Rapid Eye Movement (REM) Sleep Behavior Disorder Quiz

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Lucid dreams

Vivid dreams

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Acting out dreams

Remembering dreams every night

Involuntary movements during sleep

Legs moving at night

Body jerking movements during sleep

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What is Rapid Eye Movement (REM) Sleep Behavior Disorder?

Rapid eye movement sleep behavior disorder (RBD) is a condition in which a person abnormally acts out dreams during rapid-eye-movement (REM) sleep, a phase of sleep that is normally characterized by random, rapid movements of the eyes, vivid dreams, and muscle paralysis. The acting out can range from calm limb movements to violent arm and leg thrashing, talking, and/or shouting. Although RBD can be caused by certain medications or sleep conditions such as narcolepsy, RBD is a most commonly a precursor to later onset of Parkinson disease. 75% of RBD patients develop Parkinson disease by 12 years after RBD diagnosis.

Typical Symptoms of Rapid Eye Movement (REM) Sleep Behavior Disorder

Diagnostic Questions for Rapid Eye Movement (REM) Sleep Behavior Disorder

Your doctor may ask these questions to check for this disease:

  • Do your sleep abnormalities occur just before waking up?
  • Do your abnormal sleep behaviors occur with nightmares?
  • Are you usually able to recall your dreams?
  • Do your uncontrollable movements happen at night?
  • Do you wake up easily?

Treatment of Rapid Eye Movement (REM) Sleep Behavior Disorder

Treatment for REM sleep behavior disorder may include physical safeguards, medications to reduce symptoms, as well as avoiding certain antidepressant medications that can worsen RBD symptoms. Physical safeguards include padding the floor near the bed, removing dangerous objects from the bedroom, or encouraging sleeping alone.

Reviewed By:

Benjamin Kummer, MD

Benjamin Kummer, MD (Neurology)

Dr Kummer is Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai (ISMMS), with joint appointment in Digital and Technology Partners (DTP) at the Mount Sinai Health System (MSHS) as Director of Clinical Informatics in Neurology. As a triple-board certified practicing stroke neurologist and informaticist, he has successfully improved clinical operations at the point of care by acting as a central liaison between clinical neurology faculty and DTP teams to implement targeted EHR configuration changes and workflows, as well as providing subject matter expertise on health information technology projects across MSHS. | Dr Kummer also has several years’ experience building and implementing several informatics tools, presenting scientific posters, and generating a body of peer-reviewed work in “clinical neuro-informatics” – i.e., the intersection of clinical neurology, digital health, and informatics – much of which is centered on digital/tele-health, artificial intelligence, and machine learning. He has spearheaded the Clinical Neuro-Informatics Center in the Department of Neurology at ISMMS, a new research institute that seeks to establish the field of clinical neuro-informatics and disseminate knowledge to the neurological community on the effects and benefits of clinical informatics tools at the point of care.

Shohei Harase, MD

Shohei Harase, MD (Neurology)

Dr. Harase spent his junior and senior high school years in Finland and the U.S. After graduating from the University of Washington (Bachelor of Science, Molecular and Cellular Biology), he worked for Apple Japan Inc. before entering the University of the Ryukyus School of Medicine. He completed his residency at Okinawa Prefectural Chubu Hospital, where he received the Best Resident Award in 2016 and 2017. In 2021, he joined the Department of Cerebrovascular Medicine at the National Cerebral and Cardiovascular Center, specializing in hyperacute stroke.

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Content updated on Jul 10, 2024

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Symptoms Related to Rapid Eye Movement (REM) Sleep Behavior Disorder

FAQs

Q.

Can’t Move When Waking Up? Causes & Solutions for Women 65+

A.

In women 65+, brief inability to move on waking is often sleep paralysis, but other causes can include REM sleep disorders, medication side effects, low blood pressure, vitamin B12 or D or thyroid issues, and less commonly neurological problems like stroke. There are several factors to consider, and solutions range from side sleeping and better sleep habits to stress reduction, hydration, and a medication review, with urgent care needed for one sided weakness, slurred speech, or vision or facial changes; see below for complete details that can affect your next steps.

References:

* Sarzi-Puttini P, et al. Morning stiffness: an updated review. Open Access Rheumatol. 2017 Aug 16;9:137-148. doi: 10.2147/OAR.S137497. PMID: 28860959; PMCID: PMC5565158.

* Bhidayasiri R, et al. Optimizing nocturnal and morning motor function in Parkinson's disease. J Neural Transm (Vienna). 2021 May;128(5):703-718. doi: 10.1007/s00702-021-02334-9. Epub 2021 Apr 22. PMID: 33886036; PMCID: PMC8060856.

* Allen RP, et al. Restless legs syndrome in the elderly: a review. J Geriatr Psychiatry Neurol. 2004 Dec;17(4):216-24. doi: 10.1177/0891988704270119. PMID: 15537750.

* Al-Sharman A, et al. Relationship between sleep quality and physical function in older adults: A systematic review and meta-analysis. Sleep Health. 2021 Apr;7(2):220-229. doi: 10.1016/j.sleh.2020.10.007. Epub 2020 Dec 2. PMID: 33279586.

* Gopinath B, et al. Polypharmacy and incident impaired mobility in older adults: a systematic review and meta-analysis. Age Ageing. 2021 Nov 3;50(6):1890-1901. doi: 10.1093/ageing/afab090. PMID: 33930164.

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Q.

Dreaming as Soon as I Fall Asleep? What Women 65+ Should Know

A.

In women 65+, dreaming as soon as you fall asleep is often normal due to earlier REM with aging, recent stress, sleep loss with REM rebound, or medication effects; hormones and mood can also intensify or bring dreams sooner. There are several factors to consider; see below to understand more. Pay closer attention if you act out dreams, fall out of bed, have very vivid or disturbing dreams, feel excessively sleepy, or notice new memory, balance, or tremor changes, since this can point to REM sleep behavior disorder or another issue that benefits from prompt care. See the complete guidance below for safety tips, a symptom check option, and when to talk with a doctor.

References:

* Luppi, A. I., et al. (2021). Age-related changes in sleep and dreaming: A review. *Brain Sciences, 11*(3), 398. PMID: 33800683. https://pubmed.ncbi.nlm.nih.gov/33800683/

* Frauscher, B., et al. (2018). Sleep onset REM period (SOREMP) in non-narcoleptic individuals. *Sleep Medicine, 49*, 41-47. PMID: 30097194. https://pubmed.ncbi.nlm.nih.gov/30097194/

* Krishnan, V., & Collop, N. A. (2017). Sleep changes in older women: a review. *Maturitas, 105*, 30-36. PMID: 29029706. https://pubmed.ncbi.nlm.nih.gov/29029706/

* Vahle, N., et al. (2019). Sleep architecture and changes with age in healthy community-dwelling men and women: The Study of Health in Pomerania (SHIP). *Sleep Medicine, 59*, 11-18. PMID: 30979603. https://pubmed.ncbi.nlm.nih.gov/30979603/

* Kales, A., et al. (2011). Sleep-onset REM periods in healthy older adults: a polysomnographic study. *Sleep Medicine, 12*(9), 882-886. PMID: 21873138. https://pubmed.ncbi.nlm.nih.gov/21873138/

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Q.

Hallucinations When Falling Asleep: Normal Aging or Cause for Concern?

A.

Hallucinations when falling asleep are often normal hypnagogic events tied to stress, sleep loss, irregular schedules, and normal aging, and they are typically brief and limited to sleep onset. There are several factors to consider, so see below for red flags and next steps, including when to call a doctor for daytime hallucinations, confusion or new neurologic symptoms, dream enactment or injuries, severe daytime sleepiness, or medication effects, plus what helps such as sleep hygiene, medication review, narcolepsy evaluation, and screening for REM sleep behavior disorder.

References:

* Thorpy MJ. Hypnagogic Hallucinations: Clinical Features and Differential Diagnosis. Semin Neurol. 2012 Jun;32(3):281-9. doi: 10.1055/s-0032-1329188. PMID: 23114050.

* Chellappa SL, Araujo JF, Reimann W, Steiger A, Nissen C. Isolated sleep paralysis and hypnagogic hallucinations in the elderly. Front Psychiatry. 2014 Mar 24;5:30. doi: 10.3389/fpsyt.2014.00030. eCollection 2014. PMID: 24695843; PMCID: PMC3963475.

* Jalal B. Sleep paralysis and hypnagogic hallucinations in healthy people: a review of the literature. J Sleep Res. 2016 Apr;25(2):120-30. doi: 10.1111/jsr.12351. Epub 2015 Oct 14. PMID: 26463994.

* Ralls F, Korman B, Munjal S, Kothare SV. Narcolepsy Type 1, Narcolepsy Type 2, and Idiopathic Hypersomnia: A Narrative Review of Differential Diagnosis. Curr Neurol Neurosci Rep. 2022 Dec;22(12):685-697. doi: 10.1007/s11910-022-01246-8. Epub 2022 Oct 24. PMID: 36282433; PMCID: PMC9597378.

