Sleep well, live well
Nighttime Mysteries: REM Behavior Disorder vs. Sleep Terrors—What’s Really Happening in Your Sleep?
- Imtiaz Ahmad MD, MPH, FCCP
- Updated on: January 31, 2025
- Parasomnia, Sleep & Health, Sleep & Normal Variant
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Table of Contents
REM Behavior Disorder (RBD) and sleep terrors (also known as night terrors) are both sleep disorders that can cause unusual behaviors during sleep, but they are distinct conditions with different causes, characteristics, and treatments. Here’s a detailed comparison to help clarify the differences:
Stage of Sleep
RBD: Occurs during REM (rapid eye movement) sleep, the stage of sleep associated with vivid dreaming. Normally, the body is paralyzed during REM sleep, but in RBD, this paralysis is incomplete or absent, allowing individuals to physically act out their dreams.
Sleep Terrors: Occur during non-REM sleep, typically in the deeper stages (stage 3 or 4) of the sleep cycle. This is a stage of sleep where dreaming is less vivid or absent, and the body is not paralyzed.
Behaviors and Symptoms
RBD
- Individuals physically act out their dreams, which are often vivid, intense, and action-packed (e.g., fighting, running, or defending themselves).
- Movements can include punching, kicking, shouting, or even jumping out of bed.
- The person may recall the dream content upon waking.
- Injuries to themselves or their bed partner are common due to the physical nature of the movements.
Sleep Terrors
- Individuals may suddenly sit up in bed, scream, or appear terrified, often with a racing heart and sweating.
- They are typically unresponsive to attempts to comfort or wake them.
- Movements are less coordinated and purposeful compared to RBD.
- The person usually has no memory of the episode or any associated dream.
Awareness and Memory
RBD
- Individuals are often aware of their dreams and may remember them upon waking.
- They may wake up during or after an episode and be able to describe what they were dreaming about.
Sleep Terrors
- Individuals are usually unaware of their surroundings during an episode and have no memory of it the next morning.
- They may appear confused or disoriented if awakened but will not recall the event.
Causes and Risk Factors
RBD
- Linked to dysfunction in the brainstem areas that regulate REM sleep paralysis.
- Often associated with neurodegenerative conditions like Parkinson’s disease, Lewy body dementia, or multiple system atrophy.
- More common in men over the age of 50.
Sleep Terrors
- Often related to over-arousal of the central nervous system during sleep.
- More common in children, though they can occur in adults.
- Triggers may include stress, sleep deprivation, fever, or certain medications.
Diagnosis
RBD
- Diagnosed through a polysomnogram (sleep study), which shows abnormal muscle activity during REM sleep.
- Clinical evaluation of symptoms and dream recall is also important.
Sleep Terrors
- Diagnosed based on clinical history and observation of episodes.
- A sleep study is rarely needed unless other sleep disorders are suspected.
Treatment
RBD
- Medications like clonazepam or melatonin are commonly used to reduce symptoms.
- Safety measures, such as padding the bedroom or sleeping separately, are often recommended to prevent injuries.
Sleep Terrors
- Treatment focuses on reducing triggers, such as stress or sleep deprivation.
- In children, sleep terrors often resolve on their own with age.
- In adults, therapy or medications (e.g., benzodiazepines) may be used if episodes are frequent or severe.
Prognosis
RBD
- Often a chronic condition that requires long-term management.
- May be an early indicator of neurodegenerative diseases, so ongoing monitoring is important.
Sleep Terrors
-
- In children, episodes typically decrease with age and often resolve by adolescence.
- In adults, addressing underlying causes (e.g., stress or sleep disorders) can improve symptoms.
Key Takeaway
While both RBD and sleep terrors involve unusual behaviors during sleep, they occur in different stages of sleep and have distinct characteristics. RBD involves acting out vivid dreams during REM sleep, often with the potential for injury, while sleep terrors involve episodes of fear or panic during non-REM sleep, usually without memory of the event. If you or a loved one experiences symptoms of either condition, consulting a sleep specialist is essential for proper diagnosis and treatment.
QUESTIONS ABOUT A SLEEP ISSUE? LET’S TALK.
Imtiaz Ahmad, MD, MPH, FCCP
Dr. Imtiaz Ahmad is a highly qualified physician, Board Certified in Pulmonary and Sleep Medicine. He has received advanced training from some of the most prestigious institutions, including Harvard University, Cornell University, State University of New York at Brooklyn, and the University of Mississippi. SOMNAS is a medical facility that is committed to improving and maintaining the health of patients with sleep disorders. The expert team at SOMNAS is known for their compassionate and high-quality care. They offer unparalleled treatment and care to patients on the Gulf Coast of Florida, ensuring a better and healthier life for them.
Job Title: Board Certified in Pulmonary Medicine
