REM Sleep Behavior Disorder

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REM Sleep Behavior Disorder

• Christina Gridley

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• REM Sleep Behavior Disorder (RBD)
• ASDA 1990, characterized by the acting-out of
  violent dreams during REM sleep, often with
  injurious consequences .
• The absence of the normal muscle atonia during
  REM sleep
• RBD is rare and most prevalent in elderly men
  however, many who may suffer from RBD are often
  misdiagnosed.
• If assessed properly and treated with drugs
  symptoms will subside.

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• According to the International Classification of
  Sleep Disorder the minimum diagnostic criteria of
  RBD include movement of the body or limbs
  associated with dreaming and at least one of the
  following
• Potentially harmful sleep behavior
• Dreams that appear to be acted out
• Sleep behavior that disrupts sleep continuity
• (exp. Punching, wrapping up spouse in sheets,
  running into walls, jumping out of windows)

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• RBD can occur with other neurological disorders
• - Dementia
• - Parkinsons Disease
• - Autism
• However, does not predetermine the patient to any
  of these disorders

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• Diagnosis is difficult because RBD symptoms are
  much like sleepwalking, sleep temors, and other
  sleep disorders however RBD only occurs during
  REM sleep. (exp. Case study 2)
• REM sleep was discovered in 1953 by Aserinsky and
  Kleitman.
• He experimented by wiring up people to various
  machines, including one that read the eye
  movement, called an electrooculogram (EOG). When
  he noticed eye movement, he woke up the patient.
  Ninety percent of patients reported having been
  dreaming during that time

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• Sleep Cycle
• There are five stages of sleep that cycle during
  a single night. Stages 1, 2, 3, 4 and REM (rapid
  eye movement).
• Stages 1 through 4 are also known as non-rapid
  eye movement sleep (NREM).  
• About 50 of our sleeping time is spent in stage
  2 and about 20 in REM.
• A complete sleep cycle, from the beginning of
  stage 1 to the end of REM usually takes about an
  hour and a half.
• An adult normally sleeps more than 2 hours a
  night in REM

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• REM sleep and dreaming are triggered by the pons
  and neighboring structures in the brainstem. The
  pons sends signals to the thalamus and the
  cerebral cortex -- which is responsible for most
  cognitive activities. The pons also sends signals
  to shut off the neurons in the spinal cord.

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• rapid eye movement, increased in heart rate,
  respiration, blood pressure, muscle twitches,
  oxygen consumption, and gastric secretions.
• often called paradoxical sleep because the brain
  waves are closer to those of being awake than to
  those of any other type of sleep.

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• In 1965 an expermiental model shows cats acting
  their dreams out who had bilateral potine lesions
• Magnetic resonance imaging studies in adults with
  RBD show possible damage to midrosal tegmentum
  nuclie

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• Diagnosis
• Polysomnographic video recording is the most
  important diagnostic test in RBD.
• EEG, ECG, Nasal flow, multiple electromyography
  channels
• Imaging studies have not been a proven tool in
  the diagnosis of RBD

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• Treatment
• Clonazepam is effective in nearly 90 of
  patients.
• Response with in the first night with little
  evidence of abuse
• Other medications such as tricyclics
  antidepressants are effective with some patients
• Symptoms will return once off the medication
• Educate the patient and bed partner fo
  environmental safety (exp. Remove dangerous
  objects from the room, mattress placed on floor,
  zip up patient in sleeping bag)

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http//www.medicaledge.org/2001novembervideo.html
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