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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Ontology: REM Sleep Behavior Disorder (C0751772)

Definition (MSH) A disorder characterized by episodes of vigorous and often violent motor activity during REM sleep (SLEEP, REM). The affected individual may inflict self injury or harm others, and is difficult to awaken from this condition. Episodes are usually followed by a vivid recollection of a dream that is consistent with the aggressive behavior. This condition primarily affects adult males. (From Adams et al., Principles of Neurology, 6th ed, p393)
Concepts Disease or Syndrome (T047)
MSH D020187
ICD9 327.42
ICD10 G47.52
SnomedCT 415238003
Swedish Beteendestörningar, REM-sömn
English BEHAVIOR DIS RAPID EYE MOVEMENT SLEEP, BEHAVIOR DIS REM, REM BEHAVIOR DIS, RAPID EYE MOVEMENT SLEEP BEHAVIOR DIS, REM SLEEP BEHAVIOR DIS, organic REM sleep behavior disorder (diagnosis), organic REM sleep behavior disorder, Behavior Disorder, Rapid Eye Movement Sleep, Rapid Eye Movement Sleep Behavior Disorder, Behavior Disorder, REM, Behavior Disorders, REM, REM Behavior Disorder, REM Behavior Disorders, REM Sleep Behavior Disorder, REM sleep behavior dis, REM Sleep Behavior Disorder [Disease/Finding], rem sleep behavior disorder, rem behavior sleep disorder, behavior disorders rem sleep, rem behavior disorder, REM sleep behavior disorder (diagnosis), sleep disorder rem sleep behavior, REM sleep behavior disorder, REM sleep behaviour disorder, REM sleep disorder, Rapid eye movement sleep behavior disorder (disorder), Rapid eye movement sleep behavior disorder, Rapid eye movement sleep behaviour disorder
Czech porucha chování v REM spánku
Finnish REM-unen käytöshäiriö
Italian Turbe comportamentali del sonno con movimenti oculari rapidi, Turbe comportamentali del sonno REM
Polish Zaburzenia zachowania związane ze snem REM, Zaburzenia behawioralne związane z fazą REM, Zaburzenia zachowania w fazie REM
Japanese レム睡眠行動障害, 行動異常-レム睡眠時, レム睡眠時異常行動, レム睡眠時行動障害, 行動障害-レム睡眠, 行動障害-レム睡眠時
Norwegian Atferdsforstyrrelse, REM-søvn, REM-søvn, atferdsforstyrrelse
German Rapid Eye Movement, Störung des Schlafverhaltens, REM-Schlaf-Verhaltensstörung
Dutch Rapid-eye-movement-slaapgedragsstoornis, Rem-slaapgedragsstoornis, Slaapgedragsstoornis, Rem-, Stoornis, Rem-slaapgedrags-
Spanish trastorno del sueño MOR, trastorno del sueño REM, trastorno del sueño con movimientos oculares rápidos (trastorno), trastorno del sueño con movimientos oculares rápidos, Trastorno de la Conducta del Sueño de Movimiento Rápido de los Ojos, Trastorno de la Conducta del Sueño REM
Portuguese Transtorno do Comportamento do Sono de Movimento Rápido dos Olhos, Transtorno do Comportamento do Sono REM
French Troubles du comportement au cours du SP, Troubles du comportement au cours du sommeil paradoxal, Troubles du comportement en SP, Troubles du comportement en sommeil paradoxal