REM sleep behavior disorder is a relatively rare sleep disorder that has a significant correlation to neurodegenerative disorders and other co-occurring conditions.

Rapid eye movement (REM) sleep disorder is a parasomnia, or a condition where undesired events and abnormal behaviors occur during sleep. REM sleep behavior disorder is characterized by partial or non-existent paralysis, which enables a person to act out their dreams, often in a heightened, animated and sometimes aggressive manner. REM sleep behavior disorder facts show that the disorder negatively impacts sleep quality, tends to worsen over time and can potentially result in injury to the dreamer or person sleeping with them.   

The precise incidence and prevalence of this disorder remain unknown due to misdiagnosis and imprecise reporting. However, REM sleep behavior disorder statistics show that the condition is more common in men than women and occurs most often in older individuals. These statistics also show that a significant percentage of individuals diagnosed will go on to be diagnosed with neurodegenerative diseases in the future, making early diagnosis and treatment essential.

Prevalence of Sleep Behavior Disorders

REM sleep behavior disorder (RBD) is rare, even with misdiagnosis and underreporting taken into account. Statistics regarding the prevalence of REM sleep behavior disorder include:

  • RBD occurs in approximately 1% of the general population and 2% in older people
  • RBD is more prevalent in elderly males than females, with a male to female ratio of 9 to 1.
  • Approximately 80–89% of people who have RBD are elderly men
  • The prevalence of neurodegenerative disorders can be as high as 76–81% in individuals diagnosed with REM sleep behavior disorder
  • The prevalence of REM sleep behavior disorder in narcolepsy may be as high as 36%
  • Antidepressant medications can trigger symptoms of REM sleep behavior disorder in up to 6% of cases

Diagnosing REM Sleep Behavior Disorder

A physician or specialist is critical for the proper diagnosis of early-onset REM sleep behavior disorder. A physician will commonly conduct a full clinical evaluation to review symptoms and to go over a person’s medical history. The clinical evaluation often includes a thorough physical and neurological exam in addition to a discussion with a person’s sleeping partner, who can provide important information regarding the person’s sleep-related activities.

REM sleep behavior disorder is the only parasomnia where a formal sleep study is necessary for diagnosis. A polysomnography test in a sleep center is commonly used to diagnose REM sleep behavior disorder, as it closely monitors sleep, brain and muscle movement. This test can detect the lack of muscle paralysis during REM sleep and can rule out other conditions that cause sleep disruptions, including obstructive sleep apnea, periodic limb movements and nocturnal seizures.

A physician or mental health professional will formally diagnose a person with REM sleep behavior disorder if they meet the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Based on DSM-5 criteria, a person must experience numerous episodes of awakening during REM stages of sleep that involve talking or intricate movement, awakening in an alert state without confusion, receiving a REM sleep without atonia diagnosis during a formal sleep study, and experiencing distress or impairment as a result of these behaviors.

REM Sleep Behavior Disorder and Co-Occurring Conditions

There is a significant correlation between REM sleep behavior disorder and several neurodegenerative disorders. REM sleep behavior disorder often occurs first, with the neurodegenerative disorders developing several years later. REM sleep behavior disorder and Parkinson’s disease have a complex relationship. One study found that 38% of individuals diagnosed with REM sleep behavior disorder developed Parkinson’s disease on average of 12–13 years after the onset of REM sleep behavior disorder symptoms. REM sleep behavior disorder is also found in approximately 69% of people with Parkinson’s disease and multisystem atrophy.

People with REM sleep behavior disorder may also be at higher risk for developing narcolepsy, periodic limb movement disorder and sleep apnea, which are often co-occurring conditions. The prevalence of narcolepsy and REM sleep behavior disorder has been estimated to be as high as 36%.

The complex motor behaviors associated with REM sleep behavior disorder can also occur in other sleep disorders, such as sleep apnea. These behaviors occur when REM sleep is interrupted by disordered breathing, but resolve when the disordered breathing is effectively treated. This phenomenon has been termed as pseudo-RBD.

RBD and Sleep Injuries

The lack of muscle paralysis in REM sleep behavior disorder causes individuals to become physically restless and potentially aggressive. People can move their limbs, punch, kick, jump, get out of bed or participate in other behaviors associated with wakefulness. In some cases, individuals may accidentally injure themselves or their bed partners. The danger of aggressive movement is higher if a person has a violent or upsetting dream.

Statistics on REM Sleep Disorder Treatment and Prognosis

The primary goal of REM sleep behavior disorder treatment is to create a safe sleeping environment for individuals impacted by the disorder and their bed partners. Treatment often includes prescribed medications, such as melatonin and clonazepam, along with behavioral interventions and sleeping habits adaptations.

Melatonin is often recommended as a first-line treatment. Melatonin in high doses at nighttime can reduce muscle tone, which restricts movement during REM sleep. The restricted movement gives people less opportunity to enact their dreams. In one study of 45 patients with REM sleep behavior disorder, two-thirds reported mild improvement in their symptoms and 12% experienced complete resolution of their symptoms after being treated with melatonin and clonazepam.

Low doses of the benzodiazepine, clonazepam, are shown to be effective in treating the symptoms of REM sleep behavior disorder, but also present with negative side effects including morning sedation and dizziness. In three case series studies, 55–79% of people showed complete resolution of symptoms using clonazepam and an additional 11–32% showed a partial reduction in symptoms.

In conjunction with medication, behavioral interventions can be used to adapt sleeping habits,  improve sleep and reduce the occurrence and severity of REM sleep behavior disorder episodes.

If you or someone that you know is experiencing REM sleep behavior disorder and co-occurring substance abuse, help is available. The Recovery Village has knowledgeable staff who specialize in addressing co-occurring mental health conditions and addiction. Contact a representative at the Recovery Village today to learn more about integrated treatment options.

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Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
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Medically Reviewed By – Tracy Smith, LPC, NCC, ACS
Tracy Smith is a Licensed Professional Counselor, a Nationally Certified Counselor, an Approved Clinical Supervisor, and a mental health freelance and ghostwriter. Read more
Sources “What is REM Sleep Behavior Disorder (RBD)?” October 9, 2018.  Accessed May 13, 2019. “REM Sleep Behavior Disorder.” December 2, 2018. Accessed May 13, 2019. “Rapid Eye Movement Sleep Behavior Disord[…]than 50 Years of Age.” August 1, 2014. Accessed May 13, 2019. “Rapid Eye Movement Sleep Behavior Disorder.” February 19, 2019. Accessed May 13, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.