When we sleep, the body's muscles naturally relax, and we are not aware of what is happening around us or responding to environmental stimuli. However, a person may experience a type of disorder during sleep, although rare, but not random. This disorder is known as rapid eye movement disorder, which is characterized by the appearance of abnormal movements. The actions that occur during this stage are known as "REM", where dreams are very vivid. An important characteristic of this stage is that the body is in a state of activity rather than relaxation, which leads to an automatic response with a number of motor reactions associated with dreams. In this article,  Dalili Medical, we will review the factors that cause rapid eye movement disorder during sleep.

Who are most at risk of developing REM sleep disorder?

There are some factors that may increase the risk of developing this disorder, including:

**Gender and age:**Men over the age of 50 are more likely to develop this disorder, but recently, cases of women being diagnosed with this disorder have increased, especially those under the age of 50.

**Having a neurodegenerative disorder:*

Such as stroke, Parkinson's disease, or dementia.

Taking certain medications:

Such as antidepressants, alcohol, or drugs.

Some environmental or personal factors:

Such as smoking, exposure to pesticides, or a head injury.

Having a chronic sleep disorder:

Such as narcolepsy, which causes excessive daytime sleepiness, or sleep apnea, which causes frequent pauses in breathing during sleep at night.

People with periodic limb movement disorder:

This condition is a condition in which a person experiences repeated twitches or jerks in the legs during sleep.

What is REM sleep behavior disorder?

REM sleep behavior disorder is a type of sleep disorder that involves abnormal movements and behaviors during the rapid eye movement stage. During this stage, the body is usually in a relaxed state, with the muscles essentially paralyzed. However, in individuals with this disorder, muscle paralysis is incomplete or absent, allowing them to actually express their dreams.

**Causes of REM sleep behavior disorder**

The exact causes of REM sleep behavior disorder are still unclear. However, several factors are thought to contribute to its development:

. **Neurological disorders**: This disorder is often associated with neurological conditions such as Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy.

. **Medications**: Certain medications, especially those that affect the central nervous system, can cause symptoms of REM sleep behavior disorder.

. **Withdrawal**: Withdrawal from alcohol or sedative-hypnotic medications can worsen REM sleep behavior disorder.

. **Idiopathic**: In some cases, this disorder occurs for no apparent reason, and is known as idiopathic REM sleep behavior disorder.

**Genetic factors** It has also been found that the genetic factor that is linked to certain genes passed from parents to children can interfere with the occurrence of this sleep disorder, which makes the person at risk of developing it, which increases the confirmation that heredity is a fundamental component of rapid eye movement sleep behavior disorder.

**Symptoms of rapid eye movement sleep behavior disorder**

 

The symptoms of rapid eye movement sleep behavior disorder vary in severity and frequency. Common symptoms include the following:

- **Voicing**: People may talk, scream, or even shout during their sleep, and these sounds often reflect the content of their dreams.

- **Physical movements**: Movements range from mild muscle spasms to strong actions such as punching, kicking, or jumping out of bed.

- **Dream acting**: Since the body is not paralyzed, individuals may act out what happens in their dreams, which may lead to dangerous situations for them or their bed partners.

**Injuries**: Both the person suffering from rapid eye movement sleep behavior disorder and their bed partner are at risk of injury due to the physical nature of this disorder.

**Diagnosis of REM sleep behavior disorder**

 

Diagnosis of REM sleep behavior disorder requires a comprehensive evaluation, including a detailed medical history and specific diagnoses. Diagnostic tests include:

**Medical history and sleep diary**A comprehensive medical history is essential in diagnosing REM sleep behavior disorder. Patients may be asked to keep a sleep diary to document their sleep patterns and behaviors, as well as any episodes of dream enactment or injury.

**Sleep study**A sleep study, or polysomnography, is an important diagnostic tool for REM sleep behavior disorder. This overnight test monitors a range of physiological parameters, such as brain activity, eye movements, muscle activity, heart rate, and breathing. The absence of REM sleep tortuosity and the presence of abnormal behaviors during REM sleep indicate a disorder at this stage.

**Differential diagnosis**: It is important to distinguish REM sleep behavior disorder from other types of sleep disorders, such as sleepwalking, nightmares, or night terrors. This often requires the expertise of a sleep specialist.

***REM Sleep Behavior Disorder vs. Sleepwalking***

 

Although both REM sleep behavior disorder and sleepwalking involve abnormal movements during sleep, there are significant differences between them in terms of symptoms and underlying mechanisms.

Sleep stage: REM sleep behavior disorder (RBD) occurs during the REM stage of sleep, while sleepwalking typically occurs during non-REM sleep (NREM).

Awareness: OftenPeople with REM sleep behavior disorder are aware of their actions and can remember their dreams, while people who sleepwalk are not aware of their actions and do not remember them.

Behavior: Sleepwalking involves complex, often violent, dreamlike behaviors, while sleepwalking behaviors are usually more benign and routine, such as walking or performing simple tasks.

When should you see a doctor?

 

Be sure to see a doctor right away if you notice any of the following symptoms, so that they can diagnose and treat REM sleep behavior. These symptoms include some unusual behaviors during sleep, such as:

- Screaming

- Talking

- Punching

- Sleepwalking

- Kicking

- Physical abuse

- Cursing

**How ​​to prolong REM sleep**

 

To understand how to prolong REM sleep, you must first understand the stages of sleep. Sleep consists of four stages, with the fourth and final stage being REM sleep. To increase the duration of this stage of your sleep, it is essential to allow your mind and body to gradually move through the first three stages. Adhering to a regular sleep schedule and healthy sleep habits will help you achieve this.

