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REM Sleep Disorder And Parkinson’s Disease: What You Need to Know

REM sleep disorder and Parkinson's: image of an African American man sleeping with medication on his nightstand

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Table of Contents

Imagine having a frightening dream, only to wake up and find you’ve actually jumped out of bed. This is a reality for many individuals living with REM Sleep Behavior Disorder (RBD), a condition where the body acts out vivid dreams during sleep. 

Though it may not be obvious, there is an interesting link between REM Sleep Disorder and Parkinson’s Disease. 

PD, a common disorder that affects movement and coordination, can lead to tremors, stiffness, and difficulty with balance and walking. Research suggests that changes in the brain associated with PD also impact sleep regulation, making RBD a potential early warning sign for Parkinson’s. 

Understanding this connection can be crucial for early diagnosis and better management of both conditions.  In this article, we’ll explore the link between these two conditions, and how to recognize RBD before it becomes a problem.

What is REM Sleep Behavior Disorder?

In a normal REM sleep cycle, your body undergoes muscle paralysis that keeps your body still and safe, even when you’re having a scary dream.

Those living with RBD act out their dreams due to a lack of muscle paralysis that normally occurs during Rapid Eye Movement (REM) sleep.  This can result in vivid dreams and sometimes intense physical reactions.1,2

For example, you might dream of being in a fight and, as a result, begin physically moving your arms and legs, resulting in a punch to the wall or, worse, your partner. 

These actions are not voluntary and can even be dangerous. They can result in bruises, cuts, or falls for both the affected individual and their bed partner and generally disrupted sleep for both people. 

A Primer on Parkinson’s Disease

Parkinson’s Disease is a neurodegenerative disorder primarily known for its motor symptoms, including tremors, muscle stiffness, and slow movements—also known as bradykinesia

However, it also involves a range of non-motor symptoms, such as sleep disturbances, cognitive decline, mood changes, and autonomic dysfunctions. 

For instance, a person with PD might experience difficulty initiating movement, combined with sleep issues like insomnia or excessive daytime sleepiness.

How Are RBD and PD Connected?

RBD can often be an early indicator of PD, which can help with early identification and diagnosis of PD. 

Studies estimate that up to 70% of people with RBD will eventually develop Parkinson’s or other neurodegenerative disorders.

This connection makes RBD a crucial early warning sign for Parkinson’s Disease. For example, a study found that individuals diagnosed with RBD were at a higher risk of developing Parkinson’s Disease, with the average time between RBD diagnosis and PD onset being approximately fourteen years.2

Early detection is critical; it opens the door to timely interventions that can slow the progression of Parkinson’s and improve the quality of life for those affected. 

Recognizing RBD as a precursor allows healthcare professionals to monitor patients closely for the development of Parkinson’s, ensuring they receive appropriate care as early as possible. 

Why Does RBD Occur Alongside PD?

REM sleep disorder and Parkinson's: a couple gazes out the window contemplatively after a diagnosis

The brain changes associated with Parkinson’s Disease (PD), particularly the loss of dopamine-producing cells, affect areas responsible for controlling both movement and sleep. 

Dopamine plays a crucial role in coordinating smooth muscle movements and maintaining the normal sleep-wake cycle. When these dopamine-producing cells degenerate, as is the case in PD, disruptions in both motor control and sleep regulation can occur.

This helps explain why many individuals with PD also develop RBD. RBD is believed to result from dysfunction in the brainstem structures (where dopamine is created) responsible for suppressing muscle activity during REM sleep.

Research has shown that RBD is more frequently observed in people with non-motor PD symptoms such as depression and fatigue.3 

The timing of RBD onset relative to the motor symptoms of PD varies, but RBD typically precedes the onset of motor symptoms when Parkinsonism develops after the age of 50. 

This temporal relationship underscores RBD’s potential role as an early indicator of PD, providing a valuable window for early intervention and diagnosis in some cases.1

Recognizing the Symptoms and Getting Diagnosed

Identifying RBD often relies on reports from sleeping partners who observe the person acting out their dreams.  Those with RBD may not always be aware of their movements during sleep, which can include anything from minor twitching to more dramatic actions like punching or kicking. 

These behaviors can be alarming and even dangerous, as they can lead to injuries for both the person experiencing RBD and the person sleeping in bed with them.

