REM sleep behavior disorder (RBD) is a sleep disorder that causes people to act out their dreams while they are in the rapid eye movement (REM) phase of sleep. During this phase, the muscles of the body are typically paralyzed to prevent individuals from acting out their dreams. However, in people with RBD, this paralysis does not occur, which can result in a range of symptoms, including talking, shouting, punching, kicking, or thrashing in their sleep.

RBD is a rare sleep disorder that typically affects people over the age of 50, although it can occur at any age. The cause of RBD is not fully understood, but it has been linked to neurological conditions such as Parkinson's disease, multiple system atrophy, and Lewy body dementia.

The main treatment for RBD is medication, which can help to suppress abnormal movements during sleep. Clonazepam, a medication used to treat anxiety and seizures, has been shown to be effective in treating RBD. Other medications, such as melatonin or pramipexole, may also be used in some cases.

It is important for individuals with RBD to take safety measures to prevent injury to themselves or others during their sleep. This can include sleeping in a bed with padded rails or on a mattress on the floor, removing any sharp or dangerous objects from the sleeping area, and wearing protective gear such as a helmet or knee pads.

If you think you may have RBD, it is important to see a healthcare professional who can evaluate your symptoms and recommend the appropriate treatment.

Nerve pathways in the brain that prevent muscles from moving are active during normal REM or dreaming sleep, resulting in temporary paralysis of your body. In REM sleep behavior disorder, these pathways no longer work and you may physically act out your dreams.

Treatment for REM sleep behavior disorder may include physical safeguards and medications.

Physical safeguards

Your doctor may recommend that you make changes in your sleep environment to make it safer for you and your bed partner, including:

• Padding the floor near the bed
• Removing dangerous objects from the bedroom, such as sharp items and weapons
• Placing barriers on the side of the bed
• Moving furniture and clutter away from the bed
• Protecting bedroom windows
• Possibly sleeping in a separate bed or room from your bed partner until symptoms are controlled

Medications

Examples of treatment options for REM sleep behavior disorder include:

• Melatonin. Your doctor may prescribe a dietary supplement called melatonin, which may help reduce or eliminate your symptoms. Melatonin may be as effective as clonazepam and is usually well-tolerated with few side effects.
• Clonazepam (Klonopin). This prescription medication, often used to treat anxiety, is also the traditional choice for treating REM sleep behavior disorder, appearing to effectively reduce symptoms. Clonazepam may cause side effects such as daytime sleepiness, decreased balance and worsening of sleep apnea.

Doctors continue to study several other medications that may treat REM sleep behavior disorder. Talk with your doctor to determine the most appropriate treatment option for you.