II. Definitions
- REM Sleep Behavior Disorder
- Complex motor activity and behavior (e.g. acting out dreams while asleep) during REM Sleep
III. Epidemiology
- More common in men than women
- Age 40 to 60 years old most commonly affected
IV. Pathophysiology
- Loss of the typical REM Sleep atonia
V. Risk Factors
- Antidepressant medication use
VI. Signs
- Increased motor tone during sleep
- Patient acts out dreams during REM Sleep
- Flails limbs
- Vocalizes
- May fall out of bed
VII. Complications
- Risk of injury to patient or bed partner
VIII. Associated Conditions
- Parkinsonism (and related Movement Disorders)
- Lewy Body Dementia
- Multiple System Atrophy
- Spinocerebellar Ataxia
- Severe Obstructive Sleep Apnea
- Narcolepsy
- Selective Serotonin Reuptake Inhibitors
IX. Diagnosis
X. Management
- Refer to sleep medicine or neurology
- Create a safe sleep environment to ensure safety of patient and their bed partner
- Remove fragile or dangerous objects from around the bed
- Remove furniture (or apply padding)
- Lower mattress to the floor
- Consider a bed alarm
- Treat underlying causes
- Obstructive Sleep Apnea
- Narcolepsy
- Discontinue causative medications (e.g. Antidepressants)
- Observe for associated neurologic disorders (e.g. Parkinsonism, Lewy Body Dementia, Multiple System Atrophy)
- Ultimately diagnosed in >90% of patients of REM Sleep Behavior Disorder
- Roguski (2020) Front Neurol 11:610 [PubMed]
- Medication Management
- Melatonin at bedtime
- Titrate up over 3 g at bedtime every 2 weeks until symptoms improve (max: 12 mg at bedtime)
- Clonazepam 0.5 to 2 mg at bedtime
- Melatonin at bedtime