Action Dreamer - Rapid Eye Movement Behavior Disorder

Author: Liu Guorui, 905th Hospital of the Chinese People's Liberation Army Navy

Zhang Yanfei Shanghai Changzheng Hospital

Reviewer: Bai Yonghai, Chief Physician and Professor of Shanghai Changzheng Hospital

Imagine that you are having an extremely angry dream, in which you raise your fist to hit someone. At the same time, in reality, you actually raise your fist and punch the person next to you. Then, "congratulations", you may be the kind of "action dreamer", that is, our protagonist today - a patient with rapid eye movement sleep behavior disorder (RBD).

——The "Kung Fu Master" in Sleep

Rapid eye movement (REM) sleep behavior disorder refers to a sleep disorder in which we should be in the rapid eye movement (REM) sleep stage, where the whole body is relaxed, but various limb movements (from muscle twitching to various complex and violent behavioral movements) occur. In normal people, except for the eyeballs and respiratory muscles, other muscles are basically in a "resting" state during this stage. However, the muscle "rest" application of patients with REM sleep behavior disorder seems to be always rejected. They can run, hit people, and even try aerial ballet in their sleep.

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——Why do you transform into a “Kung Fu master” while sleeping?

1. Brainstem failure: There is a part of our brain called the brainstem that is responsible for notifying the body that muscles need to relax during REM sleep. But in patients with REM sleep behavior disorder, the brainstem seems to forget its job. As a result, when the plot in the dream requires jumping or fighting, the body "honestly" makes the movements. It is common in certain neurological diseases that can affect the function of the brainstem, including subarachnoid hemorrhage, multiple sclerosis, brainstem tumors, etc. REM sleep behavior disorder may be only a partial symptom of these diseases.

2. A small gathering of neurotransmitters: In the brain, some chemicals called neurotransmitters are responsible for sending "relaxation" or "activity" signals. But in the body of patients with REM sleep behavior disorder, these neurotransmitters are like having a chaotic party. The inhibitory signals are not enough, and the excitatory signals are too strong, resulting in the muscles not being able to rest well. In addition, patients who receive drugs that regulate neurotransmitters, such as tricyclic antidepressants and selective serotonin reuptake inhibitors, are also prone to acute REM sleep behavior disorder.

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3. A sign of pathological changes: REM sleep behavior disorder may be an early sign of some neurodegenerative diseases, such as Parkinson's disease and multiple system atrophy. It is like a "small earthquake" in the brain, which may indicate that a bigger "earthquake" is coming.

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4. Genetic surprises: Although the current research has not yet fully clarified it, it seems that some genetic factors also like to hitch a ride in the story of REM sleep behavior disorder. Some cases of chronic REM sleep behavior disorder have familial clustering.

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——What are the specific symptoms of REM sleep behavior disorder?

1. Behavioral manifestations: Various behaviors related to dreams, such as suddenly sitting up, jumping up, or punching, kicking, etc., which may be accompanied by shouting, and the content of the shouting is usually related to the dream.

2. Emotional expression: There may be anger or fear in the dream, and these emotions can be recalled after waking up.

3. Dream memory: After being awakened, the patient may or may not remember the content of the dream and what happened.

——What can we do in the face of REM sleep behavior disorder?

First of all, if your partner is often attacked by you for no reason, or you often perform "fighting scenes" at night and always find yourself injured when you wake up in the morning, then it is best to see a doctor. Professional polysomnography and a series of related examinations and tests can confirm whether it is really REM sleep behavior disorder that is causing the problem.

Treatment options:

1. Medication: Your doctor may prescribe symptom-control medications, such as clonazepam, to help your muscles stay active during sleep.

2. Sleeping environment safety protection: It is also important to transform your sleeping environment. Imagine turning the area around your bed into a soft paradise, where you won’t feel any pain when you fall, and you can continue to sleep soundly.

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Although we've been talking about REM sleep behavior disorder in a lighthearted way, it's a serious topic. Early diagnosis and treatment can not only protect you and your partner from nighttime "battles," but can also help identify other possible health problems in a timely manner. So, if you suspect you're having a nighttime "Infernal Affairs," it's best to see a doctor as soon as possible to get a clear diagnosis!