REM Sleep Behavior Disorder

REM sleep behavior disorder (RBD) is a parasomnia. A parasomnia involves undesired events that happen while sleeping.

RBD occurs when you act out vivid dreams as you sleep. These dreams are often filled with action. They may even be violent. Episodes tend to get worse over time. Early episodes may involve mild activity. Later episodes can be more violent. RBD is often ignored for years. At some point it is likely to result in an injury. Either the person dreaming or the bed partner may be hurt.

RBD can be confused with sleepwalking and sleep terrors. In these other disorders, the sleeper is usually confused upon waking up. He or she does not become rapidly alert. In contrast, it is normally easy to wake a person with RBD who is acting out a dream. Once awake, he or she is also able to recall clear details of the vivid dream.

The details of this dream match the unusual behavior of an RBD episode. These actions may include any of the following:

  • Shouting
  • Swearing
  • Flailing
  • Grabbing
  • Punching
  • Kicking
  • Jumping
  • Leaping

RBD episodes occur during rapid-eye-movement (REM) sleep. Normal sleep consists of a series of REM dream episodes. They occur about every 1 ½ to 2 hours each night. This means that an RBD episode tends to first appear at least 1 ½ hours after falling asleep. Episodes may continue to occur until waking up in the morning. Active RBD episodes may appear as many as four times per night. They may also occur as rarely as once per week or per month. RBD does not normally appear during a nap.

RBD by itself does not cause the dreamer to be sleepy during the day. But it is often found along with other sleep disorders. These disorders may cause daytime sleepiness.


Someone with RBD may:

  • Kick, jump, punch, flail, shout, or leap out of bed while they are still asleep
  • Have a bed partner that expresses concern about their unusual behaviors while sleeping
  • Perform actions that match vivid dreams that they clearly recall
  • Have sleep activities that result in an injury to them or their bed partner


RBD is a disorder that can get worse over time. This can put you or your bed partner in danger. RBD also tends to be linked to other medical problems. You should seek a doctor’s advice if you suspect that you might have RBD.

The doctor will ask you about your medical history. Your family history may also provide important details. The doctor should do a full exam. This should include a neurologic exam. You may be asked to complete a sleep diary. This will monitor your progress before and after treatment. You may be asked to rate your sleep with the Epworth Sleepiness Scale. This will help show how your sleep is affecting your daily life. Be sure to inform the doctor of any past or present use of any of the following:

  • Drugs
  • Alcohol
  • Medications

Also tell the doctor if you have ever had any other sleep disorder. You may also need to see a neurologist.

Tests may be needed if your medical exam shows something abnormal. People with RBD are at risk for other sleep disorders. As a result, your doctor will likely have you take an overnight sleep study. This is called a polysomnogram. It charts your brain waves, heartbeat, and breathing as you sleep. It also records how your arms and legs move. This shows if there are other disorders that are related to your sleep problems. Examples of these disorders include sleep apnea and periodic limb movement disorder. The best sleep study will also record your sleep on video. This will show if you get out of the bed and do anything unusual during the night.

Information provided by the American Academy of Sleep Medicine

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