REM sleep behavior disorder: symptoms and treatment

As a general rule, people's sleep cycles can be divided into several phases, specifically five. Four first phases that are characterized by presenting various patterns of sleep waves and the last phase known as REM sleep. This occupies between 15 and 20% of the natural sleep cycle and most of the dreams occur in it, as well as muscular atony.

However, there are occasions when an alteration occurs in this cycle, such as REM sleep behavior disorder. Throughout this article we will talk about the characteristics of this condition, as well as its symptoms, causes and the treatments that can alleviate the effects of this disorder.

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What is REM sleep behavior disorder?

REM sleep behavior disorder It was described for the first time in 1986, by the doctor and researcher Carlos H. Schenk, specialist in sleep disorders and behaviors. He defined it as a REM sleep parasomnia; that is, a group of behaviors or abnormal phenomena that appear during this phase of sleep.

This type of sleep disorder or parasomnia, It is distinguished by affecting both the development of sleep and the motor system of the person. Causing the appearance of episodes of intense motor activity which affects various muscle groups.

These movements are manifested in the form of shaking the legs, kicking, blows with the fists and arms, and even verbal manifestations such as shouting. Which can harm the person who accompanies you in your sleeping hours.

The patient can even get out of bed, walk or walk in response to the dream activity that is experienced at that very moment. The violence of these motor activities finds its explanation in the content of the dreams, which are usually described as unpleasant, aggressive and virulent.

The incidence of this disorder among the population is really low, being reduced to only 0.5% of it. However, on many occasions this is masked by other syndromes with similar clinical pictures. It is often misdiagnosed as a nocturnal seizure disorder, a rare variety of obstructive sleep apnea syndrome.

In addition, this disorder is much more common in men, accounting for 90% of TCR cases and usually appearing between 50 and 60 years of age.

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What types are there?

REM sleep behavior disorder can manifest itself in two different categories: acutely, idiopathically or chronically.

The acute type of this disorder tends to be associated with periods of alcohol withdrawal. Especially in those people with a history of years of alcohol abuse. Similarly, certain drugs or medications such as sedative-hypnotics, anticholinergics, or lipid-soluble blocking drugs can also cause this type of sleep disturbance.

Likewise, two more types of TCR have been identified. One of them consists of an idiopathic form of the disorder; that is, in which the TCR consists of a disease by itself not associated with other alterations or lesions and that can evolve over time becoming a form of neurodegenerative disease.

Regarding the chronic type of TCR, it is caused or is part of the clinical picture of a series of neurodegenerative diseases. such as Parkinson's disease, Lewy body dementia, multiple system atrophy or, to a lesser extent, paralysis supranuclear, Alzheimer disease, corticobasal degeneration and spinocerebellar ataxias. In the same way, may be associated with disorders such as narcolepsy, injuries of the brainstem, tumor formations and strokes.

The symptoms of this parasomnia

Within the typical clinical picture of sleep behavior disorder, we find a state of lack of muscular atony that is manifests itself in the form of sudden and violent movements that appear at the beginning of the REM sleep phase and are maintained throughout this. These movements are an involuntary response to the content of the daydreams. experienced by the patient, who describes them as vivid, unpleasant and aggressive.

In most cases patients describe their dreams as a highly unpleasant in which all kinds of fights, arguments, chases and even accidents or falls.

In a percentage of patients, specifically in 25%, it has been possible to determine behavioral alterations during sleep prior to the onset of the disorder. Among these behaviors includes sleepwalking, screaming, twitching, and twitching of the extremities.

In the case of behavioral or motor symptoms typical of this disorder are:

• Talk.
• Laugh.
• Shout.
• Cursing or insulting
• gestures.
• Shaking of the extremities.
• Hits.
• kicks.
• Hops or jumps out of bed.
• Run.

Due to the aggressiveness with which these behaviors appear, it is common for the patient to end up harming or hitting the person next to them, as well as causing self-harm. Among the damages that are inflicted both on the companion and on oneself are lacerations, subdural hematomas and even fractures.

What is known of its causes?

The information obtained about the causes of REM sleep behavior disorder is quite scant. In more than half of the cases, the cause of this condition is related to the future appearance of some type of neurodegenerative disease.

However, recent studies carried out with animal models point to the possibility that there is a dysfunction in the brain structures of the pontine tegmentum, locus coeruleus, and pedunculopontine nucleus; which are the main ones in charge of regulating muscle tone during sleep.

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Is there a treatment?

Luckily, there is a treatment for REM sleep behavior disorder. based on the administration of daily doses of clonazepam. With a dose between 0.5 and 1 mg, administered before sleeping, and whenever the doctor so indicates, it is very likely that the person will experience a greater control of sleep disturbances, including a decrease in the amount and intensity of aggressive behaviors and type dreams violent.

In patients who do not respond to clonazepam or that present some type of contraindication, it is possible to resort to the use of melatonin, pramipexole or donepezil for cases described as refractory.

Regarding the prognosis of the disease, it is expected that with drug treatment an absolute remission of symptoms will be achieved. However, there is no definitive cure for TCR, so if the dose is lowered or treatment is stopped symptoms may come back with even more force.

It is necessary to specify that in those cases where the TCR is caused by a neurodegenerative disease, the treatment with clonazepam is not effective, the patient having to follow a specific treatment for the disease major.