Dear Doctors: My boyfriend says I’ve been talking in my sleep and sometimes acting out my dreams lately. I actually hit him once. He says it could be something called REM sleep behavior disorder. This is a little scary, so please stop. Will going to a sleep clinic help?
Dear Reader: Sleep disorders are estimated to affect up to 70 million people in the United States. Sleep disorders include the most common sleep disorders insomnia, restless leg syndrome, obstructive sleep apnea, narcolepsy, and parasomnia. REM sleep behavior disorder, also known as RBD, falls into the last category.
The term parasomnia refers to abnormal behaviors that occur during sleep. Sleep talking, sleep paralysis, nocturnal enuresis, recurrent bruxism, sleepwalking, and nightmare disorders are also considered parasomnias.
REM stands for “rapid eye movement”. REM sleep is one of the four stages of the complete sleep cycle. The majority of dreams occur during REM sleep. Scanning a sleeping person shows a significant amount of brain activity during REM sleep, about the same amount that person exhibits when awake. At the same time, signaling mechanisms in the brain cause a kind of muscle paralysis in the sleeping person. This is known as Atonia. Atony, also called REM sleep muscle palsy, is normal, part of REM sleep, and even necessary.
If someone has REM Sleep Behavior Disorder, it means that Atony’s safety net – sleep muscle paralysis – has been broken. This allows a person to physically respond to their dreams or make them come true. The resulting activity can range from small movements such as waving hands to vigorous full-body movements. In the latter case, not only the sleeper but also those around them can be at risk. A person with RBD may punch, kick, punch, punch. This can cause injury to yourself or your bed partner. When I wake up, I often have a clear memory of the dream I had.
Diagnosing a sleep disorder usually includes a medical history, a detailed sleep history, and may include a physical and neurological examination. Sleep studies that record an individual’s physiological and behavioral data are also often requested.
When someone has RBD, data collected in sleep studies reveal a lack of atony during REM sleep, or sleep paralysis. Treatment of this condition focuses on changing the sleep environment and using drugs to make it safer. These include melatonin, a hormone that helps regulate sleep cycles, and certain anti-anxiety medications.
The cause of RBD is still unknown. In some cases, it is thought to be associated with neuropathy and antidepressant use. Some people feel that the episode is temporary and will go away on its own. If symptoms persist, consult your healthcare provider. If necessary, we will refer you to a sleep clinic for a detailed evaluation and necessary treatment.
Eve Glazier, MD, MBA, is an internist and associate professor at UCLA Health. Elizabeth Koh, M.D., is an internist and assistant professor at UCLA Health. Please direct questions to email@example.com or write to: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Due to the high volume of emails, we are unable to respond personally.