The behavioral disorder in REM sleep is characterized by the loss of the muscular atony peculiar to paradoxical sleep and the abnormal, often violent, behaviors appearing during REM sleep and corresponding to the theme of the dream in progress (acting dreams).
Sometimes dangerous behavior
These behaviors can range from simple motor activities, talking, laughing, screaming, and swearing, to more complex, frequent activities such as slapping, punching, walking, catching the spouse and throwing him out of the house. Bed. These actions can lead to injuries to the patient or his wife, bruising, hematomas, lacerations, fractures, teeth breakage. Sometimes you can hurt your friend when she is sending good night messages to her friends by this disorder. Among the frequently encountered dream themes, vigorously defend your spouse against an attack by a person or animal or push her out of bed to avoid a flow of water. At the end of the episode the patient wakes up quickly, is immediately alert, and the memory of dream fits perfectly with the observed behavior. The frequency of the disorders is variable: once a week on average, they can occur in the most extreme cases between 3 and 4 times per night, for several consecutive nights. The aggressiveness of patients at the time of the disorder generally contrasts with their usual softness. The sleep recording of these subjects shows the intermittent or complete loss of muscle tone associated with excessive phasic muscle activity, and possibly an episode of the behavioral disorder occurring electively during a paradoxical sleep episode of the second part of sleep.
A paradoxical behavioral disorder predominantly male
Paradoxical behavior disorder affects men in 87% of cases and most often occurs after the age of 50. Disturbances in paradoxical, idiopathic and chronic sleep behavior are distinguished. The idiopathic disorder is that which occurs in the absence of any neurological disease or any other cause. It should be noted, however, that 30 to 65% of patients with the idiopathic form eventually develop a neurodegenerative disease. The secondary disorder itself recognizes two forms. The acute disorder is usually due to the withdrawal of a psychotropic substance, intoxication, taking an antidepressant drug. Chronic disorder may occur in the long term in connection with taking certain medications, in association with narcolepsy, with neurological disorders, cerebrovascular disease, and multiple sclerosis and especially in association with neurodegenerative diseases, Parkinson’s disease, Lowy body dementia, multi-system atrophy. The capital point, a behavioral disorder in REM sleep can precede more than ten years after the outbreak of neurodegenerative disease.
What treatment for these disorders?
The treatment of these disorders focuses on two aspects: behavioral and pharmacological. It is first of all necessary to protect the sleeper suffering from these disorders by limiting the risk of injury: place the mattress on the floor for example, or remove dangerous objects from the bedroom. As for drug treatment, it is clonazepam which is usually quickly effective. However, it must be known that it can be insufficient or ineffective in approximately 10% of patients or be responsible for side effects, such as falls or confusion, hence the need for alternative treatments In this sense, it is possible to resort to melatonin, product likely to improve the condition of some patients Last point: Regularly follow the patient with behavioral disorder in REM sleep to detect early onset neurodegenerative disease.