What is REM sleep?

Good sleep is very important for maintaining health. Most of us experience sleeping issues at some point of time in life. This may be temporary and caused due to travel, ailments, mental stress or hurdles that change the normal routines. Yet many people experience long term difficulties in falling asleep as they struggle with sleep disorders. These disorders are conditions that affect an individual’s ability to sleep regularly and peacefully for getting sufficient rest.

Prolonged sleeping problems must be scrutinized for any underlying medical conditions by consulting an ENT doctor (ENT-Ear Nose Throat). Diagnosis may be done by undertaking sleep studies to identify the cause of sleep disturbances in a Sleep Laboratory at an ENT Hospital which is also usually equipped with an Audiology Lab. Commonly diagnosed sleep disorders include snoring, sleep apnea and REM sleep Behavioural Disorder (RBD).

Let us discuss REM sleep and RBD here.

REM sleep (Paradoxical/Desynchronized Sleep)

During sleep, the brain transits through five distinct stages. One of them is Rapid Eye movement (REM) sleep which occurs at intervals during the night. This phase is characterised by vivid dreaming, lower muscle tone, faster pulse rates and breathing. The skeletal muscles appear to be paralyzed. The other four phases are termed as Non-REM (NREM) sleep. During REM sleep, the behaviour of the brain and body is very different than those during other sleep phases.

There are physiological similarities to the waking phase in REM sleep with rapid, low-voltage and desynchronized brain waves. This cycle is typically characterized by an abundance of a neurotransmitter called acetylcholine and almost a near absence of other mono amine neurotransmitters like histamine, serotonin, and nor epinephrine.

RBD is a type of sleep disorder that involves unusual actions or behaviours during the REM phase. Here strange or dangerous events occur that disturb or intrude sleep. Other related manifestations include nocturnal dissociative disorder and walking, talking or terrors in sleep. People with this order don’t experience the temporary muscle paralysis as in REM cycle. These are either incomplete or may be completely absent. So, the person with RBD physically enacts his dreams, sometimes in dramatic or violent ways.

RBD Symptoms:

• Physical agitation, active movement of limbs, getting up and executing actions of ‘wakefulness’
• Talking, shouting, screaming, hitting or punching during sleep.
• Injury of self or bed-partners
• Making violent movements while witnessing frightened dreams

Common Causes for RBD:

• Degenerative neurological diseases including Parkinson’s Disease, Dementia, Multiple System Atrophy, Shy-Drager syndrome and Narcolepsy
• Cognitive problems, stress, anxiety, executive functioning disorders, low attention scores, apathy
• Reaction to certain drugs or sudden withdrawal of some medications
• Sleep Apnea also affects REM memory and REM Sleep

RBD Treatment:

Medication:

• Most RBD cases are treated by drugs like low doses of Clonazepam that suppresses the muscular activity and relaxes the body during the sleep duration. However, this drug must be with caution patients with Dementia, Gait Disorders and Obstructive Sleep Apnea. OSA requires sleep apnea treatment that may involve lifestyle changes or using treatment options like Airway Therapy, Surgery or Oral Appliances.
• Patients not responding to Clonazepam may be treated with anti-depressants or melatonin for reducing violent behaviour.

Improving Sleeping Habits:

• Adopting healthy sleep patterns for ensuring predictable sleep-wake cycles, reducing sleep deprivation and avoiding alcohol consumption helps in RBD Treatment. Other strategies for safe sleeping include
• Using a floor mattress with cushions all around
• Installing padded bedrails for avoiding  injuries
• Sleeping on the floor(for RBD sleep walkers)
• Not keeping furniture and sharp objects near the bed
• Removing dangerous objects from the bedroom

Thus RBD may be successfully handled by ENT treatment by usage of appropriate medication and adoption of healthy sleeping habits.