REM sleep behavior disorder

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REM sleep behavior disorder (RBD) is a type of parasomnia characterized by acting out vivid, intense dreams during rapid eye movement (REM) sleep, often leading to physical injury. This disorder occurs when the normal sleep paralysis of the muscles during REM sleep is lost, allowing the person to act out their dreams.


The exact cause of RBD is not known, but it is associated with certain medical conditions, such as neurodegenerative disorders, such as Parkinson's disease, as well as medications, such as antidepressants.


It is more common in older adults and affects about 0.5-1% of the general population.

Symptoms of RBD

  • Acting out vivid, intense dreams with physical movements
  • Loud vocalizations, such as shouting or grunting
  • Physical injury to self or bed partner
  • Difficulty awakening from the episode


Diagnosis of RBD involves a detailed medical and sleep history, physical examination, and polysomnography (a sleep study) to assess sleep patterns and muscle activity during REM sleep.


Treatment of RBD involves avoiding triggers, such as alcohol and certain medications, and using medications, such as clonazepam, to reduce muscle activity during REM sleep. In some cases, therapy, such as cognitive behavioral therapy, may be helpful in reducing the frequency and severity of episodes.

Underlying medical conditions

It is important to seek medical evaluation for RBD as it may be a sign of an underlying medical condition and can lead to physical injury. Proper treatment can help improve sleep quality and reduce the frequency and severity of episodes.


  • American Academy of Sleep Medicine. (2021). International Classification of Sleep Disorders, Third Edition (ICSD-3). Darien, IL: American Academy of Sleep Medicine.
  • Iranzo, A., Santamaria, J., Serradell, M., Marti, M. J., Valldeoriola, F., & Tolosa, E. (2006). Rapid-eye-movement sleep behaviour disorder in Parkinson's disease: a study of frequency, phenomenology and pathogenic mechanisms. Brain, 129(11), 2970-2980.
  • Dauvilliers, Y. (2007). Rapid eye movement sleep behaviour disorder. Sleep Medicine Reviews, 11(4), 259-268.
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