REM Sleep Behavior Disorder

Often, patients realize something is wrong when they — or their bed partner— sustain injuries such as bruising, cuts, fractures, swelling or dislocated joints during sleep. If you experience this situation, especially when paired with vivid dreams, see a neurology and sleep medicine expert right away.

During your first visit, we will ask you a series of questions to determine whether you have RBD or another condition. Questions will cover potential risk factors, such as: 

• General health – Constipation and chronic loss of the sense of smell can be symptoms of RBD, as well as early indicators of Parkinson’s disease 
• Mental health – Individuals with a current mood disorder (such as PTSD or anxiety) or history of traumatic brain disease may be at increased risk 
• Types of medication you take – In some patients, beta blockers, sleep aids and anti-anxiety/depression medications increase the risk of RBD 
• Home and work environment, such as potential pesticide exposure 
• Whether others have observed unusual behavior while you’re asleep 
• Whether you consume alcohol or have recently stopped drinking 

In many cases, your answers to these questions are enough to diagnose RBD. However, if we suspect another concern, such as dementia or narcolepsy, we will recommend additional exams.

A sleep study with audio/video recording is the gold-standard diagnostic exam. Using EEG brain wave monitoring, we can tell whether actions or verbalizations during sleep are occurring in the rapid eye movement (REM) sleep cycle.

Brain imaging also can show structural lesions that may cause symptoms, such as a benign or cancerous brain tumor, demyelination of nerve fibers or hardening of the arteries in the brain.  

Create a Safe Sleep Environment

This step is crucial to reduce the risk of injuring yourself or a loved one. Start by removing all objects from the bedside that could be thrown or easily broken, such as a nightstand lamp. Also remove all firearms and sports equipment from the bedroom.

Consider adding padding to your bedrails and headboard. Some patients choose to sleep in a secured sleeping bag or in a separate room to avoid injuring themselves or others during an episode. 

Select a Medication, If Needed

Many patients experience a noticeable change within the first week of taking medication for RBD. For some, the over-the-counter supplement melatonin is enough to control symptoms.

If you need a stronger sleep aid, your specialist can recommend a prescription medication, such as clonazepam. Certain medications for movement disorders can reduce involuntary movements during REM sleep. In some cases, medications that inhibit neurotransmitters in the central nervous system can reduce symptoms.  

If your current therapy is not working or if you are at risk for a neurological condition, Houston Methodist can take your care to the next level. Our integrated team collaborates with behavioral health, cardiovascular and otolaryngology experts who can diagnose and treat underlying diseases and conditions associated with RBD.

Houston Methodist offers world-class movement disorder care for patients who develop Parkinson’s disease and unmatched expertise in care for memory conditions such as Lewy body dementia.