REM sleep behavioral disorder (RBD):

This is another manifestation of REM related parasomnias in which the patient acts out their dreams. In this condition, the patient appears not to have the typically protective atonia that is seen in REM sleep. This condition is commoner in older individuals and can be seen in patients with Parkinson’s disease. When seen in younger individuals it is associated with an increased likelihood that they will develop Parkinson’s disease in later life. In this condition, the patient may be a risk to themselves and others and it is not uncommon to see spouses injured by the actions of their bed partner.

Predisposing factors for parasomnias:

Genetic factors, insufficient sleep, stress, anxiety and affective disorders.


Take a good history and physical examination. Obtain a good medication and drug use history. Does not typically require overnight sleep study although in cases of REM it may be helpful in clearly defining the condition. Videotaping of REM behavioral disorder events may also be helpful.


Safety is paramount especially in cases of RBD. Maintaining an uncluttered environment is helpful.

Psychotherapy may be necessary in some patients with nightmares

Review of drug management, and consideration of different drug options if such medications are inducing the nightmares.

Benzodiazepines can be used to ameliorate the nightmares. Tricyclic antidepressants and Selective serotonin reuptake inhibitors can also be used to reduce nightmares but withdrawal can result can result in REM rebound.