II. Definitions

  1. REM Sleep Behavior Disorder
    1. Complex motor activity and behavior (e.g. acting out dreams while asleep) during REM Sleep

III. Epidemiology

  1. More common in men than women
  2. Age 40 to 60 years old most commonly affected

IV. Pathophysiology

  1. Loss of the typical REM Sleep atonia

V. Risk Factors

  1. Antidepressant medication use

VI. Signs

  1. Increased motor tone during sleep
  2. Patient acts out dreams during REM Sleep
    1. Flails limbs
    2. Vocalizes
    3. May fall out of bed

VII. Complications

  1. Risk of injury to patient or bed partner

VIII. Associated Conditions

IX. Diagnosis

X. Management

  1. Refer to sleep medicine or neurology
  2. Create a safe sleep environment to ensure safety of patient and their bed partner
    1. Remove fragile or dangerous objects from around the bed
    2. Remove furniture (or apply padding)
    3. Lower mattress to the floor
    4. Consider a bed alarm
  3. Treat underlying causes
    1. Obstructive Sleep Apnea
    2. Narcolepsy
    3. Discontinue causative medications (e.g. Antidepressants)
  4. Observe for associated neurologic disorders (e.g. Parkinsonism, Lewy Body Dementia, Multiple System Atrophy)
    1. Ultimately diagnosed in >90% of patients of REM Sleep Behavior Disorder
    2. Roguski (2020) Front Neurol 11:610 [PubMed]
  5. Medication Management
    1. Melatonin at bedtime
      1. Titrate up over 3 g at bedtime every 2 weeks until symptoms improve (max: 12 mg at bedtime)
    2. Clonazepam 0.5 to 2 mg at bedtime

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