![]() ![]() 6 Pleasant and non-violent behaviour can also occur 7 and, importantly, the bed partner may provide the most crucial accounts as recall of the dream behaviour is inconsistently reported by patients. 5 Nearly 20% of patients have a lifetime incidence of head injury with unconsciousness caused by their RBD. 3,4 Consequently, RBD can cause severe self-injuries as well as injuries to the bed partner. Poor complex interaction with the environment whilst dreaming has been reported and although the patient may fall, they rarely climb out of bed, in contrast to the activity seen in sleepwalking. The most striking features of RBD relate to dream enactment behaviour with often purposeful limb movements and vocalisation, including shouting, swearing, crying or singing. Sleep disorder is not better explained by any other disorder, medical or neurological disorder, mental disorder, medication use or substance.Absence of epileptiform activity during REM sleep unless RBD can be clearly distinguished from any concurrent REM sleep-related seizure disorder.abnormal REM sleep behaviours documented on polysomnography.sleep-related injurious or potentially injurious disruptive behaviours by history.Presence of REM sleep without atonia defined as sustained or intermittent elevation of submental EMG tone or excessive phasic muscle activity in the limb EMG.Diagnostic criteria of REM sleep behaviour disorder (ICSD-2) 1 In 1987, Schenck et al 2 reported a case series of 15 elderly patients with motor components occurring pathologically throughout the REM stage of sleep.The diagnostic criteria of RBD proposed by the International Classification of Sleep Disorders (ICSD-2) requires specific features in the sleep study as well as in the clinical setting (Table 1). ![]() ![]() 1 Sleepwalking, confusional arousal and sleep terror are considered as disorders of arousal occurring from NREM sleep, whereas RBD occurs during REM sleep. The hallmark of parasomnia is any abnormal behaviour that evolves from sleep where motor or other arousal phenomena are expressed within a persistent sleep or partial sleep state. Sleep stages alternate in a cyclic pattern every 60–90 minutes and are divided into NREM and REM sleep. The stages of sleep are based on EEG appearances. Definition and classification of parasomnias James was followed up every year and after 3 years he developed PD. Therefore, clonazepam was switched to melatonin 3 mg and within days James felt a significant improvement. James was commenced on clonazepam 0.5 mg, which relieved his dream enactment behaviour but caused some residual sedation during the day. muscle activity when the muscles should be at rest). His sleep study ruled out sleep disordered breathing but revealed REM sleep without atonia (ie. His physical examination findings were unremarkable, as was neuroimaging. James was very healthy and not on any medication. According to his wife, James had been having similar experiences for a couple of years but could not always remember his dream content. The previous month he hit his wife while dreaming a tiger was attacking him. James was 54 years old when he was referred to a sleep disorder clinic because he broke his wrist diving out of bed while dreaming he was about to be hit by a train. It is anticipated that early recognition of RBD will be critical in the future use of neuroprotective agents to help tackle conditions like PD and LBD. This article focuses on the role of the general practitioner (GP) in the diagnosis and management of RBD. In addition, the emergence of RBD in people over the age of 50 years has been flagged as an early indicator of neurodegenerative diseases, including Parkinson’s disease (PD) and Lewy body dementia (LBD). In REM sleep behaviour disorder (RBD), there is a loss of this muscle atonia where patients are able to act out their dreams, which can result in serious injury to the patient and their bed partner.
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