A typical night’s sleep consists of four to five sleep cycles. One sleep cycle comprises all four sleep stages and usually lasts for approximately 90 to 110 minutes. The first three stages of sleep involve non-rapid eye movement (NREM) sleep, while rapid eye movement (REM) sleep takes place in the fourth stage.
During normal REM sleep, much of the body experiences a temporary reduction in muscle tone, which prevents a person from acting out their dreams. In those with a condition known as REM sleep behaviour disorder (RBD), the body maintains relatively increased muscle tone during REM sleep, allowing a person with this disorder to move and physically react to their dreams. Movements can range from minor leg twitches to complex behaviour that may result in injury to the person with RBD or their bed partner.
Several steps can be taken to manage RBD, such as establishing safety precautions in the sleep environment and treating other sleep disorders that may coexist with RBD.
Can REM sleep behaviour disorder be cured?
Isolated (idiopathic) REM sleep behaviour disorder is a type of RBD that develops spontaneously and cannot be attributed to an underlying cause. Symptomatic (secondary) RBD occurs as a result of an underlying cause. Known causes of symptomatic RBD include type 1 narcolepsy and certain antidepressants.
The onset of isolated RBD can be sudden or gradual, and the condition tends to worsen with time. Although there is currently no cure for isolated RBD, a variety of treatment approaches exist to aid in the management of symptoms. A key objective of treatment for RBD is to reduce the risk of injury from involuntary movements and actions that can occur during an episode. Any symptoms of RBD should be discussed with a doctor so that the condition can be diagnosed and suitable treatment options can be considered.
Is melatonin good for REM sleep behaviour disorder?
Melatonin is a naturally occurring hormone that plays a significant role in regulating the sleep-wake cycle. It works to synchronize circadian rhythms by binding to receptors at the hypothalamic suprachiasmatic nucleus (SCN), a small region of the brain that acts as the central pacemaker of the body’s circadian timing system.
A variety of causes and factors can be involved in sleep disorders, and melatonin has been shown to improve sleep quality and duration in both healthy individuals and in people with certain conditions, such as respiratory diseases, metabolic disorders, primary sleep disorders, and neurodegenerative diseases. As such, melatonin is commonly prescribed in the early treatment of sleep disorders to stabilize underlying circadian desynchronizations.
Changes in REM circadian rhythmicity are understood to take place as a result of REM sleep behaviour disorder. Because melatonin is usually well-tolerated with few side effects, supplementary melatonin may be prescribed as a first-line treatment option for RBD. A number of studies investigating the use of melatonin to treat RBD have found it to be an effective treatment, with several studies reporting reductions in RBD motor behaviour occurrence. A 2014 study suggests that melatonin may be especially beneficial to “elderly individuals with underlying neurodegenerative disorders, co-morbid sleep apnea, and those receiving polypharmacy with other medications.”
Natural treatment for REM sleep behaviour disorder
A doctor may recommend both natural and pharmacological treatments to alleviate the symptoms of REM sleep behaviour disorder, and taking safety precautions at home can help reduce the risk of injury during an RBD episode. It is recommended that people with RBD put physical safeguards in place to make their sleep environment safer for themselves and their bed partners. This may include:
- Removing dangerous items (such as sharp objects) from the bedroom
- Moving furniture away from the bed
- Adding barriers to the sides of the bed
- Padding the floor near the bed
- Securing and protecting windows in the bedroom
The bed partner of a person with RBD may find it beneficial to sleep in a separate bed or room until symptoms can be managed.
What is the best treatment for REM sleep behaviour disorder?
The appropriate treatment for REM sleep behaviour disorder should be determined case by case by a doctor. To make a diagnosis, the doctor will first conduct a physical and neurological exam to eliminate any other potential causes of RBD symptoms. The doctor may also ask the patient’s bed partner to describe any “dream-enacting” movements or actions they have seen the patient perform while they are asleep.
A sleep study is often part of the process of diagnosing RBD, and the doctor will use the results of these combined with the patient’s medical history and symptoms to make their diagnosis. Different treatment options may be recommended depending on the severity of symptoms, medical history, the type of RBD present (isolated or symptomatic), and a number of other factors.
Traditionally, clonazepam — a tranquilizer of the benzodiazepine family — has been prescribed to help reduce RBD symptoms. Clonazepam may cause side effects, such as decreased balance, daytime sleepiness, and worsening of sleep apnea. Melatonin is sometimes prescribed as a replacement treatment if a patient is experiencing severe side effects as a result of taking clonazepam, but it can also be taken alongside clonazepam when this medication alone is not effective in alleviating RBD symptoms.
In addition to affecting sleep quality, the motor symptoms of REM sleep behaviour disorder — such as kicking, punching, and flailing — can put both a person with RBD and their bed partner at risk for injury. Notably, a growing body of research indicates that RBD is an early indicator of certain neurodegenerative diseases, such as Parkinson’s disease and dementia with Lewy bodies. It’s important to consult a doctor for guidance and treatment if symptoms of RBD arise.