What is REM Sleep Disorder?

Woman with insomnia
Woman with insomnia lying in bed with open eyes

Rapid eye movement (REM) sleep handles the development of the learning and emotional regulation parts of the brain. Failure to develop these skills can impact the quality of a person’s life and potentially lead to chronic anxiety or depression.

For this reason, understanding the difference between bad sleeping patterns and a chronic condition is crucial for personal health.

Grasping a better understanding of sleep disorders can help you identify your symptoms early on and lead to a faster treatment process. This guide helps to answer the question ‘What is REM sleep disorder?’ for those interested in exploring more about the diagnosis process.

What is REM Sleep Disorder?

The sleep disorder formally known as REM sleep behavior disorder (RBD) is a form of sleep disorder that interrupts a person’s REM sleep cycle. REM sleep is responsible for decreasing the body’s muscle tone while sleeping and promotes vivid dreaming.

In a typical functioning REM sleep cycle, your body experiences a mix of mental stimulation and muscular immobility. Vivid dreams usually provoke an increase in heart rate as well as stimulation in the face, legs and fingers.  

For those who achieve REM sleep, these behaviors are normal and can aid in a restful night’s sleep.

Alternatively, people who experience disruptions during their REM sleep often feel tired and are at greater risk of injuring themselves or loved ones throughout the night. This is due to the increased risk of physical movement inflicted by this type of sleep disorder.


The most common symptoms of RBD include physically acting out your dreams throughout the night. Depending on the person, and the nature of the dream, the behaviors can vary in intensity.

RBD does not discriminate between the types of dreams people experience. For this reason, a person with RBD may become violent when experiencing a nightmare or feelings of distress in a dream.

Common symptoms of RBD include:

  • Vocalizations (laughing, talking, screaming, emotional outbursts)
  • Physical movement (jumping, kicking, arm/leg flailing, punching)
  • Dream recollection after awaking mid-dream

If you begin to notice feelings of tiredness after sleeping through the night, consider monitoring your sleep cycles more in-depth or reach out to a doctor. RBD is a condition that typically worsens over time and can considerably impact your quality of life if left untreated.


Throughout a typical REM sleep, the brain’s nerve pathways prevent the muscles in your body from moving. In those with RBD, these pathways no longer function- causing you to act out dreams instead of remaining in a temporary state of paralysis.

Although this condition is physiologically understood, the reason for the degeneration of these nerve pathways remains unknown. 

Risks Associated With RBD 

Currently, there is no definitive cause of RBD however, a recent study shows that it may be linked to a variety of degenerative neurological conditions. Such conditions include:

  • Parkinson disease
  • Shy-Drager syndrome
  • Multiple-system atrophy
  • Lewy-body dementia

Many studies also believe that RBD is secondary to other common neurological diseases that cause sleep disruption. Some conditions are: 

  • Autism
  • Tourette syndrome
  • Multiple sclerosis

Traumatic brain injuries and post-traumatic stress disorder have also been suggested to contribute to the onset of RBD however, there is no definitive correlation at this time. 

Additional Potential Risks

Excessive use of or withdrawal from alcohol or drugs has been stated to make RBD more likely to occur. Older adults are also more likely to show symptoms out of the 0.5% of the general population that develops RBD.

Current Opinion

The most likely belief surrounding the cause of RBD has to do with the effects of certain prescribed medications. According to the same study, some of these medications include: 

  • Serotonin reuptake inhibitors (fluoxetine)
  • Monoamine oxidase inhibitors (phenelzine/selegiline)
  • Beta-blockers (bisoprolol)

Due to the many ideas of causation for RBD, it is hard to definitely state who is most at risk. For those currently taking any of these medications, it is strongly suggested that you track your sleep health.

