2 De Octubre

REM Behavior Disorder & Sleep

For most people, dreaming is purely a "mental" activity: they occur in the mind while the body is at rest. But people who suffer from REM behavior disorder (RBD) act out their dreams. They physically move limbs or even get up and engage in activities associated with waking. Some engage in sleep talking, shouting, screaming, hittting or punching. Some even fly out of bed while sleeping! RBD is usually noticed when it causes danger to the sleeping person, their bed partner, or others they encounter. Sometimes ill effects such as injury to self or bed partner sustained while asleep trigger a diagnosis of RBD. The good news is that RBD can usually be treated successfully.

What we call "sleep" involves transitions between three different states: wakefulness, rapid eye movement (REM) sleep, which is associated with dreaming, and non rapid eye movement (N-REM) sleep. There are a variety of characteristics that define each state, but to understand REM Behavior Disorder it is important to know that it occurs during REM sleep. During this state, the electrical activity of the brain, as recorded by an electroencephalogram, looks similar to the electrical activity that occurs during waking. Although neurons in the brain during REM sleep are functioning much as they do during waking, REM sleep is also characterized by temporary muscle paralysis.

In some sleep disorders such as narcolepsy and parasomnias, like REM behavior disorder, the distinctions between these different states breaks down; characteristics of one state carry over or "invade" the others. Sleep researchers believe that neurological "barriers" that separate the states don't function properly, though the cause of such occurrences is not entirely understood.

Thus, for most people, even when they are having vivid dreams in which they imagine they are active, their bodies are still. But, persons with RBD lack this muscle paralysis, which permits them to act out dramatic and/or violent dreams during the REM stage of sleep. Sometimes they begin by talking, twitching and jerking during dreaming for years before they fully act out their REM dreams.

In the course of "acting out their dreams," people with RBD move their arms and legs in bed or talk in their sleep, or they might start sleepwalking without waking or realizing they're dreaming. The only sensations the sleeper experiences are what is occurring in their dream. And many of these dreams can be violent or frightening, causing injury to the sleeper and his bed partner.

Causes & Diagnosis of REM Behavior Disorder

Studies of animals may explain REM behavior disorder. Animals who have suffered lesions in the brain stem have exhibited symptoms similar to RBD. Cats with lesions affecting the part of the brain stem that involves the inhibition of locomotor activity will have motor activity during REM sleep: they will arch their backs, hiss and bare their teeth for no reason, while their brain waves register normal REM sleep.

"REM behavior disorder underscores the importance of basic science research in animals," says Mahowald, "because without the information obtained in basic science animal research, the disorder could never have been identified. Sleep is such a young field that we have the opportunity to take advantage of the fact that there is a close collaboration between basic science and clinicians."

DIAGNOSIS OF REM BEHAVIOR DISORDER

Because a number of parasomnias may be confused with RBD, it is necessary to conduct formal sleep studies performed at sleep centers that are experienced in evaluating parasomnias in order to establish a diagnosis. In RBD, a single night of extensive monitoring of sleep, brain, and muscle activity will almost always reveal the lack of muscle paralysis during REM sleep, and it will also eliminate other causes of parasomnias.

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