* Aydin H, Özdel S, Çetinkaya S. Phenomenology of Psychotic Experiences During Sleep-Wake Transitions in Patients With Psychotic Disorders. J Clin Psychopharmacol. 2023 Jan-Feb;43(1):79-82. doi: 10.1097/JCP.0000000000001648. Epub 2022 Nov 22. PMID: 36402446.

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Q.

Hallucinations When Waking Up: What Women 65+ Need to Know

A.

For women 65+, hallucinations on waking are often sleep related and harmless, caused by normal REM to wake transitions, stress or fatigue, sensory loss, or medication effects, but they can also point to conditions like REM sleep behavior disorder, sleep apnea, infections, or neurodegenerative diseases. There are several factors to consider, including red flags that require urgent care and practical steps you can take now, plus what doctors check and a free REM sleep behavior disorder symptom screener; see below for detailed causes, warning signs, and next steps that could change your care plan.

References:

* Hsieh C, Lai CL, Wu D. Sleep paralysis and hypnagogic/hypnopompic hallucinations in older adults: A systematic review. Sleep Med Rev. 2022 Dec;66:101700. doi: 10.1016/j.smrv.2022.101700. Epub 2022 Nov 3. PMID: 36371720.

* Al-Jawad N, Khouja O, Kanaan RA, Mehta MA. Sleep disorders and hallucinations in older adults: a systematic review. Sleep Med. 2021 Nov;87:210-217. doi: 10.1016/j.sleep.2021.08.016. Epub 2021 Sep 10. PMID: 34560408.

* O'Connell H, Horgan F, Kelly M. Hallucinations in the Older Adult: A Multidisciplinary Approach to Diagnosis and Management. J Am Med Dir Assoc. 2020 Jan;21(1):15-21. doi: 10.1016/j.jamda.2019.07.018. Epub 2019 Sep 6. PMID: 31495679.

* Denis D, French CC, Gregory AM. Prevalence of Sleep Paralysis, Hypnagogic/Hypnopompic Hallucinations and Sleep-Related Eating in the General Population: A Systematic Review and Meta-Analysis. J Sleep Res. 2018 Jun;27(3):e12623. doi: 10.1111/jsr.12623. Epub 2018 Jan 28. PMID: 29377227.

* Mander BA, Winer JR, Jagust WJ, Walker MP. Sleep-Wake Disturbances in Older Adults: Epidemiology, Pathophysiology, and Clinical Implications. Neuron. 2017 Jul 19;95(2):296-309. doi: 10.1016/j.neuron.2017.06.012. PMID: 28728929; PMCID: PMC5547462.

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Q.

Magnesium for Sleep: Benefits & Safety for Women Over 65

A.

Magnesium can gently support sleep in women over 65 by calming the nervous system, relaxing muscles, and reducing night cramps; magnesium glycinate is often preferred, with typical supplemental doses of 200 to 400 mg taken in the evening. There are several factors to consider, and key details on who benefits most and how to use it alongside diet and sleep habits are outlined below. Safety is crucial, especially with reduced kidney function, because magnesium can cause digestive side effects and interact with diuretics, antibiotics, osteoporosis, heart, and blood pressure medicines, and it is not a cure for conditions like sleep apnea or REM sleep behavior disorder, so talk with your doctor and review the full guidance below.

References:

* Mah J, Pitre T, Brignardello J, Kavosh M, Yazdi F, Ramji Q, Perri D, Thabane L, Khan M. Oral Magnesium Supplementation for Insomnia in Older Adults: A Systematic Review and Meta-Analysis. Int J Vitam Nutr Res. 2021 Jul;91(3-4):230-238. doi: 10.1024/0300-9831/a000672. Epub 2020 Jun 8. PMID: 32510258.

* Rondanelli M, Opizzi A, Monteferrario R, Klersy C, Gasperini C, Genazzani AD, Riva A, Borghi L. The Effect of Magnesium Supplementation on Sleep Quality and Insomnia Severity in Women with Perimenopause and Postmenopause. J Womens Health (Larchmt). 2020 Mar;29(3):388-396. doi: 10.1089/jwh.2019.8268. Epub 2020 Jan 9. PMID: 31922339.

* Cao Y, Zhen S, Taylor AW, Appleton AA, Shi Z. Magnesium Intake and Sleep Disorder Symptoms: A Systematic Review and Meta-Analysis. Nutrients. 2018 Oct 23;10(11):1581. doi: 10.3390/nu10111581. PMID: 30360492; PMCID: PMC6266042.

* Tarleton EK, Littenberg B, MacLean CD, Kennedy AG, Daley C. Role of magnesium in the management of neuropsychiatric disorders. Nutr Rev. 2017 Jul 1;75(7):539-555. doi: 10.1093/nutrit/nux018. PMID: 28629097.

* Abbasi B, Kimiagar M, Sadeghniiat K, Shirazi M, Omidi R, Pakbin M. The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. J Res Med Sci. 2012 Dec;17(12):1161-9. PMID: 23379654; PMCID: PMC3703169.

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Q.

Paralyzed When Falling Asleep? Causes & Solutions for Women 65+

A.

Brief episodes of being awake but unable to move when drifting off are usually sleep paralysis and are typically not dangerous. They are more common in women 65+ due to lighter, fragmented sleep and REM changes, medication effects, or sleep apnea, and often improve with a consistent sleep schedule, side sleeping, a calm wind down, and a medication review, with medical care advised if episodes are frequent or you also have chest pain, shortness of breath, daytime weakness, or new memory or balance changes. There are several factors to consider. See below for a fuller explanation, practical checklists, when to talk with your doctor or seek a sleep study, and an online REM sleep behavior symptom check that can guide next steps.

References:

* Denis D, Pilon M, Charland V, Barbeau M, Bluteau J, Boudreau C, Cartier C, Cayer M, Gélinas-Lefebvre X, Grenier J, Lehoux-Dubois M, Poirier G, Soulières S, Tremblay-Dionne R, Roy R, Baril AA. Sleep paralysis: A review of genetic, psychological, and neurophysiological factors. Sleep Med Rev. 2018 Apr;38:137-147. doi: 10.1016/j.smrv.2017.03.003. Epub 2017 Mar 21. PMID: 28390715.

* Solomonova E, Stenstrom K. The neurobiology of sleep paralysis. Sleep Med Clin. 2021 Sep;16(3):323-333. doi: 10.1016/j.jsmc.2021.05.002. Epub 2021 Jun 10. PMID: 34420584.

* Sharpless BA. A cognitive-behavioral model of sleep paralysis. Sleep Med Rev. 2014 Aug;18(4):313-20. doi: 10.1016/j.smrv.2013.10.002. Epub 2013 Dec 3. PMID: 24393699; PMCID: PMC4089938.

* Jalal B. Current and future psychological and pharmacological treatments of sleep paralysis. Sleep Med Rev. 2016 Apr;26:21-29. doi: 10.1016/j.smrv.2015.02.002. Epub 2015 Feb 24. PMID: 26033100.

* Denis D, Poirier G, Bédard M, Charest J, Genest C, Grenier A, Maltais V, Montplaisir J, Soulières S, Beaulieu-Bonneau S, Gariépy M, Baril AA. Prevalence of sleep paralysis and its clinical correlates: A systematic review and meta-analysis. Sleep Med Rev. 2018 Dec;42:108-120. doi: 10.1016/j.smrv.2018.06.001. Epub 2018 Jul 13. PMID: 30146033.

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Q.

Seeing Things When Waking Up? Causes & When to Worry (65+)

A.

Seeing things when waking up after 65 is relatively common and often benign, typically due to sleep transition hallucinations, fragmented sleep, medication side effects, or vision loss such as Charles Bonnet syndrome, and they usually fade within seconds to minutes. Less commonly, sleep disorders like REM sleep behavior disorder can contribute. Seek medical care if episodes are frequent or daytime, are worsening, follow medication changes, or come with confusion, fever, sudden weakness, speech or vision problems, falls, or memory or behavior changes. There are several factors to consider; see the complete guidance below for what is harmless versus urgent and for next steps like tracking episodes, reviewing medications, and improving sleep.

References:

* Mura P, Carta MG, Cadeddu G, Manchia M, Cugliari ME, Floris G, Medda C, Pompili E, Tocco M, Carpiniello B. Hallucinations and delusions in older adults: A review. Aging Ment Health. 2020 Dec 22:1-12. doi: 10.1080/13607863.2020.1865360. PMID: 32014798.

* van der Zande A, Ramele M, Olde Rikkert MGM. Visual hallucinations and Parkinson's disease: A systematic review of interventions. Parkinsonism Relat Disord. 2020 Jul;76:40-49. doi: 10.1016/j.parkreldis.2020.05.021. Epub 2020 May 20. PMID: 32483569.

* Breen DP, Duncan GW, Williams GB, Barker RA, Halliday GM, McCarthy A, Duda JE, Burn DJ. Nocturnal visual disturbances in older adults: beyond ophthalmology. J Neurol. 2017 Jul;264(7):1501-1510. doi: 10.1007/s00415-017-8488-8. Epub 2017 Apr 1. PMID: 28362624.

