North Carolina Neurological Foundation (NCNF)

REM Sleep Behavior Disorder

REM sleep behavior disorder (RBD) is a parasomnia characterized by loss of normal muscle atonia during REM sleep, resulting in dream-enacting behaviors. Etiology includes neurodegenerative conditions such as Parkinson’s disease, synucleinopathies, medications, and idiopathic cases. Clinically, patients may exhibit shouting, punching, or complex movements during dreams, sometimes causing injury. Diagnosis involves polysomnography demonstrating REM sleep without atonia. Management includes safety precautions, melatonin or clonazepam therapy, and treatment of underlying neurological conditions if present.