Rapid Eye Movement Sleep Behavior Disorder

Rapid Eye Movement Sleep Behavior Disorder

Rapid eye movement sleep behavior disorder is a sleep disorder where the person vividly acts out physically during sleep and it is often accompanied by dreams, vocal and sudden sounds, and violent movement of arms and legs while sleeping (Zahng et al, 2016). This discussion will focus on diagnostic criteria of REM sleep behavior disorder and the psychotherapy and psychopharmacologic treatment. Rapid Eye Movement Sleep Behavior Disorder

Diagnostic Criteria of Rapid Eye Movement Sleep Behavior Disorder

According to the DSM-5 criteria, the REM sleep behavior disorder is characterized by the following clinical features: frequent episodes of arousal while asleep accompanied by vocalization and serious motor behaviors that occur during sleep; the person wakes up from these episodes with total confusion, disorientation while completely alert; Rapid eye movement sleep without atonia and a confirmed synucleinopathy diagnosis; the REM sleep behavior disorder episodes result in significant distress and significantly impairs social, work or any other functionality and may encompass serious self-injury; the sleep disturbance is not caused by medication or substance abuse; and the episodes are not attributable to any other medical condition or psychiatric disorder (Zahng et al, 2016). Rapid Eye Movement Sleep Behavior Disorder

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Psychotherapy Treatment

So far there has been no effective psychotherapy for the treatment of REM sleep behavior disorder. Nonetheless, controlling environmental safety has been shown to be an effective intervention in the management of this sleep disorder. Therefore, patients and their families should be educated on the importance of removing potentially dangerous objects from the bedroom, window protection, positioning mattresses on the flow and also putting cushions around the bed (Galbiati et al, 2015). These interventions are particularly effective in protecting patients from injuries during episodes of REM sleep behavior disorder.

Pharmacological Treatment

Melatonin: Melatonin is recommended for REM sleep disorder due to its efficacy and also because the medication has few side effects and hence well tolerable. Melatonin treats REM sleep disorder by promoting sleep and has also been shown to help in treating an underlying disorder of desynchronization. According to McGrane et al (2015) melatonin works by directly impacting REM sleep atonia, modulating GABAergic inhibition, desynchronization, improving the efficiency of sleep, and stabilization of circadian clock variability. Melatonin has also been demonstrated to be effective in reducing REM motor behaviors and restoration of REM muscle atonia (McGrane et al, 2015).

Referral of the Client to a Specialist

Clients with REM sleep disorder who are not responding to the melatonin or clonazepam should be referred to a sleep specialist for further management and to rule of other complication such as nocturnal seizures, confusional arousals, or conditions that can exacerbate dream enactment (McCarter & Howell, 2016). A movement disorder specialist can also conduct a comprehensive neurological assessment in order to identify any motor dysfunction. In addition, a neurology referral can be very important for symptomatic management such as acetylcholinesterase inhibitors for cognitive impairment, as well as for commencement of prognostic psychotherapy and neuroprotective treatments and for patients with REM sleep disorder who are at risk of developing the neurodegenerative disease (McCarter & Howell, 2016).  Rapid Eye Movement Sleep Behavior Disorder

References

Galbiati A, Rinaldi F, Giora E, Luigi F & Sara M. (2015). Behavioral and Cognitive-Behavioural Treatments of Parasomnias. Behavioral Neurology. 1(8), 1-8.

McGrane I, Leung J, Louis E & Boeve B. (2015). Melatonin Therapy for REM Sleep Behavior Disorder: A Critical Review of Evidence. Sleep Med.  16(1): 19–26.

McCarter S & Howell M. (2016). Importance of Rapid Eye Movement Sleep Behavior Disorder to the Primary Care Physician. Mayo Proceedings. 91(100), 1460–1466.

Zahng H, Chen J, Yang Z, Fu Y, Shen Y, Mao J & Liu C. (2016). Rapid Eye Movement Sleep Behavior Disorder Symptoms Correlate with Domains of Cognitive Impairment in Parkinson’s Disease. Chin Med J (Engl). 129(4), 379–385. Rapid Eye Movement Sleep Behavior Disorder