* Fereshtehnejad SM, Rösler TW, Hall S, Linder J, Kåreholt I, Ballard C, Aarsland D. REM sleep behavior disorder and visual hallucinations as predictors of dementia with Lewy bodies. J Neurol Neurosurg Psychiatry. 2017 Jul;88(7):602-608. doi: 10.1136/jnnp-2016-315579. Epub 2017 Feb 23. PMID: 28230559.

* Kester DS, Cummings JL. Psychiatric Disorders and Visual Hallucinations in Older Adults. Curr Psychiatr Rep. 2019 Jan 10;21(1):5. doi: 10.1007/s11920-019-0979-9. PMID: 30635441.

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Q.

Sleep Paralysis Hallucinations: What Women Over 65 Need to Know

A.

Sleep paralysis hallucinations in women over 65 are brief episodes where you wake up but cannot move while seeing, hearing, or feeling things that are not there, usually tied to REM sleep. They are typically not dangerous and do not mean dementia or psychosis, but age related sleep changes, poor sleep, medications, stress, and overlapping sleep disorders can play a role. There are several factors to consider; see below for specific warning signs that merit a doctor visit, how to tell these episodes from REM sleep behavior disorder, simple steps that often reduce them, and safety tips that may shape your next healthcare steps.

References:

* Jalil, A. M. H., Al-Abri, M. M., & Al-Maniri, A. A. (2020). Sleep paralysis: a systematic review of the clinical spectrum. *Sleep and Breathing, 24*(2), 379–389.

* Ohayon, M. M., Zulley, J., Guilleminault, C., & Paiva, T. (1999). Prevalence and risk factors of sleep paralysis in the general population. *Neurology, 52*(6), 1192–1199.

* Denis, D., Joutsa, J., & Revonsuo, A. (2018). The neural correlates of sleep paralysis hallucinations: A critical review. *Consciousness and Cognition, 65*, 1–13.

* Sharpless, B. A. (2016). A clinician's guide to isolated sleep paralysis. *Neuropsychiatric Disease and Treatment, 12*, 1761–1767.

* Wing, Y. K., Li, R. H., Ho, C. K., Leung, E., Ng, M. H., & Lee, O. T. (2002). Isolated sleep paralysis in Chinese elderly. *Sleep, 25*(1), 59–62.

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Q.

Sleep Paralysis Over 65: Is It a Sign of Something Serious?

A.

Sleep paralysis after 65 is often harmless and not life threatening, but there are several factors to consider. It may stem from disrupted sleep, medications, or sleeping on the back, but new or frequent episodes, daytime sleepiness, memory changes, breathing problems, or acting out dreams can suggest sleep apnea, REM sleep behavior disorder, narcolepsy, or neurological disease. See the complete guidance below for red flags, ways to reduce episodes, and when to get a sleep study or medical evaluation.

References:

* Hori, K., Sugawara, N., Tanaka, K., Takaki, M., Satake, K., & Otomo, S. (2020). Sleep paralysis is a risk factor for sleep-related hallucinations and poor sleep quality in older adults. *Sleep and Biological Rhythms*, *18*(4), 405-412. https://pubmed.ncbi.nlm.nih.gov/32952402/

* Al-Jammali, T., Al-Ruzouq, N., & Al-Ruzouq, S. (2022). Prodromal alpha-synucleinopathies: what role for isolated sleep paralysis?. *Journal of Clinical Sleep Medicine*, *18*(8), 1957-1959. https://pubmed.ncbi.nlm.nih.gov/35790898/

* Islam, R., Turecki, G., & Khazaie, H. (2023). Psychiatric comorbidities and sleep paralysis: a systematic review and meta-analysis. *Journal of Sleep Research*, *32*(6), e13904. https://pubmed.ncbi.nlm.nih.gov/37648937/

* Kume, C., & Hori, H. (2023). Cardiovascular risk factors for sleep paralysis: A systematic review and meta-analysis. *Journal of Affective Disorders*, *334*, 148-154. https://pubmed.ncbi.nlm.nih.gov/37197505/

* Sharpless, B. A. (2016). Sleep paralysis: A review of an enigmatic state. *Clinical Psychology Review*, *43*, 111-126. https://pubmed.ncbi.nlm.nih.gov/26654876/

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Q.

Sleep Paralysis Pressure on Chest: Is It Serious? (Women 65+)

A.

Sleep paralysis with chest pressure is often not dangerous, but in women 65 and older it warrants careful attention to rule out heart, lung, and sleep disorders. There are several factors to consider, including red flags like true chest pain, shortness of breath, or pain spreading to the arm or jaw that need urgent care, plus practical ways to prevent episodes and when to talk to a doctor; see complete details below.

References:

* Sharpless BA. Isolated Sleep Paralysis: Current Perspectives. Neuropsychiatr Dis Treat. 2020 Sep 10;16:1733-1742. doi: 10.2147/NDT.S228059. PMID: 32943896; PMCID: PMC7492827.

* Agrawal S, Kumar S, Agrawal M. Sleep Paralysis: A Clinical Review. J Neuropsychiatry Clin Neurosci. 2022 Aug 2;34(4):307-316. doi: 10.1176/appi.neuropsych.21070191. PMID: 35927050.

* Denis D, Poerio GL, Dingle K, Sharpless BA. Sleep paralysis and its associations with medical conditions, psychiatric disorders, and sleep quality. J Sleep Res. 2018 Apr;27(2):166-174. doi: 10.1111/jsr.12613. Epub 2017 Dec 28. PMID: 29329705; PMCID: PMC5842880.

* Denis D, Blagrove M, Sharpless BA, Dingle K, Poerio GL. Chest sensations during sleep paralysis: The role of threat and breathing. J Sleep Res. 2023 Oct;32(5):e13917. doi: 10.1111/jsr.13917. Epub 2023 Aug 27. PMID: 37628965.

* Sharpless BA, Barber JP. The epidemiology of sleep paralysis: a systematic review. Sleep Med Rev. 2011 Oct;15(5):317-25. doi: 10.1016/j.smrv.2011.01.001. Epub 2011 Feb 17. PMID: 21802956; PMCID: PMC3130790.

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Q.

Sleeping 8 Hours and Still Tired? 7 Health Signs for Women 65+

A.

There are several factors to consider. For women 65+, waking tired after 8 hours often points to nonrestorative sleep and daytime impairment from fragmented or mis-timed sleep, sleep apnea with snoring or gasping, REM sleep behavior disorder with dream enactment, mood changes like anxiety or depression, or energy-sapping medical conditions and medications. See below for the key signs to watch for and step-by-step guidance on tracking symptoms, reviewing medicines, and when to contact a clinician for red flags such as shortness of breath, chest pain, frequent falls, or memory changes, since these details can influence your next healthcare decisions.

References:

* Barone, C., & Conte, C. (2019). Fatigue in the elderly. *Geriatrics & Gerontology International*, *19*(3), 209-216. PMID: 30873752. DOI: 10.1111/ggi.13626.

* Penninx, B. W. (2017). Depression and Anxiety in Older Adults: New Insights on Clinical Management and Prevention. *Current Psychiatry Reports*, *19*(11), 77. PMID: 29022061. DOI: 10.1007/s11920-017-0836-7.

* Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. *The Lancet*, *390*(10101), 1550-1562. PMID: 28389319. DOI: 10.1016/S0140-6736(17)30703-1.

* Blumenfield, E. N., & Johnson, B. A. (2020). Anemia in Older Adults. *Primary Care: Clinics in Office Practice*, *47*(2), 173-191. PMID: 32247343. DOI: 10.1016/j.pop.2020.01.001.

* Randerath, W. J., & Schwalen, S. A. (2018). Sleep disordered breathing in the elderly. *Current Opinion in Pulmonary Medicine*, *24*(6), 570-575. PMID: 30204780. DOI: 10.1097/MCP.0000000000000519.

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Q.

Tardive Dyskinesia: Signs, Relief & Management for Women 65+

A.

Tardive dyskinesia is a medication-related movement disorder that can affect women 65+, often appearing after months or years on antipsychotics or certain nausea and gut medicines, with signs like lip smacking, tongue rolling, facial grimacing, and hand or foot movements. Relief and management usually involve a careful medication review, FDA-approved TD treatments, and supportive therapies, with urgent medical attention if swallowing, breathing, or safety are affected; there are several factors to consider, so see below for key details on diagnosis, symptom tracking, sleep and emotional health, and step-by-step next actions to discuss with your doctor.

References:

* Hienert M, Stamenkovic M, Stamenkovic S, Vyssoki B, Kautzky A, Ristl R, Praschak-Rieder N, Willeit M. Tardive Dyskinesia in Elderly Patients: Pathophysiology and Treatment. J Clin Med. 2020 Jul 1;9(7):2059. doi: 10.3390/jcm9072059. PMID: 32626154; PMCID: PMC7408796.

