Beware of "Dreams Hurting People"! Uncovering the Truth of Rapid Eye Movement Sleep Behavior Disorder (RBD)

Everyone dreams when they sleep, and they may shout or make body movements. People may think they are having nightmares and don't pay much attention to them. But Mr. Zhuang, 70, who lives in Kaifu District, Changsha, is deeply troubled by it.

Mr. Zhuang reported that since 2022, he would not only suddenly yell and kick after falling asleep, but also make physical movements related to the content of his dreams, such as punching, kicking, yelling, etc., sometimes accompanied by falling out of bed or injuring his bedmate.

The abnormal behavior mostly occurred in the second half of the night, with 1-2 attacks every night, each lasting for several minutes, and he could clearly recall the content of his dreams after waking up. Mr. Zhuang was in great pain and dared not sleep at night for fear of hurting himself and others.

Recently, Mr. Zhuang was diagnosed with "rapid eye movement sleep behavior disorder" at the Sleep Disorders and Neurology Department of Hunan Provincial Second People's Hospital (Provincial Brain Hospital) .

So what is rapid eye movement sleep behavior disorder (RBD)? Chen Jinhong, deputy chief physician of the Sleep Disorders and Neurology Department of Hunan Second People's Hospital (Provincial Brain Hospital), explained:

Human sleep is divided into two stages: non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM). Under normal circumstances, muscles in the REM period (the peak period of dreaming) are in a "paralyzed" state, preventing us from putting dreams into action. However, the muscle tension of patients with REM abnormal behavior disorder (RBD) has not disappeared, causing them to "perform" violent or intense behaviors in their dreams, such as punching, kicking, shouting, and even falling out of bed and getting injured.

What are the typical symptoms of rapid eye movement sleep behavior disorder (RBD)?

Dr. Chen Jinhong reminds us that there are several typical manifestations:

1. Synchronicity of dreams and behaviors: Patients often dream of being chased, fighting, and other scenes, and perform corresponding actions.

2. Easy to get injured during sleep: The patient may bump into furniture, fall off the bed, or even accidentally injure the bed partner.

3. Clear memory in the morning: The patient can recall dreams in detail but is unaware of his or her own behavior.

4. More common in middle-aged and elderly men: It is more common in people over 50 years old, but young people may also get the disease.

If you have REM sleep behavior disorder (RBD), it is not just a sleep problem! Dr. Chen Jinhong explains:

1. It can cause physical harm: Accidents such as fractures and scalp lacerations are common.

2. Neurodegenerative diseases require warning: About 50% of RBD patients will develop Parkinson's disease, Lewy body dementia, etc. after 10-15 years.

3. Psychological pressure: Patients suffer from anxiety and depression due to fear of sleep.

How should REM sleep behavior disorder be diagnosed and treated? Dr. Chen Jinhong explains:

1. The "gold standard" for diagnosing rapid eye movement sleep behavior disorder: Polysomnography (PSG) records sleep cycles through electroencephalogram, electromyography and other equipment to detect abnormal muscle activity during the REM period.

2. Treatment plan: Drug treatment for REM sleep behavior disorder mainly includes:

① Clonazepam: It is the first-line drug for the treatment of REM sleep dysbehavior disorder. About 70%-90% of patients with REM sleep dysbehavior disorder have their symptoms significantly improved.

② Melatonin: Highly safe, suitable for long-term use in treating REM sleep behavior disorder.

3. In addition to drug treatment, environmental modification is also important!

Patients with REM sleep behavior disorder should have guardrails installed at the bedside and sharp objects removed from the bedroom. We recommend that patients sleep in separate beds from their partners to avoid accidental injury to their partners.

The following is a must-read emergency treatment guide for families of patients with REM sleep behavior disorder:

1. Never wake the patient up by force; it is safer to call their name softly.

2. Record the frequency of attacks and the content of dreams to provide clues for doctors.

3. Avoid drinking alcohol and caffeine before going to bed and reduce stimulation.

4. Care for and understand patients and provide psychological support.

5. Maintain a regular schedule, avoid head trauma, and exercise appropriately.

Finally, Dr. Chen Jinhong appealed to everyone: Rapid eye movement sleep behavior disorder (RBD) is a "warning signal" sent by the brain. If you or your family members have related symptoms, please go to the sleep medicine center or neurology department for treatment in time.

Early diagnosis and early intervention can not only improve sleep quality, but also be a key step to protect future brain health! Sleep is important, pay attention to rapid eye movement sleep behavior disorder (RBD) to restore peace of mind.

Hunan Medical Chat Special Author: Xiong Fang, Department of Sleep Disorders and Neurosis, Hunan Second People's Hospital (Provincial Brain Hospital)

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(Edited by YT)