REM Sleep Behavior Disorder

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Houston Methodist neurologists are experts in the diagnosis and treatment of REM sleep behavior disorder, a rare and complex condition. Sleep medicine specialists are embedded in our comprehensive neurology team to manage and streamline every aspect of your care.   

As one of only nine centers accredited by the American Academy of Sleep Medicine (AASM), Houston Methodist offers the latest diagnostic and treatment options for rapid eye movement sleep behavior disorder (RBD). 

Underlying mechanisms of RBD can cause patients to physically harm themselves or their loved ones due to vivid, sometimes violent reenactment of dreams — from uncontrolled hand gestures to flailing, kicking, punching and jumping while asleep. 

Our integrated sleep medicine and neurology team of experts streamlines advanced interventions to manage current symptoms. With ongoing care backed by the latest research, our experts can help reduce the risk of developing future complications. 

Advanced, Streamlined RBD Treatment

RBD can arise from varied central nervous system and neurological dysfunctions. Patients with RBD are at increased risk of developing associated neurological problems, such as Parkinson’s disease, multiple system atrophy or Lewy body dementia.  

Patients with RBD require ongoing, specialized care to reduce or manage connected symptoms, such as: 


  • Compromised immunity 
  • Decreased mental focus and mood 
  • Inability to heal or grow new tissues 
  • Pain sensitivity 


Your neurology and sleep medicine team will connect you with specialists to mitigate these issues and help you improve your quality of life. 

Here for Every Stage of RBD Care

How is RBD diagnosed?

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.  

What treatment options are available?

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.  

I need advanced care or a second opinion.

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.

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