From the Guidelines
The main symptoms to screen for in a REM Sleep Behavior Disorder (RBD) workup include dream-enactment behaviors, such as punching, kicking, grabbing, or jumping from bed, which can lead to sleep-related injuries, as well as vocalization during sleep, including shouting, talking, or screaming. These behaviors typically manifest as complex motor activities that correspond to dream content, and patients often report vivid, action-filled, or threatening dreams 1. A thorough screening should include questions about sleep disruption, sleep-related injuries, and whether the patient has awareness of these behaviors upon waking. It's essential to note that patients with RBD lack the normal muscle atonia (paralysis) that typically occurs during REM sleep, allowing them to physically act out dreams. RBD is particularly significant as it can be an early marker of neurodegenerative disorders, especially synucleinopathies like Parkinson's disease, with up to 80% of idiopathic RBD patients developing these conditions within 10-15 years 1. Screening should also include assessment for other sleep disorders, neurological symptoms, and medication use that might mimic or exacerbate RBD symptoms.
Some key points to consider when screening for RBD include:
- Dream-enactment behaviors, such as punching, kicking, or jumping from bed
- Vocalization during sleep, including shouting, talking, or screaming
- Sleep-related injuries, such as bruises, abrasions, or lacerations
- Sleep disruption and awareness of these behaviors upon waking
- Presence of other sleep disorders, neurological symptoms, or medication use that might contribute to RBD symptoms
According to the most recent guidelines, management of RBD should prioritize securing the bedroom environment to reduce the risk of injury, and pharmacotherapy may be considered in cases of persistent violent dream enactment 1. The American Academy of Sleep Medicine recommends clonazepam, melatonin, and rivastigmine as potential treatment options for RBD, although the choice of medication should be individualized based on the patient's underlying disease and symptoms 1.
From the Research
Main Symptoms to Screen for in RBD Workup
The main symptoms to screen for in a REM Sleep Behavior Disorder (RBD) workup include:
- Loss of atonia and excessive phasic motor activity during REM sleep 2
- Elaborate behaviors during REM sleep, such as:
- Action-filled dreams, often with violent or unpleasant content 2, 3, 4
- Increased risk of self-injury and harm to others due to dream-enacting behaviors 3, 5, 4
- Other symptoms, such as:
- Unpleasant dreams, such as being attacked or chased 6
Important Considerations
It is essential to note that RBD can be idiopathic or associated with other neurological diseases, such as alpha-synucleinopathies, including Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy 2. A thorough diagnosis and proper treatment are crucial to prevent injuries and address underlying conditions. Polysomnographic (PSG) recording and video-polysomnography are important tools in diagnosing RBD and ruling out other sleep disorders 2, 6, 3.