Diagnosis Process

The process of diagnosing RBD is very similar to most diagnosis processes. After vocalizing your concerns and symptoms to your doctor, they will then conduct an in-depth evaluation of your medical history. Your evaluation process could include:

Physical and/or Neurological Exam

The symptoms associated with RBD are very similar to other sleep disorders. For this reason, your doctor will assess your behaviors to determine your likelihood of having RBD or if any other disorders are coexisting. 

Disorders such as obstructive sleep apnea, narcolepsy, nocturnal panic attacks and seizures are just some of the conditions that may warrant a differential diagnosis

Discussion With Partner

For those who have a sleeping partner, a doctor may ask them to fill out a questionnaire about your sleep behaviors. Your partner can give extensive insight into how often you experience behaviors associated with RBD and how extreme they are.

Sleep Studies  

Sleep studies are often used as a method of diagnosis by physicians. During this process, you typically take part in an overnight study. This study monitors your heart, arm and leg movements, any vocalizations, brain activity and blood oxygen levels. 

This method of diagnosis is videotaped and then documented to determine your behaviors during REM sleep. If you are uncomfortable with being recorded, your doctor can resort to other methods.


Imaging tests, such as CT scans or an MRI, are rarely conducted during the diagnostic process of RBD. In certain circumstances, you may be asked to undergo imaging studies. This includes any abnormalities during your neurological exam or if you are under 40.

Diagnostic Criteria

REM sleep behavior disorder is diagnosed using the diagnostic tool known as the International Classification of Sleep Disorders, Third Edition (ICSD-3). Diagnosis of RBD must include the following:

  • You become aroused while sleeping (exhibiting physical/vocal behaviors associated with dream content)
  • You can remember dreams associated with sounds/movements
  • You are not confused or disoriented after awakening mid-episode
  • Sleep study indicates muscle activity during REM sleep
  • Other sleep disturbance disorders, mental health disorders, medication/substance abuse has been ruled out

Receiving an RBD diagnosis may be an early sign of neurodegenerative disease development later in life. Although it is not guaranteed that everyone with the diagnosis will develop it, precautionary measures with your doctor should still be discussed.

Treatment Process

Due to the nature of some of the symptoms related to RBD, people with the diagnosis are more at risk for injuries to self or others. The primary form of treatment for people with this condition involves treating physical as well as physiological well-being.

Medicinal Treatments

A commonly prescribed medication that is used to treat RBD is Clonazepam (Klonopin). This medication is a benzodiazepine- typically prescribed to treat patients with anxiety, seizures or panic disorders. 

Clonazepam has shown significant results in decreasing the symptoms RPD produces however, you may experience some side effects. Decreased coordination, daytime sleepiness and worsened sleep apnea can manifest in certain people during the treatment process. 

The decision to stop this medication should be overseen by a physician as the withdrawal may produce increased agitation and nightmares.   

Additionally, your doctor may recommend using melatonin. This approach works similarly to Clonazepam without producing as many adverse effects. Natural supplements such as this can aid in the treatment process depending on your personal preference. 

To discover other varieties of supplements, you can view more here.

Addressing Personal Safety

For some people, making changes to sleep routines and physical surroundings is an effective form of treatment. Managing your physical safety can help prevent you or your partner from injuries if or when you experience RBD symptoms.

Changes to your sleeping environment may include:

  • Installing padding on floors and windows near the bed
  • Remove dangerous objects from the room
  • Install barriers on the sides of your bed
  • Sleep in a different room than your partner until symptoms are managed

Since this disorder’s origins are still unknown, most individuals will likely receive different variations of treatment. To achieve optimal care, work with your doctor when deciding on which approach works best for you.

Make Your Health a Priority

Answering the question ‘What is REM sleep disorder?’ assists in your process of receiving a formal diagnosis. Alternatively, it also helps you rule out other conditions.

Recognizing and tracking symptoms is the first step to monitoring your health responsibly. For those who fall into the risk groups, it is recommended that you seek extra advice from medical professionals. 

Furthermore, to continue your research, feel free to explore our website’s health-related resources.

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