REM Behavior Disorder (RBD):   A lack of atonia during REM sleep, accompanied by dramatic dreams, resulting in violent behaviors as dreams are enacted. RBD is a parasomnia that occurs specifically during REM or dream sleep. The dreamer is very much asleep, despite the heightened or even violent level of activity.


      Acting out violent, intense dreams is the major and often only feature of REM Sleep Behavior Disorder. The ability to move about while dreaming combined with the dramatic content of dreams makes RBD a potentially dangerous condition.
    The range of behaviors associated with RBD are as broad as the spectrum of possible dreams. Like all dreams, RBD dreams can be fragmented and symbolic, so behaviors do not translate precisely. Bed partners may notice a simple twitch, or complex behaviors that make sense. Complex RBD behaviors tend to be harsh if not violent in nature. Although activity is usually confined to the bed and surrounding area, other common behaviors may include:

-leaping out of bed     
-running or chasing    
-attempting to 'escape'
-screaming or swearing
-shouting or grunting

-fighting or attacking bed partners
-breaking nearby objects

People with RBD remember their dreams, often in detail, but not their enactment of them. It is important to remember that people with RBD do not have a psychiatric problem. They are not aggressive or violent while awake.


       A positive diagnosis of REM Sleep Behavior Disorder begins with a careful medical history to determine whether the problems may be secondary to another health condition or the use of certain medications. A sleep log of your sleep habits and possibly audio or video tapes of episodes will help your doctor or sleep specialist. Ultimately, an overnight sleep study will be key to conclusively identifying this sleep disorder, which can look similar to other parasomnias such as sleepwalking and sleep terrors. The sleep study or polysomnogram and a corresponding video will reveal that motor activity is occuring while you are asleep and dreaming.


      Most people respond well to the medications used to treat RBD.  Clonazepam (a benzodiazepan with anticonvlusant properties) is commonly prescribed.  It blocks neurotransmitters so atonia can then be achieved. Additional medications are available, particularly for people with renal diseases or certain other health conditions, or who are taking contradictory medications. Safety measures such as removing potentially dangerous objects from the bedroom and locking windows (to prevent attempts to 'escape') are often necessary to protect those with RBD and their bed partners.

RBD Mechanics

    Episodes of REM Sleep Behavior Disorder only occur during REM or dream sleep, approximately every 1 1/2 to 2 hours. Normally, the neurotransmitters that control voluntary movement are blocked during REM sleep--a process called atonia. The resulting sleep- paralysis keeps most of us from acting out our dreams. In RBD, those neurotransmitters are not blocked, so neurotransmitters interpret dreams similarly to the conscious 'messages' of wakefulness, with action!

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REM Sleep Behavior Disorder