagnosed with the disorder, especially under age 50, and young adults and children can develop the disorder, usually in association with narcolepsy, antidepressant use or brain stem tumors
  • Having a certain type of neurodegenerative disorder, such as Parkinson's disease, multiple system atrophy or dementia with Lewy bodies — in fact, REM sleep behavior disorder can be the first indication of future development of a neurodegenerative disease
  • Having a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep (narcolepsy)
  • Taking certain medications, especially newer antidepressants, or the use or withdrawal of drugs or alcohol

Recent evidence has suggested that there may also be several specific environmental or personal risk factors for REM sleep behavior disorder, including occupational pesticide exposure, farming, previous head injury or smoking.

Complications caused by REM sleep behavior disorder can include:

  • Injury to yourself or your sleeping partner
  • Distress to your sleeping partner or other people living in your home
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