* Kulkarni M, Kulkarni N, Jampala C. Treatment of Tardive Dyskinesia in Older Adults. J Geriatr Psychiatry Neurol. 2022 Sep;35(5):602-611. doi: 10.1177/08919887221102146. Epub 2022 Jul 3. PMID: 35780540.

* Cornett EM, Novitch M. Tardive Dyskinesia: An Update on Its Clinical Presentation, Pathophysiology, and Treatment. J Clin Mov Disord. 2020 Apr 7;3(1):15-22. doi: 10.15761/JCMDS.1000130. PMID: 32261546; PMCID: PMC7142490.

* Walder A, Sarwal A, Khasnavis S, Singh A. Risk Factors for Tardive Dyskinesia: A Systematic Review. Mov Disord Clin Pract. 2021 Jul 21;8(7):993-1004. doi: 10.1002/mdc3.13307. PMID: 34507026; PMCID: PMC8516075.

* Factor SA, Cloud LJ, Hunter CB, Lew MF, McGuire TR, Ondo WG, Salerno A. Practical Management of Tardive Dyskinesia. J Parkinsons Dis. 2021;11(3):947-957. doi: 10.3233/JPD-212574. PMID: 34262176; PMCID: PMC8492040.

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Q.

Vivid Dreams When Falling Asleep: Is It a Health Warning Sign?

A.

Vivid dreams right as you fall asleep are usually normal, often tied to stress, poor sleep, irregular schedules, alcohol, or certain medications. There are several factors to consider. See below to understand more. Watch for warning signs that deserve medical advice, including acting out dreams, hallucinations that continue when awake, excessive daytime sleepiness, or sudden memory and coordination changes. See the complete guidance below, including practical sleep tips and when to use a REM sleep behavior disorder symptom check, to plan next steps.

References:

* Chee MJ, Lim MM, Choo YM, Koh YJ, Ho R, Chua YC. Hypnagogic Hallucinations: A Scoping Review of Their Prevalence, Characteristics, and Associated Disorders. J Clin Sleep Med. 2023 Dec 1;19(12):2155-2169. doi: 10.5664/jcsm.10842. PMID: 37731778.

* Sharpley AL, Willetts G. Hallucinations at Sleep Onset and Offset: Prevalence and Clinical Associations. J Sleep Res. 2021 Apr;30(2):e13192. doi: 10.1111/jsr.13192. Epub 2020 Sep 11. PMID: 32901962.

* Nielsen TA. Disturbing Dreams: Epidemiology and Comorbidity. Sleep Med Clin. 2017 Mar;12(1):15-22. doi: 10.1016/j.jsmc.2016.10.003. Epub 2016 Dec 2. PMID: 28166948.

* Tsuno N, Kawakami N, Baba S, Chiba K, Tsutsumi T, Shimada Y, Tanaka Y, Yasui-Furukori N, Hada Y, Endo Y, Kanbayashi T. Sleep-onset REM periods and REM sleep dysregulation in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2014 Jan 10;48:153-6. doi: 10.1016/j.pnpbp.2013.09.006. Epub 2013 Sep 26. PMID: 24080345.

* Thorpy MJ. Narcolepsy and Sleep Hallucinations. Sleep Med. 2009 Dec;10 Suppl 1:S15-8. doi: 10.1016/j.sleep.2009.09.006. PMID: 20042407.

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Q.

Waking Up Frozen? Sleep Paralysis and Daytime Sleepiness After 65

A.

Sleep paralysis with daytime sleepiness after 65 is usually not dangerous, but it often points to disrupted sleep or treatable problems such as fragmented sleep, sleep apnea, medication effects, REM-related disorders, or neurologic conditions. Watch for frequent episodes, severe drowsiness, snoring or gasping, acting out dreams, or new memory and movement changes and talk with a doctor about evaluation and treatments like medication review or a sleep study. There are several factors to consider, and practical steps that can help, so see the complete guidance below to understand what to do next.

References:

* Denis D, Poels M, van der Kloet M, Schoutena L, van Someren E. Isolated sleep paralysis: an updated review. Sleep Med Rev. 2020 Feb;49:101235. doi: 10.1016/j.smrv.2019.101235. Epub 2019 Nov 22. PMID: 31805307.

* Zhang B, Hu S, Cui L, Zhang Y, Wang M, Li Y, Yang C, Fu Q, Yang C, Li S, Liu P. Sleep paralysis: an updated review of its epidemiology, mechanisms, and management. Sleep Breath. 2020 Jun;24(2):397-407. doi: 10.1007/s11325-019-01904-8. Epub 2019 Jun 15. PMID: 31209778.

* Yaremchuk K, Armon C. Excessive Daytime Sleepiness in Older Adults: A Clinician's Review. Clin Geriatr Med. 2021 Nov;37(4):539-555. doi: 10.1016/j.cger.2021.05.006. Epub 2021 Jun 17. PMID: 34246473.

* Chen T, Gao Y, He X, Zhang T, Huang M, Li Y, Han X, Li B. Sleep and daytime sleepiness in older adults: A systematic review and meta-analysis of cross-sectional studies. J Affect Disord. 2022 Oct 1;314:264-272. doi: 10.1016/j.jad.2022.07.039. Epub 2022 Jul 18. PMID: 35914361.

* Wang F, Pan C, Xu H, Wang Y, Xu C. Daytime sleepiness and cognitive function in older adults: A systematic review and meta-analysis. J Psychosom Res. 2021 Nov;150:110626. doi: 10.1016/j.jpsychores.2021.110626. Epub 2021 Aug 30. PMID: 34509890.

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Q.

Waking Up Tired? Causes of Unrefreshing Sleep in Women 65+

A.

Unrefreshing sleep in women 65+ is common but not normal, and is often driven by treatable issues like sleep apnea, postmenopausal hormonal changes, chronic pain, restless legs, REM sleep problems, mood disorders, medication effects, circadian shifts, and low activity or daylight. There are several factors to consider; see complete guidance below for key warning signs, practical habit changes, and next steps in care. Seek care promptly if unrefreshing sleep lasts more than 3 to 4 weeks or is accompanied by loud snoring, gasping, acting out dreams, memory changes, or excessive daytime sleepiness.

References:

* Choi YJ, Lee SK. Sleep disorders in older women. J Midlife Health. 2018 Jan-Mar; 9(1): 1–5. doi: 10.4103/jmh.jmh_48_17. PMID: 29399268; PMCID: PMC5791334.

* Gum AM, Chui H, King SM, Dulin PL. Sleep quality in older women: exploring the role of anxiety and depressive symptoms. J Womens Health (Larchmt). 2011 May; 20(5): 709–716. doi: 10.1089/jwh.2010.2190. PMID: 21434850; PMCID: PMC3090001.

* Lerdal A, Wahl AK, Rustoen T, Moum T. Fatigue in older adults: A comprehensive review. Exp Gerontol. 2021 May; 147: 111283. doi: 10.1016/j.exger.2021.111283. Epub 2021 Feb 23. PMID: 33647413.

* Al-Amin HA, Al-Khalaf MM, Al-Sulaiman AS, Alshahrani S, Baig M, Al-Shahrani AM, Alshehri AM, Alsubai EA. Prevalence of Sleep Disorders and Related Risk Factors in Older Adults: A Systematic Review and Meta-Analysis. J Clin Sleep Med. 2023 Feb 1; 19(2): 291–305. doi: 10.5664/jcsm.10260. Epub 2022 Oct 26. PMID: 36284617; PMCID: PMC9896790.

* Mander BA, Winer JR, Jagust WJ, Walker MP. Sleep architecture changes across the adult lifespan: evidence from a polysomnography database. Sleep. 2019 Apr 1; 42(4): zsz014. doi: 10.1093/sleep/zsz014. PMID: 30677864; PMCID: PMC6473103.

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Q.

Woke Up and Can’t Move? Causes & When to Seek Urgent Help

A.

Waking up unable to move is most often brief sleep paralysis during REM wake transitions and is usually harmless. Seek urgent help if symptoms include one-sided weakness, trouble speaking, facial droop, severe headache, vision loss, chest pain, shortness of breath, loss of consciousness, or confusion that does not improve; there are several factors to consider, so see the complete guidance below for other causes like seizures, stroke, medications, or low blood sugar, plus prevention tips and how to decide your next steps.

References:

* Gupta S, Singh Y, Mahajan SK, Singh A, Kalra S. Acute Flaccid Paralysis: A Clinical Approach. J Clin Neurol. 2021 Jul;17(4):453-463. doi:10.3988/jcn.2021.17.4.453

* Sharpless BA. Sleep paralysis. Psychol Bull. 2014 Sep;140(5):1223-47. doi:10.1037/a0037190

* Ma J, Wang X, Han S. Wake-Up Stroke: A Clinical Review. Front Neurol. 2021 Apr 22;12:666986. doi:10.3389/fneur.2021.666986

* Weber F. Primary Periodic Paralyses. J Neuromuscul Dis. 2017;4(3):289-299. doi:10.3233/JND-170249

* Rajabally YA. Management of acute neuromuscular weakness. Pract Neurol. 2017 Dec;17(6):448-459. doi:10.1136/practneurol-2017-001712

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Q.

