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Has your bed partner ever complained about you flailing, punching, or shouting out in your sleep? If it happens frequently, it may be the sign of an unusual sleep problem. You could have REM sleep behavior disorder.

Here’s what you need to know about this rare but serious condition.

What Is REM Sleep Behavior Disorder?

REM sleep behavior disorder is a type of parasomnia, or abnormal sleep behavior. It is a condition where you have sudden body movements — and sometimes loud exclamations — while you’re dreaming. It can be an early sign of neurological disorders like Parkinson’s disease or Lewy body dementia.

REM sleep behavior disorder happens during rapid eye movement, or REM sleep, when vivid dreams occur. REM sleep accounts for 20% to 25% of your sleeping hours, mostly during the second half of the night.

Although your eyes are moving and brain activity is high during REM sleep, your body is normally quiet. That’s because most of your muscles (except lungs, heart, and other internal organs) experience atonia, or temporary muscle paralysis.

If you have REM sleep behavior disorder, your muscles don’t get the message to remain still. They move in tandem with your brain activity. That means you physically act out your dreams, sometimes violently.

REM sleep behavior disorder is rare. It occurs in less than 1% of the population. It can occur in women and children but is most common in men over 50.

Is REM Sleep Behavior Disorder the Same as Sleepwalking?

REM sleep behavior disorder is not the same as sleepwalking. People who sleepwalk often have their eyes open and walk out of the bedroom. They may perform complex tasks like getting dressed while asleep.

People with REM sleep behavior disorder rarely open their eyes or leave the bedroom. While they’re having an episode, they don’t eat or drink. REM sleep behavior disorders don’t involve sexual activity or going to the bathroom.

Causes of REM Sleep Behavior Disorder

There are some drugs that cause REM sleep behavior disorder. They include different types of antidepressants. You can talk to your doctor about side effects of these medications.

But in many cases, doctors don’t know exactly what causes REM sleep behavior disorder. It often coexists with or precedes other brain-related conditions.

These conditions include:

• Lewy body dementia.
• Multiple system atrophy.
• Narcolepsy.
• Parkinson’s disease.
• Stroke.

Risk Factors for REM Sleep Behavior Disorder

Risk factors for developing REM sleep behavior disorder include:

• Being male.
• Being over 50.
• Having Lewy body dementia.
• Having multiple system atrophy.
• Having Parkinson’s disease.
• Using antidepressants.
• Using or going through withdrawal from drugs or alcohol.

You may have more than one sleep disorder. REM sleep behavior disorder sometimes occurs along with other sleep disorders, including:

• Narcolepsy— a disorder that affects the brain’s ability to control sleep-wake cycles. People with narcolepsy often have an uncontrollable urge to sleep during the day.
• Periodic limb movement disorder — repetitive jerking, cramping, or twitching of the lower legs during sleep.
• Sleep apnea — a condition where your airway gets blocked or narrowed. Breathing stops and starts many times while you sleep.

Symptoms of REM Sleep Behavior Disorder

You may not know you’re having symptoms of REM sleep behavior unless you fall out of bed or injure yourself. Your bed partner may bring your actions to your attention.

The symptoms of REM sleep behavior can include:

• Falling or leaping out of bed.
• Kicking, punching, flailing.
• Performing actions that match behavior in your dreams (such as throwing or kicking a ball).
• Sitting up in bed.
• Talking, yelling, or screaming.
• Violent movements of the arms and legs.

Diagnosing REM Sleep Behavior Disorder

If you or your bed partner notice any symptoms of REM sleep behavior disorder, you should see a sleep doctor right away. REM sleep behavior disorder can get worse with time. By ignoring it, you could put yourself and your bed partner in danger of physical injury.

A sleep doctor will ask you about your family and medical history. They will do a full physical exam to rule out other causes. They may refer you to a neurologist for tests on your brain.

You should tell your doctor if you ever had another sleep disorder. You should also be honest about any illicit drug or alcohol use. If you sleep with a partner, your doctor may ask them to describe your behavior when acting out dreams.

Your doctor may recommend an overnight sleep study, or polysomnogram. During the study, sensors monitor breathing, eye movements, arm and leg movements, brain and heart activity, and blood oxygen levels. Sleep clinic staff may videotape the study for future reference.

Your doctor may ask you to keep a sleep diary to keep track of your progress during treatment.

REM Sleep Behavior Disorder Treatment

Your doctor may recommend a combination of approaches to treat your REM sleep behavior disorder.

Medications

Your doctor may recommend medicine to treat your sleep disorder. Medicines include:

• Clonazepam — this prescription drug is often used to treat anxiety. It also reduces symptoms in many people with REM sleep behavior disorder. Side effects may include sleepiness, forgetfulness, impaired balance, and worsening of sleep apnea.
• Melatonin — this popular over-the-counter supplement signals that it’s time for your body to get ready for sleep. But the amount you need to treat REM sleep behavior disorder is different from the amount needed to help you fall asleep. Your doctor can help you choose the right dosage.

Injury prevention

It’s important to keep your environment safe. People with REM sleep behavior disorder are at risk for bruises, cuts, fractures, blunt trauma, and head trauma. If you sleep with a partner, you may want to sleep in separate bedrooms until your symptoms are under control.

To keep your bedroom safe, you should:

• Add padded bedrails to the side of the bed.
• Add padding or blankets to the floor.
• Move furniture, lamps, fans, and any clutter away from the bed.
• Pad the corners of furniture in the room.
• Remove any weapons from the bedroom.
• Remove sharp objects from the bedroom.

Lifestyle changes

Some small changes may help calm your REM sleep behavior disorder symptoms. Maintain good sleep habits, such as:

• Avoid alcohol and nicotine, especially before bedtime.
• Develop a calming bedtime routine (i.e., yoga, light stretching, or soft music).
• Don’t eat a big meal late in the evening.
• Go to bed and wake up at the same time every day, including weekends.
• Keep your bedroom cool and dark.
• Limit screen time before bed.