REM sleep behavior disorder: symptoms and treatment

Generally, people’s sleep cycles can be divided into several phases, especially five. First four phases characterized by the presentation of various sleep wave patterns and the last phase known as REM sleep. This takes up between 15-20% of the natural sleep cycle and produces most dreams, as well as muscle sluggishness.

However, there are times when there is an alteration of this cycle, as is the case with conduct disorders during REM sleep. Throughout this article, we will be talking about the characteristics of this condition, as well as its symptoms, causes, and treatments that may lessen the effects of this disorder.

    What is conduct disorder during REM sleep?

    Behavioral disorder during REM sleep was first described in 1986 by Dr. and researcher Carlos H. Schenck, Specialist in sleep disorders and behaviors. He defined it as a sleep-sleep parasomnia; that is to say a grouping of abnormal behaviors or phenomena that appear during this phase of sleep.

    This type of sleep disorder or parasomnia, is distinguished by affecting both sleep development and a person’s motor system. Causing the onset of episodes of intense motor activity that affects several muscle groups.

    These movements manifest in the form of kicking, kicking, punching and arming and even verbal manifestations such as screaming. This can hurt the person accompanying him in his hours of sleep.

    The patient can even get out of bed, Walking or strolling in response to a dream activity experienced at this very moment. The violence of these motor activities finds its explanation in the content of dreams, often described as unpleasant, aggressive and virulent.

    The incidence of this disorder in the population is really low, being reduced to only 0.5% of the population. However, in many cases this it is masked by other syndromes with similar clinical images. In a large number of occasions, it is misdiagnosed as a nocturnal seizure disorder, consisting of a strange variety of obstructive sleep apnea syndrome.

    In addition, this disorder is much more common in men, accounting for 90% of cases of RCT and usually appearing between the ages of 50 and 60.

      What types are there?

      Behavioral disturbances during REM sleep can manifest themselves 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 people who have years of alcohol abuse. Likewise, certain medications or drugs such as sedative hypnotics, anticholinergics or fat soluble inhibitors can also lead to this type of sleep disorder.

      Likewise, two other types of TCR have been identified. One is 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 which can progress over time become a form of neurodegenerative disease.

      As for the chronic typology of CCT, it is caused or is part of the clinical picture of a series of neurodegenerative diseases such as Parkinson’s disease, Lewy body dementia, multisystem atrophy or, to a lesser extent, supranuclear palsy, Alzheimer’s disease, corticobasal degeneration and spinocerebellar ataxias. In the same way, it may be associated with disorders such as narcolepsy, Truncated brain lesions, tumor formations and strokes.

      Symptoms of this parasomnia

      In the clinical picture of conduct disorder during sleep, there is a state of absence of muscular atony which manifests itself in the form of sudden and violent movements which appear at the beginning of the phase of REM sleep and are maintained throughout. of it. These movements are an involuntary response to the content of dreams that the patient is experiencing, which describes them as lively, obnoxious 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 depicted.

      In a percentage of patients, in particular in 25%, it was possible to determine alterations in behavior during sleep before the onset of the disorder. Among these behaviors includes sleepwalking, screaming, twitching and limb convulsions.

      In the case of behavioral or motor symptoms of this disorder are:

      • Speak.
      • To laugh.
      • Yell.
      • Curse or insult.
      • gestures.
      • Shaking of limbs.
      • Cops.
      • Kicking.
      • Jump or jump out of bed.
      • Run.

      Due to the aggressiveness with which these behaviors appear, it is common for the patient to end up hurting or hitting the person next to them, as well as self-harm. Damage to both companion and self includes lacerations, subdural hematomas, and even fractures.

      What do we know about its causes?

      The information obtained on the causes of conduct disorders during REM sleep is quite scarce. In more than half of the cases, the cause of this condition is linked to the future onset of a certain type of neurodegenerative disease.

      However, recent studies with animal models indicate the possibility of dysfunction of the brain structures of the pontine roof, locus coeruleus and pedunculopontin nucleus; which are the main ones responsible for regulating muscle tone during sleep.

        Is there a treatment?

        Fortunately, there is a treatment for conduct disorders during REM sleep. based on the administration of daily doses of clonazepam. With a dose between 0.5 and 1 mg, given before bedtime, and for as long as the doctor tells you to, it is very likely that the person will experience better control of sleep disturbances, including a decrease in the amount. and the intensity of the attacks. violent behaviors and dreams.

        In patients who do not respond to clonazepam or who have some form of contraindication, the use of melatonin, pramipexole or donepezil may be resorted to because cases described as refractory.

        Regarding the prognosis of the disease, it is expected that with pharmacological treatment, absolute remission of symptoms will be achieved. However, there is no definitive cure for CCT, so if the dose is lowered or treatment is stopped symptoms may reappear even more strongly.

        It should be clarified that in cases where TCR is caused by neurodegenerative disease, treatment with clonazepam is not effective as the patient must undergo specific treatment for the main disease.

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