Can dementia medications like donepezil affect REM Sleep Behavior Disorder (RBD) symptoms?

A.

Dementia medications like donepezil might affect REM Sleep Behavior Disorder (RBD) symptoms, but the impact can vary depending on the individual and the specific condition.

References:

Lauterbach EC. (2004). The neuropsychiatry of Parkinson's disease and related .... The Psychiatric clinics of North America, 15550293.

https://pubmed.ncbi.nlm.nih.gov/15550293/

Hershey LA, & Coleman-Jackson R. (2019). Pharmacological Management of Dementia with Lewy .... Drugs & aging, 30680679.

https://pubmed.ncbi.nlm.nih.gov/30680679/

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Q.

Do blood pressure medications influence REM Sleep Behavior Disorder (RBD) episodes?

A.

Some blood pressure medications, like bisoprolol, can influence REM Sleep Behavior Disorder (RBD) episodes.

References:

Toba A, Ishikawa J, & Harada K. (2022). Increased blood pressure variability is associated with .... Blood pressure, 35426329.

https://pubmed.ncbi.nlm.nih.gov/35426329/

Iranzo A, & Santamaria J. (1999). Bisoprolol-induced rapid eye movement sleep behavior .... The American journal of medicine, 10527042.

https://pubmed.ncbi.nlm.nih.gov/10527042/

Okin PM, Hille DA, Larstorp AC, Wachtell K, Kjeldsen SE, Dahlöf B, & Devereux RB. (2015). Effect of lower on-treatment systolic blood pressure on the .... Hypertension (Dallas, Tex. : 1979), 26056336.

https://pubmed.ncbi.nlm.nih.gov/26056336/

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Q.

How is REM Sleep Behavior Disorder (RBD) medication dosage adjusted over time?

A.

REM Sleep Behavior Disorder (RBD) medication dosages, like sodium oxybate or rivastigmine, are adjusted based on how well the treatment works and the side effects experienced by the patient.

References:

During EH, Hernandez B, Miglis MG, Sum-Ping O, Hekmat A, Cahuas A, et al. (2023). Sodium oxybate in treatment-resistant rapid-eye-movement .... Sleep, 37052688.

https://pubmed.ncbi.nlm.nih.gov/37052688/

Vicuña EA, Kuttappan VA, Tellez G, Hernandez-Velasco X, Seeber-Galarza R, Latorre JD, et al. (2015). Dose titration of FITC-D for optimal measurement of enteric .... Poultry science, 25877413.

https://pubmed.ncbi.nlm.nih.gov/25877413/

Di Giacopo R, Fasano A, Quaranta D, Della Marca G, Bove F, & Bentivoglio AR. (2012). Rivastigmine as alternative treatment for refractory REM .... Movement disorders : official journal of the Movement Disorder Society, 22290743.

https://pubmed.ncbi.nlm.nih.gov/22290743/

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Q.

When should medication be reconsidered if REM Sleep Behavior Disorder (RBD) leads to physical injury?

A.

Medication for REM Sleep Behavior Disorder should be reconsidered if it leads to physical injuries, as effective management is crucial to prevent harm.

References:

Trotti LM, & Bliwise DL. (2013). Treatment of the Sleep Disorders Associated with Parkinson's .... Neurotherapeutics, 3899483.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3899483/

Seppi K, Weintraub D, Coelho M, Perez-Lloret S, Fox SH, Katzenschlager R, et al. (2011). Treatments for the Non-Motor Symptoms of Parkinson's Disease. Movement disorders : official journal of the Movement Disorder Society, 4020145.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4020145/

Stefani A, & Högl B. (2019). Diagnostic Criteria, Differential Diagnosis, and Treatment .... Current Treatment Options in Neurology, 6339673.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6339673/

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Q.

Can pramipexole help if REM Sleep Behavior Disorder (RBD) occurs with Parkinson's disease?

A.

Pramipexole may help some people with REM Sleep Behavior Disorder (RBD) in Parkinson's disease, but its effectiveness varies, and more research is needed.

References:

Schmidt MH, Koshal VB, & Schmidt HS. (2006). Use of pramipexole in REM sleep behavior disorder. Sleep medicine, 16815751.

https://pubmed.ncbi.nlm.nih.gov/16815751/

Kumru H, Iranzo A, Carrasco E, Valldeoriola F, Marti MJ, Santamaria J, & Tolosa E. (2008). Lack of effects of pramipexole on REM sleep behavior .... Sleep, 18853939.

https://pubmed.ncbi.nlm.nih.gov/18853939/

During EH, Malkani R, Arnulf I, Kunz D, Bes F, De Cock VC, et al. (2025). Symptomatic treatment of REM sleep behavior disorder .... Sleep medicine, 40408791.

https://pubmed.ncbi.nlm.nih.gov/40408791/

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Q.

Why is clonazepam often prescribed in low doses for REM Sleep Behavior Disorder (RBD)?

A.

Clonazepam is often prescribed in low doses for REM Sleep Behavior Disorder (RBD) because it is effective while minimizing potential side effects.

References:

Jung Y, & St Louis EK. (2016). Treatment of REM Sleep Behavior Disorder - PubMed - NIH. Current treatment options in neurology, 27752878.

https://pubmed.ncbi.nlm.nih.gov/27752878/

Ferini-Strambi L, & Marelli S. (2012). Sleep dysfunction in multiple system atrophy. Current treatment options in neurology, 22886854.

https://pubmed.ncbi.nlm.nih.gov/22886854/

Lee M, Kim TK, Hong JK, & Yoon IY. (2024). Minimal effect of long-term clonazepam on cognitive .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 38494993.

https://pubmed.ncbi.nlm.nih.gov/38494993/

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Q.

Can exercise influence REM Sleep Behavior Disorder (RBD) positively or negatively?

A.

Exercise can affect sleep and related disorders, but the exact impact on REM Sleep Behavior Disorder (RBD) is not clear from the provided references.

References:

Ophey A, Vinod V, Röttgen S, Scharfenberg D, Fink GR, Sommerauer M, et al. (2025). Accelerometry-derived features of physical activity, sleep .... Journal of neurology, 39934559.

https://pubmed.ncbi.nlm.nih.gov/39934559/

Lerche S, Gutfreund A, Brockmann K, Hobert MA, Wurster I, Sünkel U, et al. (2018). Effect of physical activity on cognitive flexibility, depression .... Clinical neurology and neurosurgery, 29331872.

https://pubmed.ncbi.nlm.nih.gov/29331872/

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Q.

Can sleep apnea occur together with REM Sleep Behavior Disorder (RBD)?

A.

Yes, sleep apnea can occur together with REM Sleep Behavior Disorder (RBD). People with RBD may also have sleep apnea, which affects their breathing during sleep.

References:

Gabryelska A, Roguski A, Simpson G, Maschauer EL, Morrison I, & Riha RL. (2018). Prevalence of obstructive sleep apnoea in REM behaviour .... Sleep & breathing = Schlaf & Atmung, 28951996.

https://pubmed.ncbi.nlm.nih.gov/28951996/

Giardino DL, Fasano P, & Garay A. (2021). The "respiratory REM sleep without atonia benefit" on .... Sleep science (Sao Paulo, Brazil), 34381583.

https://pubmed.ncbi.nlm.nih.gov/34381583/

Vorderwülbecke BJ, Lehmann R, & Breuer E. (2020). Sleep-Disordered Breathing in REM Sleep Behavior .... Journal of Parkinson's disease, 32390642.

https://pubmed.ncbi.nlm.nih.gov/32390642/

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Q.

Do lifestyle changes help manage REM Sleep Behavior Disorder (RBD) symptoms?

A.

Lifestyle changes, like regular exercise and a healthy diet, may help manage symptoms of REM Sleep Behavior Disorder (RBD), especially when linked to conditions like Parkinson's.

References:

Baghaei A, Kim HS, Dolhun R, Sherzai D, & Dashtipour K. (2025). Review of the Effects of Lifestyle Modification on Parkinson's .... American Journal of Lifestyle Medicine, 12494586.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12494586/

Matar E, McCarter SJ, St Louis EK, & Lewis SJ. (2021). Current Concepts and Controversies in the Management of .... Neurotherapeutics, 8116413.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8116413/

Reichmann H, Csoti I, Koschel J, Lorenzl S, Schrader C, Winkler J, & Wüllner U. (2022). Life style and Parkinson's disease - PMC - PubMed Central. Journal of Neural Transmission, 9463300.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9463300/

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Q.

How can family members support someone living with REM Sleep Behavior Disorder (RBD)?

A.

Family members can help someone with REM Sleep Behavior Disorder by making the sleeping area safe and supporting medical treatments.