. **Stage 1:** This is the transition to sleep stage and lasts about five minutes. During this stage, your eyes move slowly and your eyelids are closed, and your muscle activity slows down, making it easy to wake you up with noises or sounds.

. **Stage 2:** This stage represents the beginning of actual sleep and lasts from 10 to 25 minutes. During this stage, your eye movement stops completely, your heart rate slows, and your body temperature drops.

. **Stage 3:** This stage is the beginning of deep sleep, where it becomes difficult to wake you up. If you do wake up, you may feel confused and distracted for a few minutes. During this stage, your brain waves are very slow, and blood flow is directed away from the brain to the muscles, giving your body the energy it needs.

**Stage 4:** The final stage of sleep is the rapid eye movement (REM) stage, also known as dream sleep. This stage occurs about 70 to 90 minutes after you start falling asleep. During this stage, you may notice that your eyes move rapidly while your breathing slows, and your heart rate and blood pressure may increase. Your arms and legs are also paralyzed during this period.

It is worth noting that nighttime sleep follows a certain pattern, as it alternates between deep sleep and REM sleep. Each sleep cycle lasts about 90 minutes and occurs about four to six times during the night. As the night progresses, the length of each stage changes; most of the deep sleep occurs in the first half, while the REM sleep period increases in the second half.

** Maintain a regular sleep schedule: ** It is important to establish a sleep schedule that allows you to go to sleep and wake up at the same time every day. It is recommended to get seven to nine hours of sleep on average. Sticking to a regular sleep schedule will help you enjoy longer periods of REM sleep as you move between the stages of the sleep cycle several times during your sleep period. Some people believe that cutting back on one hour of sleep will not affect their performance during the day, or that they can make up for the lack of sleep on the weekend or a rest day. But the reality is that this is not the case. Any changes to your regular sleep schedule will have a negative impact on your sleep habits, and may result in less deep sleep or REM sleep.

The myth that the body can quickly adapt to changing sleep schedules is not true. While most people can reset their biological clock, this requires gradual and systematic changes, preferably between one and two hours per day. Keep in mind that it can take more than a week for your internal clock to adjust to traveling across time zones or moving to the evening.

** Turn off all electronics and distractions several hours before bed. Turn off your TV, smartphone, tablet, and computer, or even better, remove them from your bedroom. The type of light emitted by these screens can stimulate your mind, suppress the secretion of melatonin (which helps with REM sleep), and interfere with your internal body clock.

Another option is to set a time when your computer is turned off. This will automatically turn off your computer and prevent you from working on it too late or too close to your bedtime. There are sleep-related features on PCs and Macs that you can turn on. Also, if you want your computer to be ready to go when you wake up in the morning, you can set a turn-on time.

** Keep your bedroom dark, cool, and quiet.** Use heavy curtains or dark shades to block out light from the windows. Cover any electronic devices that are on, such as a TV or computer, so they don’t light up the room. You can also use a sleep mask to cover your eyes and create a dark environment that helps you relax and sleep.

If you have trouble sleeping due to outside noise or someone else’s annoying voices, consider investing in earplugs or a noise-cancelling device.

** Avoid caffeine or alcohol for four to six hours before bed.** About half of the caffeine you consume at 7 p.m. will be in your system until 11 p.m. Caffeine is a well-known stimulant that can disrupt REM sleep. It's found in coffee, chocolate, soft drinks, non-herbal teas, and some appetite suppressants and pain relievers. Try to limit the number of cups of coffee you drink before bed, or eliminate caffeine from your diet altogether.

Alcohol also inhibits deep sleep and REM sleep, keeping you in the lighter stages of sleep and making it harder to fall back asleep if you wake up. So, avoid drinking alcohol several hours before bed.

Try to go to bed 30 minutes earlier than usual. The REM period isREM sleep is longer in the morning, so it’s helpful to increase the duration of this stage by adding an extra 30 minutes of sleep. Adjust your bedtime so that you go to bed 30 minutes earlier than usual, and stick to this change every night.

Always be consistent with your sleep schedule adjustments, because you need to get enough of each sleep stage, especially deep sleep, to improve the quality of your REM sleep. If you don’t get enough deep sleep at night, your body may try to make up for it the next night at the expense of REM sleep.

**Use treatments and exercises**

 

Speak to your doctor about taking melatonin to improve your REM sleep. Recent research has shown that taking melatonin supplements at a dose of about 3 mg per day can enhance your REM sleep and help you stay in this stage of the sleep cycle longer. Your doctor may recommend a melatonin supplement, which usually comes in tablet form, and determine the right dose for your body.

Melatonin is also beneficial for older adults and people who work late night shifts, as it can help regulate your sleep cycle and improve your overall health.

Be wary of over-the-counter medications, as they can disrupt REM sleep. Many of these medications have side effects that can negatively impact your sleep patterns and daytime alertness. Medications that can negatively impact REM sleep include:

Nasal decongestants include:

- Aspirin and other headache relievers.

- Pain relievers that contain caffeine.

- Cold and allergy medications that contain antihistamines.

- Some appetite suppressants and antidepressants.

If you are taking any of these medications, try reducing your dose or looking for alternatives to treat these problems, which will allow you to stop taking these over-the-counter medications.

Make sure to exercise for at least 20 to 30 minutes a day. Studies have shown that regular exercise improves sleep quality and helps prolong the REM stage of sleep. However, you should avoid exercising close to bedtime, as it can negatively impact your sleep schedule. It is best to exercise five to six hours before bedtime.