Rapid eye movement (REM) sleep behavior disorder, often referred to as RBD, is a condition with the ability to severely disturb a person’s sleep pattern. Despite the facts about the condition being widely available, there are still misunderstandings about the diagnosis.
Misunderstandings can lead to REM sleep behavior disorder myths, so there must be an emphasis on the truth to end the rumors. By knowing the truths behind the myths, people and their loved ones can seek the best treatment available.
Myth #1: RBD is primarily a psychiatric condition
Fact: RBD is a neurological condition recognized by medical and mental health professionals.
People may mistakenly think that REM sleep behavior disorder is mainly a mental health issue because it has to do with disrupted sleep caused by dysfunction in the brain. The myth is likely reinforced by the condition’s inclusion in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) by the American Psychiatric Association (APA).
In actuality, the DSM-5 contains many physical health and mental health disorders, especially when physical health disorders connect to psychological symptoms like depression and anxiety. The DSM-5 lists many sleep-wake disorders including:
- Hypersomnolence disorder
- Breathing-related sleep disorders
- Nightmare disorder
- Restless leg syndrome
- REM sleep behavior disorder
No one would likely consider narcolepsy and restless leg syndrome firstly as psychiatric conditions, so the same standards should apply to RBD. RBD is a neurological condition, not a psychiatric condition.
When a person is in REM sleep, the brain is supposed to shut down muscles to prevent movement. In REM sleep behavior disorder, these nerve pathways do not function properly, resulting in unwanted and unexpected movements.
Myth #2: REM sleep behavior disorder is the same as sleepwalking
Fact: Sleepwalking occurs during non-REM sleep.
This myth is a complete misunderstanding of what REM sleep behavior disorder is and what sleepwalking is. Although the two might share some similarities on the surface, the differences involving REM sleep behavior disorder vs. sleepwalking become evident quickly.
As the name suggests, REM sleep behavior disorder occurs during REM sleep. This segment of sleep is when dreaming occurs.
The movements and actions a person engages in during RBD are linked to the dream they are experiencing. During an episode of RBD, the person’s body is acting out the content of their dream, so if they are fighting off an attacker, they may hit, kick or yell in their bed.
Sleepwalking, on the other hand, occurs during non-REM sleep, the segment of sleep without dreaming. During an episode of sleepwalking, the person:
- Gets out of bed
- Walks around their room or home
- Has a blank face
- Does not respond to verbal commands
- Is difficult to wake up
- Typically returns to bed and continues sleeping
When awake during the night or in the morning, the individual will have no memory of the sleepwalking. Someone sleepwalking is not acting out a dream, because they are not dreaming during this type of sleep.
Myth #3: RBD affects everyone in the same way
Fact: Each episode of RBD is a unique experience.
Each person with REM sleep behavior disorder responds differently. It is the content of the dream that drives the RBD events, so certain types of dreams will produce certain actions.
If a person with only a mild case of RBD is dreaming about a meeting an old friend, they may mutter a few words under their breath during the episode. The symptoms will only be short in and low in intensity.
If a person who is highly influenced by RBD is having a dream about a physical altercation with a real or imagined enemy, they could exhibit a severe range of REM sleep behavior disorder effects. In this example, the person could:
- Yell or swear
- Kick their legs
- Swing their arms
- Leap out of bed
- Act aggressively or violently
RBD episodes are dangerous for the person with the condition as well as anyone who shares their bed. They could hurt themselves or others based on the content of the dreams they are enacting.
Myth #4: People with RBD can’t remember their dreams
Fact: Upon waking, people with RBD can clearly recall the dream details.
This myth may be another example of REM and non-REM sleep disorder confusion. People with non-REM disorders cannot remember the dreams connected to their behaviors because there are no associated dreams.
According to the DSM-5, there are two main types of non-REM sleep arousal disorders: sleepwalking and sleep terrors. Sleep terrors, often called night terrors, involve a person exhibiting a scared or panicky reaction during a period of sleep.
During a sleep terror, the person will display signs of:
- Dilated pupils
- Speedy heart rate
- Quick breathing
Episodes last for a few minutes, and the person may never truly wake during a night terror. In the morning, they will have no memory of the event or a triggering dream. Amnesia is a central feature of non-REM sleep disorders because dreams do not create these episodes.
Someone with REM sleep behavior disorder will almost always remember their dreams. Since the episodes occur during the dreaming part of sleep, the people, location and content of the dream stay fresh in the person’s mind when they awake.
Myth #5: REM sleep behavior disorder is difficult to treat
Fact: Treatment for RBD is effective and accessible.
People may think that REM sleep behavior disorder is difficult to treat because the condition appears so complex and multifaceted. This belief is completely false.
As far as neurological conditions go, RBD is simple to treat. Before the treatment begins, a person with symptoms of a sleep disorder needs a proper diagnosis.
A formal sleep study is an essential part of the diagnostic process since a number of sleep issues could produce symptoms that overlap with REM sleep behavior disorder. Without a sleep study, people may confuse RBD with:
- Other sleep issues like non-REM disorders
- Nocturnal seizures
- Sleep apnea
Once the specialist finds the proper diagnosis, treatment may begin. REM sleep behavior disorder treatment frequently focuses on the use of a medication called clonazepam to address symptoms. Clonazepam, sold under the brand name Klonopin, effectively reduces or eliminates symptoms of RBD in 90% of cases.
When Klonopin is not helpful, people may use antidepressants or a melatonin supplement to treat REM sleep behavior disorder. These options can reduce aggression and violence during the night.
Regardless of the treatment effectiveness, someone with RBD should consider making their bedroom as safe as possible. They should set up some RBD safeguards like:
- Padding the area around the bed
- Removing sharp or dangerous items
- Protecting the windows
- Reducing obstacle in the bedroom
- Sleeping alone
REM sleep behavior disorder is a problematic condition, but effective treatment can reduce symptoms quickly and completely. If you or a loved one live with a substance use disorder that co-occurs with a mental health disorder like RBD, contact The Recovery Village. Call to speak with a representative who can help you learn about treatment options. A healthier future is possible, call today.