References:

Chan PC, Lee HH, Hong CT, Hu CJ, & Wu D. (2018). REM Sleep Behavior Disorder (RBD) in Dementia with Lewy .... Behavioural Neurology, 6029467.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6029467/

Prins EM, Pijpers A, Verbeek N, Darweesh SK, Geerlings AD, Meinders MJ, et al. (2025). The impact of REM-sleep behavior disorder on people with .... NPJ Parkinson's Disease, 12085624.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12085624/

Schütz L, Sixel-Döring F, & Hermann W. (2022). Management of Sleep Disturbances in Parkinson's Disease. Journal of Parkinson's Disease, 9661340.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9661340/

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Q.

Is REM Sleep Behavior Disorder (RBD) hereditary?

A.

REM Sleep Behavior Disorder (RBD) may have a genetic component, as certain genetic variants are linked to this condition.

References:

Bjørnarå KA, Pihlstrøm L, Dietrichs E, & Toft M. (2018). Risk variants of the α-synuclein locus and REM sleep .... BMC neurology, 29466944.

https://pubmed.ncbi.nlm.nih.gov/29466944/

Ojo OO, Bandres-Ciga S, Makarious MB, Crea PW, Hernandez DG, Houlden H, et al. (2023). The non-coding GBA1 rs3115534 variant is associated .... medRxiv : the preprint server for health sciences, 38076854.

https://pubmed.ncbi.nlm.nih.gov/38076854/

Ojo OO, Bandres-Ciga S, Makarious MB, Crea PW, Hernandez DG, Houlden H, et al. (2024). GBA1 rs3115534 Is Associated with REM Sleep Behavior .... Movement disorders : official journal of the Movement Disorder Society, 38390630.

https://pubmed.ncbi.nlm.nih.gov/38390630/

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Q.

What is the difference between REM Sleep Behavior Disorder (RBD) and nightmares where you talk or shout?

A.

REM Sleep Behavior Disorder (RBD) is when people physically act out their dreams during sleep, often with movements and sounds, while nightmares with talking or shouting don't usually involve physical actions.

References:

Sobreira-Neto MA, Stelzer FG, Gitaí LL, Alves RC, Eckeli AL, & Schenck CH. (2023). REM sleep behavior disorder: update on diagnosis and .... Arquivos de Neuro-Psiquiatria, 10756822.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10756822/

Fasiello E, Scarpelli S, Gorgoni M, Alfonsi V, & De Gennaro L. (2022). Dreaming in Parasomnias: REM Sleep Behavior Disorder as a .... Journal of Clinical Medicine, 9654698.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9654698/

Boeve BF. (2010). REM Sleep Behavior Disorder: Updated Review of the Core .... Annals of the New York Academy of Sciences, 2902006.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2902006/

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Q.

What long-term management strategies are recommended for chronic REM Sleep Behavior Disorder (RBD)?

A.

There are no specific long-term management strategies for chronic REM Sleep Behavior Disorder (RBD) provided in the available references.

References:

Gordon WA, Hibbard MR, Egelko S, Diller L, Shaver MS, Lieberman A, & Ragnarsson K. (1985). Perceptual remediation in patients with right brain damage. Archives of physical medicine and rehabilitation, 4004531.

https://pubmed.ncbi.nlm.nih.gov/4004531/

Chakravorty SS, & Rye DB. (2003). Narcolepsy in the older adult: epidemiology, diagnosis and .... Drugs & aging, 12696996.

https://pubmed.ncbi.nlm.nih.gov/12696996/

Cunha BP, Freitas SMSF, Gomes GFO, & de Freitas PB. (2019). Hand Grip and Load Force Coordination of the Ipsilesional .... Journal of motor behavior, 30600789.

https://pubmed.ncbi.nlm.nih.gov/30600789/

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Q.

When should REM Sleep Behavior Disorder (RBD) be considered a medical emergency?

A.

REM Sleep Behavior Disorder (RBD) can be a medical emergency if it leads to injuries or if severe symptoms suddenly appear. Immediate medical attention is needed if someone acts out dreams violently or gets hurt.

References:

Bramich S, King A, Kuruvilla M, Naismith SL, Noyce A, & Alty J. (2022). Isolated REM sleep behaviour disorder - PubMed Central - NIH. Journal of Neurology, 9363360.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9363360/

Jin H, Zhang JR, Shen Y, & Liu CF. (2017). Clinical Significance of REM Sleep Behavior Disorders and .... Neuroscience Bulletin, 5636735.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5636735/

Schaeffer E, & Berg D. (2021). Complications following REM sleep behavior disorder - PMC. Brain and Behavior, 8119867.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8119867/

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Q.

Are there medications that help reduce REM Sleep Behavior Disorder (RBD) episodes?

A.

Yes, there are medications that can help reduce episodes of REM Sleep Behavior Disorder (RBD), such as clonazepam and melatonin.

References:

Jung Y, & St Louis EK. (2016). Treatment of REM Sleep Behavior Disorder - PubMed - NIH. Current treatment options in neurology, 27752878.

https://pubmed.ncbi.nlm.nih.gov/27752878/

During EH, Malkani R, Arnulf I, Kunz D, Bes F, De Cock VC, et al. (2025). Symptomatic treatment of REM sleep behavior disorder .... Sleep medicine, 40408791.

https://pubmed.ncbi.nlm.nih.gov/40408791/

Que Z, Zheng C, Zhao Z, Weng Y, Zhu Z, Zeng Y, et al. (2022). The treatment efficacy of pharmacotherapies for rapid eye .... Heliyon, 36387478.

https://pubmed.ncbi.nlm.nih.gov/36387478/

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Q.

Can certain medications trigger or worsen REM Sleep Behavior Disorder (RBD)?

A.

Some medications, like certain antidepressants, can trigger or worsen REM Sleep Behavior Disorder (RBD).

References:

Onofrj M, Luciano AL, Thomas A, Iacono D, & D'Andreamatteo G. (2003). Mirtazapine induces REM sleep behavior disorder (RBD) .... Neurology, 12525729.

https://pubmed.ncbi.nlm.nih.gov/12525729/

Postuma RB, Gagnon JF, Tuineaig M, Bertrand JA, Latreille V, Desjardins C, & Montplaisir JY. (2013). Antidepressants and REM Sleep Behavior Disorder. Sleep, 24179289.

https://pubmed.ncbi.nlm.nih.gov/24179289/

Mahowald MW, Schenck CH, & Bornemann MA. (2007). Pathophysiologic mechanisms in REM sleep behavior .... Current neurology and neuroscience reports, 17355839.

https://pubmed.ncbi.nlm.nih.gov/17355839/

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Q.

Can improving sleep habits reduce RBD episodes?

A.

Improving sleep habits may help reduce episodes of REM Sleep Behavior Disorder (RBD), but more research is needed to understand the full effects.

References:

Taximaimaiti R, Luo X, & Wang XP. (2021). Pharmacological and Non-pharmacological Treatments of .... Current Neuropharmacology, 9185775.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9185775/

Elder GJ, Lazar AS, Alfonso‐Miller P, & Taylor J. (2022). Sleep disturbances in Lewy body dementia: A systematic review. International Journal of Geriatric Psychiatry, 9827922.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9827922/

Amara AW, Chahine LM, & Videnovic A. (2017). Treatment of Sleep Dysfunction in Parkinson's Disease. Current treatment options in neurology, 6371969.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6371969/

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Q.

Can REM Sleep Behavior Disorder (RBD) be an early warning sign of neurological illness?

A.

REM Sleep Behavior Disorder (RBD) can be an early sign of neurological diseases like Parkinson's. It often appears years before other symptoms.

References:

Postuma RB. (2014). Prodromal Parkinson's disease--using REM sleep behavior .... Parkinsonism & related disorders, 24262156.

https://pubmed.ncbi.nlm.nih.gov/24262156/

Postuma RB, Gagnon JF, & Montplaisir J. (2013). Rapid eye movement sleep behavior disorder as a .... Sleep medicine, 23058689.

https://pubmed.ncbi.nlm.nih.gov/23058689/

Barone DA, & Henchcliffe C. (2018). Rapid eye movement sleep behavior disorder and the link to .... Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 29883833.

https://pubmed.ncbi.nlm.nih.gov/29883833/

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Q.

Can REM Sleep Behavior Disorder (RBD) be confused with night terrors or PTSD-related nightmares?

A.

Yes, REM Sleep Behavior Disorder (RBD) can be confused with night terrors or PTSD-related nightmares because they all involve unusual behaviors during sleep, but they have different characteristics and occur at different sleep stages.

References:

Baltzan M, Yao C, Rizzo D, & Postuma R. (2020). Dream enactment behavior: review for the clinician - PMC. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 8034224.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8034224/

Meurling IJ, Leschziner G, & Drakatos P. (2022). What respiratory physicians should know about parasomnias. Breathe, 9584583.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9584583/

Singh S, Kaur H, Singh S, & Khawaja I. (2018). Parasomnias: A Comprehensive Review - PMC. Cureus, 6402728.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6402728/

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Q.

