Dreams emerge as expeditions of our central nervous system, unfolding during periods of bodily repose, yet with our minds beholden to the rapid eye movement (REM) phase of slumber. For individuals afflicted by an uncommon malady, their entire physique enacts the dreams, at times leading them to vacate their bedchambers or even their domicile.
REM sleep behavior disorder (RBD) stands apart from noctambulation and, if the movements are sufficiently forceful, can pose peril to the afflicted individual as well as to a slumbering companion.
RBD is an affliction warranting earnest attention, as posited by Jeanne Feuerstein, MD, an adjunct professor of neurology at the University of Colorado School of Medicine, due to its potential link to other neurological disorders, such as dementia with Lewy bodies, multiple system atrophy (MSA), or Parkinson’s disease.
In the ensuing question-and-answer session, Feuerstein elucidates this enigmatic condition, the avenues of treatment, its association with other neurological ailments, and the focal points of her investigation, including an exploration of RBD’s correlation with post-traumatic stress disorder (PTSD), according to medicalxpress.com.
What characterizes REM sleep behavior disorder?
During the REM phase of sleep, which signifies a profoundly entrenched stage of slumber, the brainstem regulates bodily flaccidity. However, individuals afflicted with REM sleep behavior disorder do not experience such flaccidity, resulting in somatic mobility, a phenomenon termed REM sleep without atonia. Consequently, they may exhibit markedly exaggerated dream enactments. Diagnosis is contingent upon a sleep analysis, which captures instances of nocturnal mobility.
Could you elaborate on the diagnostic process for this disorder? What transpires during the sleep assessment?
Typically, diagnosis ensues from an in-clinic sleep analysis. Confirmation necessitates the presence of both REM sleep without atonia and dream enactments, the latter being unobservable via domiciliary sleep assessments. Video documentation in the sleep laboratory is instrumental in documenting dream enactments. Individuals with RBD invariably manifest some degree of REM sleep without atonia nightly, albeit the severity varies.
How do individuals discern their affliction? How does it evolve?
The natural progression remains inadequately explored, although there is speculation that individuals evincing REM sleep without atonia may subsequently develop RBD. Typically, awareness is aroused by a bedmate. Those with RBD are seldom perturbed by their condition unless it culminates in ejection from bed or bodily harm. Generally, it is the bedfellow who discerns the anomaly.
I heard an anecdote about an individual dreaming of being targeted by an incoming missile and, in a bid to evade harm, leaping from a second-story hotel window. He landed unscathed on the verdant turf but narrowly evaded, severing his femoral artery by a mere fraction of a millimetre.
Are such extreme manifestations of RBD commonplace?
Certain individuals sustain injuries from bed falls or inflict harm upon their partners or bedfellows. They may topple lamps or collide with furniture, precipitating potential peril. Anecdotes abound of individuals physically enacting their dreams in myriad ways. In one instance, an individual delivered a political oration, while another was observed smoking. The spectrum of dream enactments is remarkably diverse.
Individuals with RBD must ensure that weaponry is secured, and sharp objects are inaccessible. Some opt for mattresses on the floor or padding on bedposts as safety measures. Oftentimes, affected individuals find themselves sleeping alone, as their significant other refrains from sharing the bed.
How does RBD differ from noctambulation?
Noctambulation occurs during a distinct sleep stage—stage two—which denotes a lighter phase of slumber than REM.
What is the prevalence of REM sleep behavior disorder?
Data remain somewhat equivocal owing to underreporting, yet prevalence is estimated at approximately 0.5%. Of particular interest is the observation that individuals with RBD harbor a considerable likelihood—ranging from 70% to 90%—of developing a synucleinopathy, such as Parkinson’s disease.
Estimates indicate that approximately 30% to 50% of Parkinson’s patients exhibit REM sleep behavior disorder. Incidence rates of RBD are elevated in cases of MSA and dementia with Lewy bodies.
This underscores the imperative for individuals exhibiting dream enactment behavior disorder to undergo a sleep analysis. It is imperative to differentiate their experience from other sleep parasomnias manifesting in alternate sleep stages, as REM sleep behavior disorder may herald a diagnosis of a graver condition.
Are the neural motor pathways implicated in sleep enactment disorder dissimilar from those engaged during wakefulness?
No, the motor mechanisms are largely analogous. During REM sleep, multiple brainstem nuclei interact with spinal cord cells, inhibiting movement. Various brainstem regions contribute to impeding motor pathways in the spinal cord, precluding mobility.
When these connections are suppressed, activation of said pathways ensues, prompting somnambulation. My research at the VA focuses on individuals with PTSD. Those afflicted with PTSD may evince analogous dream enactment behavior—REM sleeps without atonia. This realm remains relatively unexplored. The question at hand pertains to discerning whether this sleep disorder linked to PTSD similarly portends the onset of a synucleinopathy or merely parallels its manifestations. Accordingly, distinguishing between RBD and PTSD constitutes the crux of my inquiry.
Can RBD be discerned via biomarkers, such as synuclein proteins?
Synuclein aggregates can be detected through a seeding technique utilizing cerebrospinal fluid. However, this applies solely to individuals predisposed to develop Parkinson’s or akin disorders. Synuclein, per se, does not serve as a definitive marker for RBD. For instance, narcoleptic individuals manifest REM sleep without atonia yet do not progress to Parkinson’s. Ergo, diverse pathways may precipitate RBD, prompting endeavors to ascertain which cohorts are predisposed to synucleinopathies.
What treatment modalities are available for RBD? The individual who leaped from the window mentioned being prescribed clonazepam.
Clonazepam features prominently among treatment options, albeit it is not the preferred choice due to its psychotropic properties and potential for addiction. Melatonin is typically the preferred treatment, having exhibited efficacy in clinical trials. Extended-release formulations may be favored by some as they mitigate addiction risk. Infrequently, if melatonin proves ineffective, benzodiazepines like clonazepam may be administered. While effective in ameliorating motor symptoms, clonazepam may compromise sleep quality, necessitating a delicate balance.
It appears that RBD remains inadequately understood.
Indeed, that appears to be the case. Sleep disorders, in general, remain enigmatic. Initially embarking on this research endeavor, I anticipated a wealth of clinical knowledge, only to encounter a paucity thereof.
It behooves individuals to recognize that, despite the seemingly eccentric or anomalous nature of nocturnal dream enactments, seeking evaluation is imperative. Equally crucial is discerning whether RBD bears any connection to synucleinopathies, which may herald graver conditions.
Numerous studies are underway for individuals with RBD devoid of Parkinson’s, affording them insights into their condition and potentially informing treatments.