What Is REM Sleep Behavior Disorder?

Reviewed by Melinda (Santa) Gladden, LCSW

Published 06/24/2022

Rapid eye movement sleep behavior disorder is a sleep disorder. If not in real life, we are likely to have seen someone acting out dreams while fast asleep, often with vocalization and violent limb movements on the screen. Science says that this dream enactment takes place during REM sleep. When this becomes a problem, you have a REM sleep behavior disorder at your hands. It is also referred to as dream enacting behavior or as a REM behavior disorder in local parlance.

REM Sleep Behavior Disorder 

Most individuals will not move just because they happen to be in the REM phase of sleep. In fact, it is perfectly normal to experience rapid eye movement sleep several times during the night.  Did you know that nearly one minute out of every five spent sleeping is actually this kind of sleep? This is also when we are typically dreaming, and we are most likely to experience REM sleep during the latter half of the night.

Research shows how several DSM-5 disorders are actually linked with one another. We also notice how there is no abrupt start to behavior or disorder. Similarly, REM sleep behavior disorder also starts out gradually and intensifies over a period. Research has been coming out for some time linking this behavior with Parkinson’s disease, Lewy body dementia, multiple system atrophy, and a few other neurological conditions.

REM sleep Behavior Disorder Symptoms

Of course, the biggest and most common symptom associated with this behavior disorder is the physical acting out of your dreams during the REM part of your sleep. People without REM Sleep Disorder would instead experience temporary paralysis of limbs, known as atonic, during sleep.

With REM behavior disorder, episodes do not have to be periodic or patterned. While the onset is typically gradual, it has also been very rapid in certain cases, and symptoms may present themselves several times over the nighttime. However, it should be noted that typically this disorder worsens with time. Taking a closer look at the symptoms, it is seen that symptoms include:

  • wide range of movementsin response to dreams that are also filled with activity. It is actually quite common to see punching, general limbs flailing, jumping in bed, and expressionism. These movements have been correlated to the ongoing action scene in the dream, typically defensive.
  • Vocalization, including emotional outcries, shouting, laughing, as well as cursing.
  • Patients can vividly recall the sequences and the scenes in their dreams, particularly if they have been awakened while exhibiting symptoms.

Causes behind REM sleep Disorder

Did you know there are actual nerve pathways in your brain whose job is to stop muscular movement when you are sleeping, particularly during REM or dreaming sleep? These nerve pathways cause temporary paralysis in your body. During the onset of sleep behavior disorder, these nerve pathways malfunction. The result is that you begin to vocalize and express yourself physically while dreaming. However, the issue needs to be looked at more carefully and in-depth because it points to general nerve-based dysfunction. If certain pathways are malfunctioning, there may also be other associated or disassociated nerval malfunctions.

Risk Factors behind REM sleep Behavior Disorder 

Certain factors are correlated with the development and onset of this disorder. The most prominent ones include the following.

  • A preexisting condition such as a neurodegenerative disorder. This builds into the discussion above that the nerval pathways do not just malfunction. Sometimes, there is a deeper issue, causing a wider problem, of whom just one is the REM sleep behavior disorder. Therefore, if the patient is already suffering from something like multiple system atrophy, Parkinson’s disease, dementia with Lewy bodies, or has had a stroke, the chances of developing this condition increase.
  • Males over 50 years old. While this conclusion is statistically driven, researchers are discovering exceptions to this trend, proving the rule, or perhaps pointing to troublesome developments over the last few years. More women are also beginning to be diagnosed with this disorder, including those under 50 years of age, along with young adults and children. Typically, these exceptions are seen alongside rampant antidepressant usage, narcolepsy, as well as preexisting conditions such as brain tumors.
  • If you have other sleep disorders such as narcolepsy, your risk factors for REM sleep behavior disorder also go up. Narcolepsy, of course, refers to a sleep disorder where you experience substantial drowsiness in the daytime.
  • Taking certain medications. This can make you more susceptible to this disorder. These include some of the newer anti-depressants, and often many of the side effects of these compounds are not fully understood. Either the abuse or withdrawal of alcohol or other psychotropic substances could also have affected you.

Finally, newly emerging studies reveal that there are other personal risk factors. These include occupational pesticide exposure, smoking habits, or even an injury to the head.

Complications Caused by REM sleep Behavior Disorder

Complications include the lifestyle deficit you are likely to experience living with this disorder.

  • People sharing your bed or even those living with you are likely to be disturbed or distressed in the long run owing to your REM sleep behavior disorder.
  • In a reactionary situation, you may self-isolate yourself to guard your condition. For some people, this may mean that they will never make up their mind about going and seeing a professional about this problem.
  • It’s actually a very probable scenario where you may end up injuring yourself or another person sleeping on the bed with you.


To diagnose rapid eye movement sleep behavior disorder, your doctor will take a close look at two things: your symptoms and your medical history. Subsequently, he is going to do his evaluation. What will this evaluation include?

  • A neurological, urological exam, along with a physical. During this neurological exam, your professional will evaluate the markers for the REM Sleep Behavior Disorder. At this time, they will also be watching for symptoms associated with other sleep disorders. Of course, you may have been suffering from more than one sleep disorder, coexisting together.  For example, we know that narcolepsy is somewhat correlated with REM sleep behavior disorder.
  • Data from your sleeping partner. To conclude your diagnosis, your medical professional may require feedback from your sleeping partner, and it is in your best interest to help with acquiring this data. Your sleeping partner will be asked if they have seen, you get vocal or physical when it may appear as if you are enacting your dreams during sleep. They will be asked if they have seen, you punch, flail your limbs around, or be vocal while asleep. If the interaction is in the form of a questionnaire, you can always help with the information transmittal.
  • Polysomnogram (sleep study). Your doctor may also want to put you in a sleep lab to look at your symptoms overnight to better understand your REM disorder. As part of this study, you will be hooked onto a number of sensors to gather data about your physiology, even as you sleep. For example, they would want to monitor your heartbeat, the amount of activity in your brain and lungs, helping to chart your breathing patterns, limb movement, and the characteristics of your vocalization as well as your blood oxygen levels. To document your behavior, after your consent, you could be recorded sleeping. This will document your behavior.

REM sleep Disorder Diagnostic Criteria

Professionals will use the symptom criteria laid out in the International Classification of Sleep Disorders to assess any RBD sleep disorders. Do not think that you should be able to do so for your partner because it is not straightforward. Written symptoms have to be modulated with practical knowledge and with what the professional observes. Diagnostic criteria include:

  1. A repetitive pattern of engaging in physicality and vocalization during the REM portion of your sleep, including performing what is classified as complex motor behaviors. These movements should typically be linked to the happenings in your dreams.
  2. The content in your dreams should be easily recalled by you.
  3. When you are disrupted during an episode, you wake up alert and conscious, not disoriented or confused.
  4. Your polysomnogram shows high muscular activity during the REM part of your sleep. Your sleep disturbances should not be explained away by a second sleep disorder, or another sleep disturbance, or a different mental health disorder altogether. Finally, you should not be on interfering anti-depressant medication or engaged in substance abuse. These habits complicate the scenery and make it difficult to make an honest diagnosis.

This sleep behavior disorder, as explained above, is caused by somewhat irregular neurological activity. Researchers also consider disorders such as early indicators of other serious neurodegenerative diseases, including multiple system atrophy, Parkinson’s disease, or dementia with Lewy bodies. Therefore, if a loved one has symptoms discussed above, it is worthwhile to consult with a medical professional and follow up on a treatment plan. Here is a free test you can take to determine if you have sleep disorder symptoms that you should talk to your doctor about.