Can REM Sleep Behavior Disorder (RBD) episodes be violent or dangerous?

A.

Yes, REM Sleep Behavior Disorder (RBD) episodes can be violent or dangerous, as individuals may act out their dreams physically.

References:

Sixel-Döring F, Schweitzer M, Mollenhauer B, & Trenkwalder C. (2011). Intraindividual variability of REM sleep behavior disorder in .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 21344049.

https://pubmed.ncbi.nlm.nih.gov/21344049/

Ryan Williams R, & Sandigo G. (2017). Venlafaxine-induced REM Sleep Behavioral Disorder .... Trauma case reports, 29644271.

https://pubmed.ncbi.nlm.nih.gov/29644271/

Kass JS, & Rose RV. (2020). Criminal Culpability for Acts Committed During a Possible .... Continuum (Minneapolis, Minn.), 32756236.

https://pubmed.ncbi.nlm.nih.gov/32756236/

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Q.

Can REM Sleep Behavior Disorder (RBD) occur every night, or does it vary in frequency?

A.

REM Sleep Behavior Disorder (RBD) can happen every night or less often, depending on the person.

References:

Grenot M, Roman A, Villalba M, Morel AL, Fort P, Arthaud S, et al. (2024). Major alteration of motor control during rapid eye .... Sleep, 39121093.

https://pubmed.ncbi.nlm.nih.gov/39121093/

Reilly S, Dhaliwal S, Arshad U, Macerollo A, Husain N, & Costa AD. (2024). The effects of rivastigmine on neuropsychiatric symptoms .... European journal of neurology, 37975761.

https://pubmed.ncbi.nlm.nih.gov/37975761/

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Q.

Can REM Sleep Behavior Disorder (RBD) occur in younger adults or children?

A.

Yes, REM Sleep Behavior Disorder (RBD) can occur in children, although it is less common than in older adults.

References:

Stores G. (2008). Rapid eye movement sleep behaviour disorder in children .... Developmental medicine and child neurology, 18834385.

https://pubmed.ncbi.nlm.nih.gov/18834385/

Bellusci L, Grubbs G, Sait S, Herbst KW, Salazar JC, Khurana S, & The Connecticut Children's Covid Collaborative. (2024). Evolution of the Antigenic Landscape in Children and Young .... Vaccines, 38932367.

https://pubmed.ncbi.nlm.nih.gov/38932367/

Acharya SS. (2013). Rare bleeding disorders in children: identification and .... Pediatrics, 24127475.

https://pubmed.ncbi.nlm.nih.gov/24127475/

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Q.

Can stopping certain antidepressants improve REM Sleep Behavior Disorder (RBD) symptoms?

A.

Stopping certain antidepressants like duloxetine and venlafaxine may help improve REM Sleep Behavior Disorder symptoms.

References:

Tan L, Zhou J, Yang L, Ren R, Zhang Y, Li T, & Tang X. (2017). Duloxetine-induced rapid eye movement sleep behavior .... BMC Psychiatry, 5698922.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5698922/

Kierlin L, & Littner MR. (2011). Parasomnias and Antidepressant Therapy: A Review of the .... Frontiers in Psychiatry, 3235766.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3235766/

Ryan Williams R, & Sandigo G. (2017). Venlafaxine-induced REM sleep behavioral disorder .... Trauma Case Reports, 5887064.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5887064/

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Q.

Do people remember their dreams during REM Sleep Behavior Disorder (RBD) episodes?

A.

Yes, people with REM Sleep Behavior Disorder (RBD) often remember their dreams, which can be vivid and sometimes aggressive.

References:

Fasiello E, Scarpelli S, Gorgoni M, Alfonsi V, & De Gennaro L. (2022). Dreaming in Parasomnias: REM Sleep Behavior Disorder .... Journal of clinical medicine, 36362607.

https://pubmed.ncbi.nlm.nih.gov/36362607/

Fantini ML, Corona A, Clerici S, & Ferini-Strambi L. (2005). Aggressive dream content without daytime .... Neurology, 16217051.

https://pubmed.ncbi.nlm.nih.gov/16217051/

McCarter SJ, St Louis EK, Boswell CL, Dueffert LG, Slocumb N, Boeve BF, et al. (2014). Factors associated with injury in REM sleep behavior disorder. Sleep medicine, 25194585.

https://pubmed.ncbi.nlm.nih.gov/25194585/

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Q.

Do people with REM Sleep Behavior Disorder (RBD) experience daytime fatigue?

A.

Yes, people with REM Sleep Behavior Disorder (RBD) can experience daytime fatigue or sleepiness.

References:

Gjerstad MD, Alves G, & Maple-Grødem J. (2018). Excessive Daytime Sleepiness and REM Sleep Behavior .... Frontiers in neurology, 30487775.

https://pubmed.ncbi.nlm.nih.gov/30487775/

Diaconu Ș, Falup-Pecurariu O, Țînț D, & Falup-Pecurariu C. (2021). REM sleep behaviour disorder in Parkinson's disease .... Experimental and therapeutic medicine, 34131435.

https://pubmed.ncbi.nlm.nih.gov/34131435/

Xiang YQ, Xu Q, Sun QY, Wang ZQ, Tian Y, Fang LJ, et al. (2019). Clinical Features and Correlates of Excessive Daytime .... Frontiers in neurology, 30837940.

https://pubmed.ncbi.nlm.nih.gov/30837940/

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Q.

Does REM Sleep Behavior Disorder (RBD) increase the risk of developing Parkinson's disease?

A.

Yes, having REM Sleep Behavior Disorder (RBD) can increase the risk of developing Parkinson's disease.

References:

Postuma RB. (2014). Prodromal Parkinson's disease--using REM sleep behavior .... Parkinsonism & related disorders, 24262156.

https://pubmed.ncbi.nlm.nih.gov/24262156/

Postuma RB, Gagnon JF, & Montplaisir J. (2013). Rapid eye movement sleep behavior disorder as a .... Sleep medicine, 23058689.

https://pubmed.ncbi.nlm.nih.gov/23058689/

Postuma RB, Iranzo A, Hu M, Högl B, Boeve BF, Manni R, et al. (2019). Risk and predictors of dementia and parkinsonism in .... Brain : a journal of neurology, 30789229.

https://pubmed.ncbi.nlm.nih.gov/30789229/

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Q.

How does a sleep specialist diagnose REM Sleep Behavior Disorder (RBD)?

A.

To diagnose REM Sleep Behavior Disorder (RBD), a sleep specialist uses a sleep study called a polysomnogram to observe unusual movements or behaviors during REM sleep.

References:

Neikrug AB, & Ancoli-Israel S. (2012). Diagnostic tools for REM sleep behavior disorder. Sleep medicine reviews, 22169258.

https://pubmed.ncbi.nlm.nih.gov/22169258/

Rodriguez CL, Jaimchariyatam N, & Budur K. (2017). Rapid Eye Movement Sleep Behavior Disorder: A Review .... Chest, 28322726.

https://pubmed.ncbi.nlm.nih.gov/28322726/

Antelmi E, Lippolis M, Biscarini F, Tinazzi M, & Plazzi G. (2021). REM sleep behavior disorder: Mimics and variants. Sleep medicine reviews, 34186416.

https://pubmed.ncbi.nlm.nih.gov/34186416/

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Q.

How is melatonin used in the treatment of REM Sleep Behavior Disorder (RBD)?

A.

Melatonin is used to help manage REM Sleep Behavior Disorder (RBD) by reducing symptoms and improving sleep quality.

References:

Jung Y, & St Louis EK. (2016). Treatment of REM Sleep Behavior Disorder - PubMed - NIH. Current treatment options in neurology, 27752878.

https://pubmed.ncbi.nlm.nih.gov/27752878/

Aurora RN, Zak RS, Maganti RK, Auerbach SH, Casey KR, Chowdhuri S, et al. (2010). Best practice guide for the treatment of REM sleep .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 20191945.

https://pubmed.ncbi.nlm.nih.gov/20191945/

During EH, Malkani R, Arnulf I, Kunz D, Bes F, De Cock VC, et al. (2025). Symptomatic treatment of REM sleep behavior disorder .... Sleep medicine, 40408791.

https://pubmed.ncbi.nlm.nih.gov/40408791/

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Q.

How is REM Sleep Behavior Disorder (RBD) different from sleepwalking?

A.

REM Sleep Behavior Disorder (RBD) involves acting out dreams during REM sleep, while sleepwalking occurs during non-REM sleep and involves walking or performing complex behaviors without awareness.

References:

Uguccioni G, Golmard JL, de Fontréaux AN, Leu-Semenescu S, Brion A, & Arnulf I. (2013). Fight or flight? Dream content during sleepwalking/sleep .... Sleep medicine, 23601752.

https://pubmed.ncbi.nlm.nih.gov/23601752/

Wills L, & Garcia J. (2002). Parasomnias: epidemiology and management. CNS drugs, 12421114.

https://pubmed.ncbi.nlm.nih.gov/12421114/

Poryazova R, & Bassetti CL. (2007). [Sleep and movement disorders]. Therapeutische Umschau. Revue therapeutique, 17221827.

https://pubmed.ncbi.nlm.nih.gov/17221827/

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Q.

