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 sleep wave patterns and the last phase known as REM sleep. This occupies between 15 and 20% of the natural sleep cycle and most daydreams occur there, as well as muscle atony.
However, there are times when an alteration occurs in this cycle, as in the case of REM sleep behavior disorder Throughout this article we will talk about the characteristics of this condition, as well as its symptoms, causes, and treatments that can alleviate the effects of this disorder.
REM sleep behavior disorder It was described for the first time in 1986, by doctor and researcher Carlos H. Schenck , specialist in sleep disorders and behaviors. He defined this as a REM sleep parasomnia; That is, a group of abnormal behaviors or 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 person’s motor system Causing the appearance of episodes of intense motor activity which affects various muscle groups.
These movements manifest themselves in the form of shaking legs, kicking, hitting fists and arms, and even verbal manifestations such as screaming. Which can harm the person who accompanies you during your sleeping hours.
The patient may even get out of bed , walking or strolling in response to the dream activity that is experienced at that same moment. The violence of these motor activities finds its explanation in the content of 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 the population. However, in many cases this is masked by other syndromes with similar clinical pictures In a large number of cases it is misdiagnosed as a nocturnal seizure disorder, consisting of a strange variety of obstructive sleep apnea syndrome.
Furthermore, this disorder is much more common in men, representing 90% of TCR cases and usually appearing between 50 and 60 years of age.
What types exist?
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. Likewise, certain drugs or medications such as sedative-hypnotics, anticholinergics or fat-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 TCR consists of a disease in itself not associated with other alterations or injuries and that can evolve over time becoming a form of neurodegenerative disease
Regarding the chronic typology of TCR, it is caused by 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, supranuclear palsy. , Alzheimer’s disease, corticobasal degeneration and spinocerebellar ataxias. In the same way, may be associated with disorders such as narcolepsy brain stem lesions, tumor formations and strokes.
Within the clinical picture of sleep behavior disorder, we find a state of lack of muscle atonia that manifests itself in the form of sudden and violent movements that appear at the beginning of the REM sleep phase and are maintained throughout it. These movements are an involuntary response to the content of the daydreams that the patient experiences, which he describes as vivid, unpleasant and aggressive.
In most cases, patients describe their dreams as an extremely unpleasant experience in which all kinds of fights, arguments, chases and even accidents or falls are represented.
In a percentage of patients, specifically 25%, it has been possible to determine behavioral alterations during sleep prior to the appearance of the disorder. Among these behaviors includes sleepwalking, screaming, twitching, and convulsions of the extremities
In the case of the behavioral or motor symptoms of this disorder, there are:
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 inflicted on both the companion and oneself are lacerations, subdural hematomas and even fractures.
What is known about its causes?
The information obtained about the causes of behavioral disorder during REM sleep is quite scarce. 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, the locus coeruleus and the pedunculopontine nucleus; which are mainly responsible for regulating muscle tone during sleep.
Luckily, there is a treatment for REM sleep behavior disorder. based on the administration of daily doses of clonazepam With a dose of between 0.5 and 1 mg, administered before sleeping, and whenever indicated by the doctor, it is very likely that the person will experience greater control of sleep disturbances, including a decrease in the amount and intensity of aggressive behavior and violent dreams.
In patients who do not respond to clonazepam or who have some type of contraindication, the use of melatonin, pramipexole or donepezil can be used to resolve cases described as refractory.
Regarding the prognosis of the disease, it is expected that with pharmacological 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 suspended symptoms may reappear even more strongly
It is necessary to specify that in those cases where the TCR is caused by a neurodegenerative disease, treatment with clonazepam is not effective, and the patient must follow a specific treatment for the main disease.
