Risk Factors And Complications Linked To REM Sleep Behavior Disorder

April 22, 2024

Two main states make up normal sleep: non-rapid eye movement and rapid eye movement sleep. Rapid eye movement sleep, also known as REM sleep, is the point during which rapid eye movements occur, blood pressure rises, the muscles are paralyzed, and breathing is irregular. This is also the portion of sleep where an individual dreams. The brain's recorded electrical activity tends to be similar to the activity recorded when an individual is awake. When a patient has REM sleep behavior disorder, they lack the paralysis that usually occurs in REM sleep. This absent or incomplete paralysis causes the patient to sleepwalk, talk, and otherwise act out their dreams.

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Narcolepsy is a sleep disorder that can occur alongside REM sleep behavior disorder and increase an individual's risk of developing it as well. Narcoleptic patients experience hallucinations, excessive sleepiness, sleep paralysis, and sometimes cataplexy. Cataplexy occurs when there is a total or partial loss of muscular control, and episodes are often brought on by strong emotions like laughter. Narcolepsy symptoms first appear in adolescence or childhood, but many patients don't get a proper diagnosis until they've had symptoms for years. The condition causes the boundary between sleeping and wakefulness to become blurred. In one study of fifty-five patients with narcolepsy, twenty had symptoms characteristic of REM sleep behavior disorder, which equates to about thirty-six percent. Though REM sleep behavior disorder is most commonly found in older men, the study indicated narcoleptic males and females are equally likely to have it. The study implies there's a significant link between the two disorders.

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Certain Medications

The precise cause of REM sleep behavior disorder is not known. However, the condition has been associated with withdrawal symptoms from certain substances, or with the use of certain medications. In fact, forty-five percent of cases have been attributed to medications and substances. Some patients might experience REM sleep behavior disorder when they're going through alcohol or sedative withdrawal. This may be because alcohol and sedatives depress the nervous system. When a patient stops depressing their nervous system to sleep, their brain may not go through the correct process to keep them paralyzed during REM sleep. Individuals have also reported REM sleep behavior disorder symptoms when taking tricyclic antidepressants like imipramine. Other medications involved with this include serotonin reuptake inhibitors like sertraline, fluoxetine, or paroxetine. There have been symptoms reported with other kinds of antidepressants as well, like mirtazapine.

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Gender And Age

Gender and age can be risk factors for REM sleep behavior disorder. The symptoms most often develop in middle-aged and elderly individuals, though there have been cases reported in younger patients. Men are also more prone to developing this condition. Since the overarching cause of REM sleep behavior disorder is unknown, it's not well understood why men are at a higher risk. In addition, it's worth noting some studies indicate in cases involving narcolepsy, patients are equally likely to develop REM sleep behavior disorder regardless of gender. Many patients are men over fifty years old. If an individual develops symptoms, it's important for them to see a sleep specialist or other medical professional. REM sleep behavior disorder can be a sign of a neurological disorder. Oftentimes, symptoms of REM sleep behavior disorder occur before other typical symptoms of serious neurological disorders.

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Neurodegenerative Diseases

Lewy body dementia has also been linked to REM sleep behavior disorder. This type of dementia is the second most common progressive dementia, with the first most common being Alzheimer's disease. It occurs when proteins called Lewy bodies build up in the brain, leading to degeneration over time. Other neurodegenerative diseases have been associated with REM sleep behavior disorder as well. Some of them are Shy-Drager syndrome, multisystem atrophy, and Parkinson's disease. Parkinson's disease progressively affects an individual's movement, beginning with tremors that worsen over time. Shy-Drager syndrome is a rare disorder that causes slow movement, tremors, postural instability, and muscle rigidity because of dysfunction in the basal ganglia.

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Distress Or Injury To Sleeping Partner

One of the most common complications of REM sleep behavior disorder is distress or injury to a sleeping partner. A patient with this condition might punch, shout, flail, jump, kick, or leap from their bed while they're still asleep. They might vividly remember the dreams that caused them to perform these actions. Since they're acting out their dreams, their bodies can go through uncontrolled movements that might cause injury to themselves or their partner. Their partner may also experience distress due to their yelling or unexpected movements. Partners will often express concern regarding a patient's strange sleeping behaviors. It's important for individuals to talk to a sleep specialist if their sleep behaviors are causing injury or distress to themselves or their partner.

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