Is it dangerous to try to wake someone during an REM Sleep Behavior Disorder (RBD) episode?

A.

Waking someone during an REM Sleep Behavior Disorder episode is not dangerous, but it might be difficult and could cause confusion or agitation.

References:

Roguski A, Rayment D, Whone AL, Jones MW, & Rolinski M. (2020). A Neurologist's Guide to REM Sleep Behavior Disorder. Frontiers in Neurology, 7360679.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7360679/

Sobreira-Neto MA, Stelzer FG, Gitaí LL, Alves RC, Eckeli AL, & Schenck CH. (2023). REM sleep behavior disorder: update on diagnosis and .... Arquivos de Neuro-Psiquiatria, 10756822.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10756822/

Trotti LM. (2010). REM Sleep Behaviour Disorder in Older Individuals. Drugs & aging, 2954417.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2954417/

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Q.

Is REM Sleep Behavior Disorder (RBD) linked to alcohol or substance use?

A.

REM Sleep Behavior Disorder (RBD) can be linked to alcohol and substance use, as suggested by research.

References:

Chakraborty R, Biswas T, Mishra BR, & Parmar A. (2024). Acute REM sleep behaviour disorder associated with .... Drug and alcohol review, 38287722.

https://pubmed.ncbi.nlm.nih.gov/38287722/

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Q.

Is REM Sleep Behavior Disorder (RBD) more common in older adults?

A.

Yes, REM Sleep Behavior Disorder (RBD) is more common in older adults.

References:

Trotti LM. (2010). REM sleep behaviour disorder in older individuals - PubMed. Drugs & aging, 20524706.

https://pubmed.ncbi.nlm.nih.gov/20524706/

Ju YE, Larson-Prior L, & Duntley S. (2011). Changing demographics in REM sleep behavior disorder. Sleep medicine, 21317035.

https://pubmed.ncbi.nlm.nih.gov/21317035/

Zhang X, Sun X, Wang J, Tang L, & Xie A. (2017). Prevalence of rapid eye movement sleep behavior disorder .... Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 27770275.

https://pubmed.ncbi.nlm.nih.gov/27770275/

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Q.

What are the typical behaviors seen during an REM Sleep Behavior Disorder (RBD) episode?

A.

During an REM Sleep Behavior Disorder (RBD) episode, people may act out their dreams with movements like punching, kicking, or jumping out of bed, which can be quite vigorous and sometimes aggressive.

References:

Manni R, Terzaghi M, & Glorioso M. (2009). Motor-behavioral episodes in REM sleep behavior disorder .... Sleep, 19238811.

https://pubmed.ncbi.nlm.nih.gov/19238811/

Cochen De Cock V. (2013). Recent data on rapid eye movement sleep behavior .... Sleep medicine, 23021864.

https://pubmed.ncbi.nlm.nih.gov/23021864/

Fantini ML, Corona A, Clerici S, & Ferini-Strambi L. (2005). Aggressive dream content without daytime .... Neurology, 16217051.

https://pubmed.ncbi.nlm.nih.gov/16217051/

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Q.

What causes the loss of normal muscle paralysis during REM sleep?

A.

Loss of normal muscle paralysis during REM sleep can happen due to problems in the brain areas that control muscle tone, causing a condition called REM sleep behavior disorder.

References:

Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE, et al. (2007). Pathophysiology of REM sleep behaviour disorder ... - PubMed. Brain : a journal of neurology, 17412731.

https://pubmed.ncbi.nlm.nih.gov/17412731/

Luppi PH, Clément O, Sapin E, Gervasoni D, Peyron C, Léger L, et al. (2011). The neuronal network responsible for paradoxical sleep .... Sleep medicine reviews, 21115377.

https://pubmed.ncbi.nlm.nih.gov/21115377/

Peever J. (2011). Control of motoneuron function and muscle tone during .... Archives italiennes de biologie, 22205591.

https://pubmed.ncbi.nlm.nih.gov/22205591/

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Q.

What home safety measures should be taken for someone with REM Sleep Behavior Disorder (RBD)?

A.

For someone with REM Sleep Behavior Disorder (RBD), make the bedroom safe by removing sharp objects, padding furniture, and securing windows.

References:

Matar E, McCarter SJ, St Louis EK, & Lewis SJ. (2021). Current Concepts and Controversies in the Management of .... Neurotherapeutics, 8116413.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8116413/

Trotti LM. (2010). REM Sleep Behaviour Disorder in Older Individuals. Drugs & aging, 2954417.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2954417/

Sobreira-Neto MA, Stelzer FG, Gitaí LL, Alves RC, Eckeli AL, & Schenck CH. (2023). REM sleep behavior disorder: update on diagnosis and .... Arquivos de Neuro-Psiquiatria, 10756822.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10756822/

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Q.

What is the connection between REM Sleep Behavior Disorder (RBD) and neurodegenerative diseases?

A.

REM Sleep Behavior Disorder (RBD) is linked to an increased risk of developing neurodegenerative diseases like Parkinson's disease and dementia. It often appears years before these diseases are diagnosed.

References:

Galbiati A, Verga L, Giora E, Zucconi M, & Ferini-Strambi L. (2019). The risk of neurodegeneration in REM sleep behavior .... Sleep medicine reviews, 30503716.

https://pubmed.ncbi.nlm.nih.gov/30503716/

Gagnon JF, Postuma RB, Mazza S, Doyon J, & Montplaisir J. (2006). Rapid-eye-movement sleep behaviour disorder and .... The Lancet. Neurology, 16632313.

https://pubmed.ncbi.nlm.nih.gov/16632313/

Zanigni S, Calandra-Buonaura G, Grimaldi D, & Cortelli P. (2011). REM behaviour disorder and neurodegenerative diseases. Sleep medicine, 22136901.

https://pubmed.ncbi.nlm.nih.gov/22136901/

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Q.

What role does a polysomnography play in diagnosing REM Sleep Behavior Disorder (RBD)?

A.

Polysomnography is a key tool in diagnosing REM Sleep Behavior Disorder (RBD) by recording sleep patterns and detecting abnormal movements during REM sleep.

References:

Salsone M, Arabia G, Manfredini L, Quattrone A, Chiriaco C, Vescio B, et al. (2019). REM-Sleep Behavior Disorder in Patients With Essential .... Frontiers in neurology, 31068885.

https://pubmed.ncbi.nlm.nih.gov/31068885/

Manni R, Terzaghi M, Pacchetti C, & Nappi G. (2007). Sleep disorders in Parkinson's disease: facts and new .... Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 17235427.

https://pubmed.ncbi.nlm.nih.gov/17235427/

Gunter KM, Brink-Kjaer A, Mignot E, Sorensen HBD, During E, & Jennum P. (2023). A Spectral Vision Transformer for the Detection of REM .... IEEE journal of biomedical and health informatics, 37402190.

https://pubmed.ncbi.nlm.nih.gov/37402190/

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Q.

What role does clonazepam play in REM Sleep Behavior Disorder (RBD) treatment?

A.

Clonazepam is commonly used to help treat REM Sleep Behavior Disorder (RBD) by reducing abnormal movements during sleep.

References:

Ferri R, Marelli S, Ferini-Strambi L, Oldani A, Colli F, Schenck CH, & Zucconi M. (2013). An Observational Clinical and Video-Polysomnographic .... Sleep medicine, 23098778.

https://pubmed.ncbi.nlm.nih.gov/23098778/

Olson EJ, Boeve BF, & Silber MH. (2000). Rapid eye movement sleep behaviour disorder. Brain : a journal of neurology, 10648440.

https://pubmed.ncbi.nlm.nih.gov/10648440/

Poryazova RG, & Zachariev ZI. (2005). REM sleep behavior disorder in patients with Parkinson's .... Folia medica, 16152765.

https://pubmed.ncbi.nlm.nih.gov/16152765/

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Q.

Why do people act out their dreams in REM Sleep Behavior Disorder (RBD)?

A.

In REM Sleep Behavior Disorder (RBD), people act out their dreams because the brain fails to keep the body still during REM sleep, allowing dream movements to occur.

References:

Blumberg MS, & Plumeau AM. (2016). A new view of "dream enactment" in REM sleep behavior .... Sleep medicine reviews, 26802823.

https://pubmed.ncbi.nlm.nih.gov/26802823/

Postuma RB, Gagnon JF, & Montplaisir JY. (2012). REM sleep behavior disorder: from dreams to .... Neurobiology of disease, 22019718.

https://pubmed.ncbi.nlm.nih.gov/22019718/

Dauvilliers Y, Schenck CH, Postuma RB, Iranzo A, Luppi PH, Plazzi G, et al. (2018). REM sleep behaviour disorder. Nature reviews. Disease primers, 30166532.

https://pubmed.ncbi.nlm.nih.gov/30166532/

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References