REM sleep behavior disorder: symptoms and treatment
This condition produces involuntary movements during sleep.
As a general rule, people's sleep cycles can be divided into several phases, namely five. The first four phases are characterized by various sleep wave patterns and the last phase known as REM sleep. This occupies between 15 and 20% of the natural sleep cycle and is where most of the dreaming occurs, as well as Muscle atonia.
However, there are occasions in which an alteration in this cycle occurs, as in the case of behavioral disorder during REM sleep.. Throughout this article we will discuss the characteristics of this condition, as well as its symptoms, causes and treatments that can alleviate the effects of this disorder.
What is REM sleep behavior disorder?
REM sleep behavior disorder was described for the first time in 1986, by the doctor and researcher Carlos H. SchenckCarlos H. Schenck, specialist in sleep disorders and behaviors. He defined it as a REM sleep parasomnia; that is, a group of abnormal behaviors or phenomena that appear during this phase of sleep.
This type of sleep disorder or parasomnia, is distinguished by affecting both the development of sleep and the person's motor system.. Causing the appearance of episodes of intense motor activity which affects various muscle groups.
These movements are manifested in the form of leg jerks, kicks, blows of fists and arms and even verbal manifestations such as screams. Which can even harm the person who accompanies him in his sleeping hours.
The patient may even get out of bed.The violence of these motor activities is explained by the content of the dreams, which are often described as unpleasant, aggressive and virulent. The violence of these motor activities is explained by the content of the dreams, which are usually described as unpleasant, aggressive and virulent.
The incidence of this disorder among the population is really low, being reduced to only 0.5% of the population. However, it is often masked by other is often masked by other syndromes with similar clinical pictures.. On a large number of occasions it is misdiagnosed as a nocturnal seizure disorder, consisting of a rare variety of obstructive sleep apnea syndrome.
Moreover, this disorder is much more frequent in men, accounting for 90% of cases of CRT and usually appearing between 50 and 60 years of age.
What types are there?
REM sleep behavior disorder can manifest itself in two different categories: acutely, idiopathically or chronically..
The acute type of this disorder tends to be associated with periods of alcohol withdrawal. Especially in those with a history of years of alcohol abuse. Likewise, certain drugs or medications such as sedative hypnotics, anticholinergics or liposoluble blocking drugs can also cause this type of sleep disturbance.
Two other types of CRT have also been identified. One of them consists of an idiopathic form of the disorder, i.e., in which CRT is a disease in itself not associated with other disorders or lesions and which may evolve over time to become a form of neurodegenerative disease..
As for the chronic typology of CRT, it is caused by or forms part of the clinical picture of a number of neurodegenerative diseases such as Parkinson's disease, Lewy body dementia, multiple system atrophy or, to a lesser extent, in supranuclear palsy, Alzheimer's disease, corticobasal degeneration and spinocerebellar ataxias. Likewise, it can be associated with disorders such as narcolepsyIt may also be associated with disorders such as narcolepsy, brainstem lesions, tumor formations and cerebrovascular accidents.
Symptomatology of this parasomnia
Within the clinical picture of sleep behavior disorder, we find a state of lack of muscular atonia that manifests itself in the form of abrupt and violent movements that appear at the beginning of the REM sleep phase and are maintained throughout this phase. These movements are an involuntary response to the content of daydreams. The patient describes them as vivid, unpleasant and aggressive.
In most cases patients describe their dreams as an extremely unpleasant experience in which all kinds of fights, arguments, chases and even accidents or falls are represented.
In a percentage of patients, specifically 25%, behavioral disturbances during sleep prior to the onset of the disorder have been identified. These behaviors include sleepwalking include sleepwalking, screaming, twitching and limb convulsions..
In the case of behavioral or motor symptoms characteristic of this disorder are:
- Talking.
- Laughing.
- Shouting.
- Cursing or swearing.
- Gesticulations.
- Shaking of the extremities.
- Striking.
- Kicking.
- Jumping or jumping out of bed..
- Running.
Due to the aggressiveness with which these behaviors appear, it is common for the patient to end up hurting or hitting the person next to him or her, as well as causing self-injury. Among the damages inflicted both on the person next to the patient and on oneself are lacerations, subdural hematomas and even fractures.
What is known about its causes?
Information about the causes of REM sleep behavior disorder is rather scarce. In more than half of the cases, the cause of REM sleep behavior disorder is related to the related to the future onset of some type of neurodegenerative disease..
However, recent studies with animal models point to the possibility of dysfunction in the brain structures of the pontine tegmentum, the locus coeruleus and the pedunculopontine nucleus, which are mainly responsible for regulating muscle tone during sleep.
Is there a treatment?
Fortunately, there is a treatment for REM sleep behavior disorder based on the administration of daily doses of clonazepam.. With a dose of between 0.5 and 1 mg, administered before bedtime, and provided that it is indicated by the physician, the person is very likely to experience greater control of sleep disturbances, including a decrease in the amount and intensity of aggressive behaviors and violent-type dreams.
In patients who do not respond to clonazepam or who present some type of contraindication, the use of melatonin, pramipexole or donepezil may be used for those cases described as refractory.
As for the prognosis of the disease, it is expected that with pharmacological treatment an absolute remission of symptoms will be achieved. However, there is no definitive cure for CRT, so if the dose is lowered or treatment is stopped, symptoms may return even more strongly. symptoms may reappear even more strongly..
It is necessary to specify that in those cases where CRT is caused by a neurodegenerative disease, treatment with clonazepam is not effective, and the patient must follow a specific treatment for the main disease.
(Updated at Apr 13 / 2024)