Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Rapid Eye Movement

Rapid Eye Movement (REM)

Rapid Eye Movement (REM) sleep behavior disorder (RBD) is a parasomnia manifested by vivid, often frightening dreams associated with simple or complex motor behavior during REM sleep. Patients appear to "act out their dreams," in which the exhibited behaviors mirror the content of the dreams.

The dream-enacting behaviors are usually non-directed and may include punching, kicking, leaping, or jumping from bed while still asleep. The person may be awakened or may wake spontaneously during the attack and vividly recall the dream that corresponds to the physical activity.

What causes REM sleep behavior disorder?

At this time the accurate cause of REM Sleep Behavior Disorder is unknown, although the disorder may be associated with other degenerative neurological conditions such as Parkinson disease, multisystem atrophy, diffuse Lewy body dementia, and Shy-Drager syndrome. It is estimated that 55% of persons with the disorder, the cause is unknown, and in 45%, the cause is associated with alcohol or sedative-hypnotic withdrawal, tricyclic antidepressant (such as imipramine), or serotonin reuptake inhibitor use (such as fluoxetine, sertraline, or paroxetine) or other types of antidepressants (mirtazapine).

How is it treated?

Medication can help to treat REM Sleep Behavior Disorder such as Clonazepam (Klonopin). Clonazepam helps to relieve symptoms in nearly 90% of patients with little evidence of tolerance or abuse. There is normally a response to the medication during the first week, often on the first night. The initial dose is 0.5 mg at bedtime, with some persons requiring a rapid increase to 1 mg. After continued use over the years, symptoms may resurface.
Several other medications, such as tricyclic antidepressants, may be effective for REM Sleep Behavior Disorder, though; tricyclics are also known to increase REM Sleep Behavior Disorder in some patients. Patients are advised to make their sleeping environment safe and notify their bed partners of potential injury if they act out their dreams.


REM sleep behavior disorder is characterized by abnormal behaviors emerging during sleep that causes injury or sleep disruption. The main symptom is dream-enacting behaviors, sometimes violent, causing self-injury or injury to the bed partner.

Houston Methodist Hospital Sleep Specialist is available to help. You can make an appointment with Dr. Aparajitha Verma, the Houston Methodist Hospital Sleep Specialist, by calling

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Rapid Eye Movement