Rapid eye movement (REM) sleep behavior disorder is a parasomnia typified by dream-acting actions that materialize in the loss of REM sleep atonia. Dream-acting disorder ranges in severity from non-threatening hand gestures to aggressive punching, thrashing, and kicking. In most cases, patients present to medical attention with concerns linked to detrimental or potentially injurious actions to selves or their bed partners. In impulsively happening instances, REM is a prodromal condition of alpha-synuclein neurodegeneration. Hence, most RBD Behavior disorders demonstrate Parkinson’s signs and symptoms or associated conditions, for example, dementia, multiple system atrophy, and Lewy bodies.
The danger of REM sleep disorder
REM sleep behavior disorder is associated with significant quality of life burden. Recurrent injuries to self and bed partners also are widespread. People with REM sleep behavior disorder have marital burdens, and single people might fear meeting possible partners owing to blushing or fear of causing injury. Patients with Parkinson’s disease with comorbid RBD have severe RBD symptoms as compared to those with Parkinson’s disease without RBD.
Health and wellness problems as a result of REM sleep behavior disorder
As earlier stated, chronic REM sleep behavior disorder commonly entails older and middle-aged men and exhibit violent dream-acting conduct that results in frequent injury to themselves and their bed partners. Documented damages resulting from jumping out of bed and sleep violence comprise subdural hematomas, fractures, dislocations, tooth chipping, rug burns, and hair pulling. Other possibly destructive behaviors constitute headlock, choking, punching a pregnant bed-partner, or diving from bed. Surprisingly, chronic RBD behaviors pose a high risk for inadvertent homicide or parasomnia pseudo-suicide.
Furthermore, though some victims may be unconscious of their strange conduct during the night, their bed partners are conscious of the behaviors and may be worried about the risk of injuries to their partners and themselves that might result in significant adverse mental implications on patients’ spouses. Therefore, there is a need for clinical interventions to manage the condition. Creating a secure sleeping environment is the principal objective of treatment; this can be attained via the modification of sleeping environments and pharmacotherapy if necessary.
Epidemiology
There is limited data on the prevalence of REM sleep behavior since accurate diagnosis needs video polysomnography, which is quite time-consuming and costly and is not readily available in clinical settings. The prevalence of REM sleep behavior disorder is roughly 0.5 to 1.25% across the general population and nearly 2% among older adults. Though this translates to 100 million expected patients across the globe, most of the cases go undiagnosed. Among young adults less than 40 years old, Rapid Eye Movement commonly transpires in settings of antidepressant medicine exposure. The disorder is relatively rare among children, with a vast majority of cases being linked to anti-depression medication use, narcolepsy type 1, and the use of antidepressant medication. REM is prevalent among Parkinson’s disease and dementia patients. Behavioral and environmental risk factors for Rapid Eye Movement generally overlap with those for Parkinson’s Disorder. REM patients have a higher probability of smoking, have fewer years of education, have a concurrent mood disorder, report heavy alcohol use, pesticide exposure, welding work, use of antidepressants, and have a history of traumatic brain damage.
REM sleep behavior disorder has a substantial male prevalence in published series (as high as 1: female-male ratios) though female cases are likely under-diagnosed or under-reported. Most of the difference might result from referral bias since males habitually have more hostile and aggressive REM episodes than women. Female patients with sleep disorders are also relatively young. Among aged women, rapid eye movement might be less likely to be witnessed, as women, in most cases, live longer than their male bed partners. Nonetheless, the frequency of RBD patients who are not conscious of their dream-enacting conduct is unknown. Finding those patients would boost the overall frequency of Rapid eye movement sleep behavior disorder though it remains unclear by how much.
REM sleep behavior disorder symptoms
What are the symptoms of rem sleep behavior disorder? REM sleep behavior disorder demonstrates strange actions during REM sleep that might disrupt sleep and cause injury. Symptoms of RBD comprise:
Movement, such as kicking, punching, arms flailing, or jumping from bed
This is the most apparent symptom of REM sleep behavior disorder among patients. It can also result in injury to self or bed partners.
Noises, such as talking, laughing, shouting, and emotional outcries
Another symptom of REM sleep behavior disorder is producing noise during their sleep.
Being able to recall the dream if you awaken during the episode
In most cases, the RBD patient wakes up abruptly with quick attentiveness and can recount the dream logically. A vast majority of patients are usually conscious of their dream-enactment conduct.
Sleepwalking
Every night, patients experience numerous cycles of REM and non-REM sleep. Most often, sleepwalking occurs during sleep, while non-REM sleep, also known as N3, sleeps early at night. This symptom is more common among young adults and children; this is due to the fact that as individuals age, they experience less N3 sleep. Most importantly, sleepwalking tends to run in families.
Having the eyes open
Most patients have their eyes open during REM sleep, the eyes rapidly move, and vivid dreams are most common.
Nonetheless, the occurrence of motor incidents might differ among RBD patients, extending from numerous episodes per night to a single episode in a month. In any single RBD patient, the frequency and severity of the conduct might also differ from day to day and throughout their illness. The mechanisms behind these variations are largely unknown.
Rapid eye movement sleep behavior disorder presents a multitude of considerations for non-specialized clinicians and neurologists alike. This condition underscored the significance of sleep for good health and the need for high awareness of sleep illnesses and their harmful implications. This condition offers researchers and scientists a chance to implement new mechanisms against neurodegenerative processes.
Rapid eye movement sleep behavior disorder is linked to several root causes, from severe emotional states to progressive neurodegeneration. For a vast majority of patients, dream-enactment conducts are the initial REM sleep behavior disorder symptoms. Therefore, the responsibility lies with the physician to identify the risks, communicate them effectually, and make a diagnosis accordingly. Though the forecast of the disorder remains uncertain, technological advancements and clinical research into the condition are leading to higher understanding and endpoint forecasts.
