REM Sleep Behavior Disorder (RBD) is a sleep parasomnia where individuals physically act out their dreams. People with RBD might talk, yell, fight, or otherwise move and make noises based on their dreams. Sometimes, these can be violent and dangerous.
When the individual wakes, they have no memory of their behaviors. There is a significant link between REM sleep behavior disorder and Parkinson’s disease, as most people who have this disorder will eventually have a neurodegenerative disorder.
There are technically two types of RBD:
- “Spontaneous” and
- “Secondary”
Of those who are diagnosed, around 1% of the general population have spontaneous sleep behavior disorder, and the majority have secondary, relating to more serious conditions that have to do with the neural pathways like Parkinson’s.
Understanding the Connection Between RBD and Parkinson’s Disease
The link between REM sleep behavior disorder and Parkinson’s has to do with the spinal motor neurons. Sleep behavior disorder happens when the spinal motor neurons are not properly inhibited during REM sleep.
Neurodegenerative disorders like Parkinson’s can result in lesions that interfere with the nuclei that control REM sleep. Neuroimaging indicates that there are progressive abnormalities in things like dopaminergic agents in people with a sleep behavior disorder, and this can lend itself to eventual neurodegeneration of those same neurons associated with the spinal motor function.
Diagnosing REM Sleep Behavior Disorder in Parkinson’s Patients
A proper diagnosis of REM sleep behavior disorder requires the following:
- Repeated episodes of sleep-related vocalizations or motor behaviors
- Polysomnography to document the behaviors
- The presence of REM sleep without atonia on polysomnography
- An absence of epileptiform activity during REM sleep
- Disturbances that are not explained by other sleep disorders, neurological disorders, mental health disorders, or substance abuse
RBD is the only parasomnia that requires a complete polysomnograph at a facility in order to be diagnosed. This means formal polysomnographs must be completed as part of a sleep study for an accurate diagnosis.
During this time, the formal polysomnographic criteria require:
- Sustained elevation of EMG activity during REM sleep
- Excessive bursts of transient muscle activity during REM sleep
Common signs of RBD in those with Parkinson’s include movement and vocalizations during sleep. Once documented in a sleep study by neurologists and sleep specialists in diagnosing RBD and Parkinson’s, a course of REM sleep behavior disorder Parkinson’s treatment can be decided upon.
Treatment Options for REM Sleep Behavior Disorder in Parkinson’s Disease
There are several treatment options that involve medication and lifestyle adjustments.
Medication-Based Treatments
REM sleep behavior disorder Parkinson’s treatment can involve melatonin as the first type of medical treatment.
Melatonin can be purchased over the counter with doses between 6 mg and 18 mg to help augment the REM atonia and improve symptoms. For severe cases a prescription might be provided with doses starting at 3 mg and subsequently increased at 3 mg increments until the symptoms start to get better, something that can be monitored and managed with help of a partner.
In more severe cases, clonazepam can be prescribed in amounts of 5 to 1 mg at bedtime to control symptoms, but clonazepam does come with side effects, which makes it a secondary option in terms of medication-based treatment.
Behavioral and Lifestyle Adjustments
Behavioral and lifestyle adjustments are a necessary part of any treatment for Parkinson’s Disease REM sleep Behavior disorder.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy can address several aspects of REM sleep behavior disorder and Parkinson’s with no harmful side effects, unlike potential medications. Cognitive therapy can help individuals identify negative thoughts and beliefs that exacerbate their sleep issues or contribute to negative sleep habits and replace them with better options.
Cognitive behavioral therapy can help reduce fear related to parasomnias as well as other sources of anxiety or stress.
Safety Measures for Managing RBD in Parkinson’s Patients
A big part of treatment plans for REM sleep behavior disorder and Parkinson’s have to do with making sure that the sleeping environment is safe, not just for the individual but for their partners.
Bedroom Modifications
Neurologists and sleep specialists can provide information on how to modify the bedroom to avoid potentially hazardous objects near the bed like glass objects or firearms.
In some cases, additional measures might be required to manage REM sleep behavior disorder and Parkinson’s disease, such as installing padded bed rails on either side of the bed or sleeping in a sleeping bag. Pillows can be placed around the bed instead, with blinds and windows secured, or a mattress on the floor next to the bed in the event that an individual gets out of bed during the physical movements.
For particularly extreme situations, it might be advised that an individual sleep alone.
Support for Sleep Partners
Partners need to be provided with education on the conditions so that they understand the enactments that happen during a REM cycle are not voluntary. Partners can not only be informed about the symptoms but be an essential part of household strategies to reduce injury during such episodes and to track the events as they transpire.
Monitoring and Managing Nighttime Movements
It is important that individuals with REM sleep behavior disorder and Parkinson’s monitor and manage their nighttime movements in a healthy and safe fashion. This type of treatment can require avoidance of certain objects, making the room much safer, keeping track of nighttime movements by way of a partner, and monitoring the efficacy of other adjustments in relation to those movements.
Addressing Quality of Life for Parkinson’s Patients with RBD
Quality of life for those who have Parkinson’s disease REM sleep behavior disorder should be addressed as part of the overall behavioral and lifestyle adjustments as well.
Physical Therapy and Exercise
Physical therapy and exercise can be essential treatments for overcoming some of the symptoms of both conditions and helping to regulate the release of certain hormones that improve sleep quality. Moreover, physical therapy and exercise can be an essential way to do away with the stress and anxiety that contribute to or exacerbate symptoms.
Mental Health Support
Similarly, it may be important to seek mental health support for an underlying anxiety or depressive disorder. Such mental health support can include other therapy or medication.
Diet and Nutritional Adjustments
There may be a requirement for dietary and nutritional adjustments as well. Things that you consume can have a direct impact on the quality of sleep you receive and how much activity happens in the muscles. By keeping a stricter diet of healthier foods and avoiding things like sugars and caffeine at night, certain symptoms can be mitigated.
Summing Up
Overall, there are several effective sleep solutions for managing RBD in Parkinson’s patients. What matters most is proactive treatment and safety for improved quality of life. In addition to all of the treatment options you can get for REM sleep behavior disorder in Parkinson’s disease, never overlook the value of support networks and professional care for Parkinson’s and RBD management.
