What Is REM Sleep Behavior Disorder? Symptoms, Causes, Diagnosis, and Treatment
Have you found yourself kicking, punching, or even leaping out of bed in the middle of a vivid dream? For people with REM sleep behavior disorder, dreams don’t just stay in their minds.
REM sleep behavior disorder (RBD) is a rare parasomnia in which you physically act out your dreams while you’re in the rapid eye movement (REM) stage of sleep, according to the Cleveland Clinic.
REM sleep is typically when we dream. Our blood pressure rises, our breathing deepens, and our eyes dart in all directions. During normal REM sleep, we don’t move. Our bodies go into temporary muscle paralysis, called atonia, while our brains are wide awake with activity, according to a study published in the Annals of the New York Academy of Sciences.
However, for people with REM sleep behavior disorder, this normal muscle paralysis doesn’t happen. Instead, they experience everything from small muscle twitches and whispering to punching, kicking, shouting, and jumping out of bed. They may even hurt themselves or others.
“The way we describe it clinically is when you act out your dreams. Most people don’t realize that they’re doing these behaviors — it is usually reported by their bed partners,” says Michael Breus, PhD, a diplomate of the American Board of Sleep Medicine and a fellow of the American Academy of Sleep Medicine.
There are two main types of REM sleep behavior disorder, according to John Cline, PhD, a Connecticut-based licensed clinical psychologist specializing in sleep medicine and a diplomate of the American Board of Sleep Medicine.
The main symptom of REM sleep behavior disorder is physically acting out your dreams, because your body isn’t immobilized like it should be during REM sleep. It may start suddenly or come on gradually but typically gets worse over time. You may have episodes every once in a while or several times in a night.
Other symptoms, according to the Mayo Clinic, include:
“Typically, these are violent dreams,” says Dr. Cline. “One patient was waving their hands because they dreamt they were swarmed by bees, and then, more rarely, there are situations where people have done complex things like diving out of bed because they dreamt they were on a diving board.”
Episodes often happen in the second half of the night into the morning, when you experience longer phases of REM sleep, according to the Sleep Foundation.
RBD appears to come from a problem with certain nerve pathways in your brain. But it isn’t clear why it happens.
“We don’t know the exact cause, but what appears to be happening is that when you are in REM sleep, you should be in a state of atonia, or paralysis, specifically so you do not act out your dreams. And this mechanism appears to be not working,” Dr. Breus says.
Certain things make you more likely to develop it, according to the Sleep Foundation:
The Sleep Foundation says that 87 percent of people with RBD are male, and the average onset is about 61 years old. “As a general guideline we do tend to see this in our older sleepers,” Breus says.
Sleep deprivation, smoking, head injury, and exposure to pesticides may also be risk factors.
More often than not, RBD is first reported by a patient’s bed partner, then it’s formally diagnosed with a sleep study, Breus says.
According to the American Academy of Sleep Medicine, a patient must meet the following four criteria:
If you often act out your dreams, talk to your doctor. They’ll ask about your sleep behavior and may have you keep a sleep diary to document how often you have episodes and what goes on during them. They’ll also consider your medical history, medications you're taking, and other factors like alcohol intake.
They may refer you to a sleep specialist for an overnight sleep study, or polysomnogram. During this test, sensors will monitor your breathing, eye movements, arm and leg movements, and brain and heart activity. The polysomnogram will also record any dream enactment behavior.
While there is no cure for REM sleep behavior disorder, treatment may include options such as lifestyle changes, medication, and protecting you — and your bed partner — from harm.
Avoid triggers. Alcohol and certain antidepressants are linked to RBD. Talk to your doctor about whether your meds may be causing your episodes and if your prescription can be changed or adjusted. Keep track of when you drink before bedtime and if this increases your risk. “Alcohol seems to play a role for some patients so avoiding it is key,” Breus says.
Practice sleep hygiene. The Sleep Foundation recommends good sleep habits, which include following a consistent sleep schedule, eliminating outside noise, and sleeping in a cool, dark room. “I will tell you that the more sleep-deprived a person is, the more likely they are to have episodes. So having both good quality and quantity sleep is always important,” Breus says.
Safeguard your bedroom. From bruises and cuts to broken bones or even head trauma, injury is a serious risk to you and anyone you sleep with. “It can be really serious. We’ve had people come in where they look beaten up because they’ve jumped out of bed and crashed into things,” Cline says. Establish a safe sleeping environment by:
Talk with your doctor to determine whether medication may be helpful to treat your RBD, Cline says.
The Mayo Clinic suggests:
Besides injuries, the main risk tied to REM sleep behavior disorder is that it could be a very early symptom of a neurodegenerative disorder. Many people who have it go on to develop Parkinson’s disease, Lewy body dementia, or multiple system atrophy.
“RBD is a serious situation and not just something funny that a family member does. Talk to your doctor about it as soon as possible. It could be an early warning sign,” Breus warns.
One almost 30-year study found that over 80 percent of a group of men age 50 or older with RBD eventually developed a neurological condition, usually within 13 years of the start of their sleep symptoms. Another slightly larger study found that 30 percent of participants were diagnosed with Parkinson’s disease or dementia three years or less after the onset of REM sleep behavior disorder and 66 percent developed those conditions within eight years of the study.
“It could be that it’s a foreshadowing of developing a very serious disorder, not always but pretty often, particularly if you’re an older male and have isolated episodes of RBD,” Cline says.
Cline says that REM sleep behavior disorder is rare. Less than 0.5 percent of the general population has RBD, although the prevalence is higher in people with certain neurocognitive disorders such as Parkinson’s disease or dementia. It may be as high as 30 percent in people who also have narcolepsy, according to Psychology Today.
©2025 sitename.com All rights reserved