Institute for Continuing Education

REM Behavior Disorder

Course Objectives

Upon successful completion of this module, you will be able to:

• Define REM behavior disorder as a parasomnia characterized by loss of REM sleep atonia and explain the underlying neurophysiology, including the role of the sublaterodorsal nucleus, locus coeruleus, and brainstem circuits in generating and maintaining normal REM atonia.
• Identify and differentiate between idiopathic and secondary forms of RBD, recognizing the associations with synucleinopathies (Parkinson disease, dementia with Lewy bodies, multiple system atrophy), narcolepsy, medications (particularly antidepressants), and structural brainstem lesions.
• Recognize RBD as a prodromal marker for neurodegenerative disease and explain the Braak staging model of Lewy body pathology, understanding that 80-90% of patients with idiopathic RBD will eventually develop a synucleinopathy over 10-15 years.
• Apply polysomnographic diagnostic criteria for RBD including identification of REM sleep without atonia (excessive tonic and phasic EMG activity), video-EEG correlation of behavioral episodes, and distinguish RBD from non-REM parasomnias, nocturnal seizures, and other sleep-related movement disorders.
• Implement comprehensive safety interventions and evaluate pharmacological treatments for RBD, including bedroom modifications to prevent injury, appropriate use of clonazepam and melatonin, and recognize situations requiring interdisciplinary referral for neurodegenerative disease monitoring.
• Interpret polysomnographic features of RBD including quantification of REM without atonia using AASM scoring criteria, documentation of behavioral episodes with detailed video analysis, and recognition of the clinical significance for long-term neurologic prognosis.

Course Information

For most people, dreams are purely a “mental” activity: they occur in the mind while the body is at rest. But people who suffer from REM behavior disorder (RBD) act out their dreams. They physically move limbs or even get up and engage in activities associated with waking. Some talk, shout, scream, hit, punch, or fly out of bed while sleeping! RBD is usually noticed when it causes danger to the sleeping person, their bed partner, or others they encounter. Sometimes ill effects such as injury to self or bed partner sustained while asleep trigger a diagnosis of RBD. The good news is that RBD can usually be treated successfully.