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1. What is REM sleep behavior disorder?
Every night, you go through four to five sleep cycles. Each cycle, lasting about 90 to 110 minutes, has four stages. That fourth stage is REM sleep.
REM sleep only comprises 20% to 25% of total sleep, but its proportion increases throughout the night. During REM sleep, your brain rhythms are similar to when you are awake, your muscles lose tone so you are unable to move, and your eyes, while closed, move quickly. This stage is often accompanied by muscle twitches and fluctuations in your respiratory rate and blood pressure.
But someone with REM sleep behavior disorder will act out their dreams. For reasons that are poorly understood, the dream content is usually violent – patients report being chased, or defending themselves, and as they sleep they shout, moan, scream, kick, punch, and thrash about.
Injuries often result from these incidents; patients may fall from bed or accidentally harm a partner. Some 60% of patients and 20% of bed partners of people with this disorder sustain an injury during sleep.
Appropriate testing, including a sleep study, are needed to determine if a patient has REM sleep behavior disorder, as opposed to another disorder, such as obstructive sleep apnea. This is a disorder in which breathing is interrupted during sleep.
REM sleep behavior disorder can occur at any age, but symptoms usually start with people in their 40s and 50s. For those younger than 40, antidepressants are the most common cause of REM sleep behavior disorder; in these younger patients, it affects biological males and females about equally, but past age 50, it’s more common in biological males.
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Past age 50, men are much more likely to have REM sleep behavior disorder than women. Jose Luis Pelaez/Stone via Getty Images
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