University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Sleep Medicine


Elyse Watkins



Rapid Eye Movement Behavior Disorder (RBD) is a parasomnia that manifests itself as dream enactment behavior during REM sleep. It is not benign. Clinical features include unpleasant dreams and violent dream enactment behavior (DEB). Severe dream enactment behavior can result in injury or death to the individual or their bed partner, leading to significant medical-legal implications. RBD is classified as primary or secondary. Primary or idiopathic RBD occurs when there are no significant comorbidities, including neurological, motor, or cognitive complaints. RBD is implicated as a prodrome for alpha-synucleopathies, most commonly Parkinson's disease (PD), Dementia with Lewy bodies (DLB), and Multiple System Atrophy (MSA). Secondary RBD is triggered by psychotropic medications and beta-blockers or comorbidities such as narcolepsy type 1 (with cataplexy), obstructive sleep apnea, neurological or neurodegenerative disorders, paraneoplastic disorders, autoimmune diseases, or brainstem lesions. Diagnosis requires a polysomnogram with audiovisual recording to rule out potential RBD mimickers, including obstructive sleep apnea, sleepwalking, sleep terrors, and confusional arousals. The course of RBD is variable. It can remain stable, wax and wane, progress, or in some instances, have complete remission. Treatment studies are limited; however, it is beneficial to remove offending pharmacologic agents and treat underlying diseases when possible. Clonazepam and melatonin reduce dream enactment behavior and dream frequency. Due to the potential risk of injury and future health consequences of RBD, it is essential that the health care provider accurately diagnose and inform the individual of possible future implications of this sleep disorder.


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