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REM Sleep Behaviour Disorder and Parkinson’s

Nightmares and vivid dreams are common and harmless.
In contrast, REM sleep behaviour disorders are a feature of neurodegenerative diseases such as Parkinson’s disease. People then physically externalize their dreams. These individuals and their spouses may become at risk of injury.

General population, 40 years and older: < 3%.
People with Parkinson's disease: 50%.

REM sleep behaviour disorders can appear several years before Parkinson’s disease. In these often unpleasant dreams, people can become physically or verbally violent, involuntarily and unconsciously.

The most common symptoms of REM sleep behaviour disorders are:

  • Sounds (screaming, swearing, laughing)
  • Physical (kicking, punching, flapping arms or jumping out of bed in response to action-packed or violent dreams)

When they wake up, people with these disorders can remember their dreams, but not what they did during those dreams. These disorders are a risk for both the person with the disorder and the partner who shares the bed. In addition, they can be very frightening for the partner. It is important to talk about this disorder and make the sleeping environment safe to reduce risks.

REM sleep behaviour disorders occur during the sleep phase in which we dream. It is a phase of about 90 minutes that is repeated four to five times a night.

During this phase, the connection between the areas of the brain that generate dreams and those that control movement is interrupted. The body is therefore immobilized and only the eyes continue to move. This phase is also called the Rapid Eye Movement (REM) phase.

In some people living with Parkinson’s disease, this connection is not made. People become actors in their dreams and will mimic the actions they experience in them.

REM sleep disorders are sometimes confused with regular nightmares, the frequency of which can be increased by antiparkinsonian medications. Nightmares, although sometimes traumatic, are harmless and do not involve violent acts.

If you have this sleep disorder, you may be able to remember your dreams. However, you probably won’t remember events that happened in your room, such as your screams or violent episodes.

Your partner is the person who can best help you recognize this Parkinson’s symptom. Talk about it together and keep a sleep diary for a few weeks to record your observations about the frequency and nature of your nighttime behaviour. These details will help your doctor better understand your condition.

For an accurate diagnosis, your doctor will refer you to a center specializing in sleep studies. You will spend one night there during which the medical team will monitor the activity of your brain, muscles and breathing. With these tests, they will be able to determine with certainty if you have REM sleep behaviour disorder. Appropriate treatment may then be recommended.

Treatment usually involves a combination of medication and a change in sleeping habits.

Before you see a doctor, you can use strategies to reduce the impact of these dreams on you and your partner’s safety. Here are some of these strategies:

  • Make sure there are no sharp objects near the bed
  • Place the bed against the wall or put pillows to prevent falls
  • Consider installing safety rails on the bed
  • Place sharp objects and furniture away from the bed
  • Move the bed away from windows
  • Sleep in separate rooms if your behaviour becomes too much of an inconvenience

An occupational therapist’s advice can also provide you with several concrete solutions to make your sleep environment safer and prevent injuries.

Your doctor may suggest several options, including medications from the benzodiazepine class. These can reduce your muscle activity and relax your body during sleep. However, they can be addictive for some people.

Melatonin is an over-the-counter medication available in pharmacies. It is a naturally produced hormone in the brain that regulates sleep. The starting dose is often 3 mg at bedtime with a gradual increase until results are achieved.

The onset of REM sleep behaviour disorders is gradual. These behaviours can become increasingly violent over time. Early diagnosis and the implementation of preventive measures can prevent possible injuries.

In recent years, some studies have shown that vivid dreams could be an early sign of certain neurological diseases, including Parkinson’s disease. Close to 38% of people with this sleep disorder will develop a neurological disease.

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