Rapid Eye Movement (REM) Sleep Behavior Disorder: A Sleep Disturbance Affecting Mainly Older Men

By Oksenberg, Arie; Radwan, Hendryk et al. | The Israel Journal of Psychiatry and Related Sciences, January 1, 2002 | Go to article overview

Rapid Eye Movement (REM) Sleep Behavior Disorder: A Sleep Disturbance Affecting Mainly Older Men


Oksenberg, Arie, Radwan, Hendryk, Arons, Elena, Hoffenbach, Dalia, Behroozi, Bezalel, The Israel Journal of Psychiatry and Related Sciences


Abstract: Rapid Eye Movement (REM) sleep behavior disorder is characterized by the intermittent loss of REM-related muscle atonia and the appearance of elaborated motor behaviors (sometimes violent behavior) and vocalizations associated with dream mentation. Nine patients were diagnosed in our Sleep Disorders Unit with this syndrome during the period August 1997-April 2000. All were male, average age 67.9+/-6.9 years. The complaint of all our patients was the occurrence of violent or injurious sleep behavior mainly during the dream stage. Jumping or falling out of bed and slapping or beating their wives were more common. None had history or showed signs of dementia, Parkinson or other neurodegenerative diseases. A relative high amount of SWS (20.9%) was found. Seven showed an intermittent increase in chin EMG tonus while the other two had an almost continuous high chin EMG tonus during REM sleep. We did not observe any violent motor behavior during the polysomnographic recordings. Phasic activities during REM sleep were high but density quantification was not performed. Six patients had also Periodic Limb Movement (PLM) Disorders, four had also Obstructive Sleep Apnea (OS A) Syndrome. The treatment recommended to all patients was Clonazepam beginning with a 0.5-mg dose. Four patients reported a decrease or disappearance of sleep agitation and nightmares and were very happy with the treatment and without side effects. The others decided not to try Clonazepam or stopped after a few days of using it. RBD appears to be a sleep disturbance affecting mainly aged men. Its violent expression may frighten the patients and their bed-partners and may cause injury to both. In some cases this sleep disorder seems to be an early manifestation of a neurodegenerative disorder while in others it may represent only an idiopathic form. Clonazepam at lower doses is a good agent for the treatment of this condition.

One of the main distinctive features that characterize Rapid Eye Movement (REM) sleep is the generalized atonia of antigravity muscles. This atonia is a consequence of an active inhibitory mechanism of motor activity by pontine areas located in the peri-locus coeruleus region. This area exerts an excitatory influence on the nucleus reticularis magnocellularis of the medulla via the lateral tegmentoreticular tract, and the nucleus reticularis magnocellularis, in turn, hyperpolarizes spinal motoneurons postsynaptic membrane via the ventrolateral reticulospinal tract (1). Normally, this atonia of REM sleep is interrupted by fast excitatory inputs producing muscle jerks and twitches which together with the rapid eye movements represent the main phasic components of this sleep stage in humans (2).

Bilateral lesions in the pontine tegmentum in the cat result in a persistent absence of this REM sleep atonia and prominent motor activity during REM sleep (3). Loss of REM sleep atonia has been shown to be necessary but not sufficient for the expression of complex behavior during REM sleep. The site of the lesion will define whether the cat will show only the absence of REM atonia or will also present a range of complex behaviors during REM sleep (4).

Rapid Eye Movement sleep behavior disorder (RBD) is characterized by the intermittent loss of electromyographic (EMG) atonia and by the appearance of elaborate motor activity associated with dream mentation. This disorder was first formally described in 1986 by Schenck et al. (5), although ten years earlier Japanese researchers, describing a disorder with similar characteristics associated with alcohol withdrawal, used the term "stage 1 - REM with tonic EMG" (6). This represents the acute form of the disorder and has been also documented in association with the use of several medications (7). The chronic form of this disorder is either idiopathic or associated with neurological disorders. The idiophatic category is observed in those patients whose RBD is not associated with psycho-- pathological or detectable neuro-- pathological disorder. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Rapid Eye Movement (REM) Sleep Behavior Disorder: A Sleep Disturbance Affecting Mainly Older Men
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.