REM Behavior Disorder

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by abnormal behaviors that emerge during sleep and disrupt your sleep. This sleep disorder is an abnormal type of sleep (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, sometimes causing self-injury or injury to their bed partner.

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.

Causes of REM Sleep Behavior Disorder
The cause of RBD is unknown, although it may be associated with other degenerative neurological conditions such as Parkinson’s diseasemultisystem atrophy and Shy-Drager syndrome, diffuse Lewy body dementia . For about 55 percent of people with RBD, the cause is unknown. In 45 percent of cases, RBD is associated with alcohol or sedative-hypnotic withdrawal, tricyclic antidepressant (medications, such as imipramine) or serotonin reuptake inhibitor use (medications, such as fluoxetine, sertraline or paroxetine) or other types of antidepressants (for example, mirtazapine).

Treatment Options for REM Sleep Behavior Disorder
Our sleep specialists at Houston Methodist employ a multidisciplinary approach to diagnose and treat REM sleep behavior disorder. Clonazepam (an FDA-approved medication used to treat seizures, panic disorder and anxiety) helps to relieve symptoms in nearly 90 percent of patients, with little evidence of tolerance or abuse. There is normally a response to the clonazepam during the first week, often on the first night. The initial dose is 0.5 mg at bedtime, with some patients requiring a rapid increase to 1 mg. After continued use over the years, symptoms of REM sleep behavior disorder (RBD) may resurface.

Several other medications, such as tricyclic antidepressants, may be effective for RBD; however, tricyclic antidepressants are also known to increase REM sleep behavior disorder in some patients. Patients are advised to make their sleeping environment safe. People who sleep in the same bed with the patients, may be injured by someone with uncontrolled RBD.


Our physicians at Houston Methodist specialize in evaluating and treating REM sleep behavior disorder at the following convenient locations.