Diagnosis typically involves a thorough medical evaluation and a sleep study. This comprehensive test monitors various physiological parameters during sleep, including brain waves, blood oxygen levels, heart rate, breathing, and eye and leg movements. 

For instance, during a sleep study, a person might be monitored overnight in a sleep lab where these metrics are recorded to capture and confirm the abnormal behaviors associated with RBD.

The sleep study provides crucial insights into the sleep patterns and disturbances that characterize RBD. By analyzing the data collected, sleep specialists can differentiate RBD from other sleep disorders like sleep apnea.

The detailed information from a sleep study not only aids in the accurate diagnosis of RBD but also helps in formulating an effective treatment plan.1,3

Identifying and diagnosing RBD can precede the onset of Parkinson’s by several years. Early diagnosis through a sleep study can serve as a significant step in monitoring and managing potential future health concerns, especially for Parkinson’s.

Managing and Treating RBD for Parkinson’s Patients

REM sleep disorder and Parkinson's: a happy group of seniors at a support group gathering

Managing RBD not only improves sleep quality but also plays a crucial role in potentially delaying the progression of Parkinson’s Disease.

Ensuring safety is the first step in managing RBD. This involves creating a safe sleep environment by removing potentially dangerous objects from the bedroom and padding furniture corners to prevent injury during episodes of movement.

Medication & Supplements

Medication plays a crucial role in managing RBD symptoms. One commonly prescribed medication is clonazepam, a long-acting benzodiazepine. 

Clonazepam helps to reduce the physical activities associated with RBD by calming the central nervous system. It has been shown to effectively decrease the intensity and frequency of dream enactment episodes.

In addition to clonazepam, melatonin is another commonly recommended supplement for RBD. Melatonin is a hormone that regulates sleep-wake cycles.  It can help improve sleep quality and reduce the occurrence of disruptive behaviors during sleep. 

Melatonin has been shown to enhance sleep continuity, limiting the abnormal movements characteristic of RBD.1

Regular follow-ups with healthcare providers are essential for individuals managing both RBD and Parkinson’s Disease. These appointments allow for ongoing assessment of symptoms, adjustment of medications as needed, and monitoring of overall health and well-being. 

Living with RBD and PD

Both conditions present daily challenges, especially regarding sleep disturbances and the daytime sleepiness that follows. 

RBD often leads to fragmented sleep patterns and increased vulnerability to injuries. Coupled with the motor and non-motor symptoms of PD, such as tremors, stiffness, and cognitive changes, individuals face a complex array of challenges that affect their daily lives.

The Role of Caregivers

As with many neurological conditions, a strong support system is vital. Caregivers and support groups provide invaluable assistance in managing the practical aspects of daily life and offering emotional support. 

Caregivers play a pivotal role in ensuring safety during episodes of RBD and assisting with medication management and daily activities. They provide a sense of security and stability, which is essential when facing the uncertainties of these neurodegenerative conditions.

Support Groups

Support groups also offer a vital lifeline for individuals and their caregivers. By connecting with others who understand their experiences firsthand, individuals can share coping strategies, exchange practical advice, and find solace in knowing they are not alone in their journey. 

For instance, joining a local support group can provide insights into effective sleep hygiene practices, tips for managing medication schedules, and strategies for improving overall quality of life.

While an RBD or Parkinson’s Diagnosis can be quite overwhelming, support is available.  If you’re unsure about where to find these resources, talk to your doctor or another qualified healthcare provider.

Key Takeaways

  • REM Sleep Behavior Disorder (RBD) causes individuals to act out vivid dreams during sleep due to a lack of muscle paralysis, which can result in potentially dangerous physical reactions.
  • Parkinson’s Disease (PD) is a neurodegenerative disorder known for its motor symptoms like tremors and stiffness, but it also affects sleep and can lead to RBD.
  • There is a significant link between RBD and PD, with research suggesting that up to 70% of people with RBD will eventually develop Parkinson’s or other neurodegenerative disorders.
  • RBD often precedes the onset of PD by several years, making it a crucial early warning sign for the disease and allowing for earlier intervention and better management.
  • Symptoms of RBD include acting out dreams with physical movements, which can lead to injuries for both the individual and their sleeping partner.
  • Diagnosis of RBD typically involves a thorough medical evaluation and a sleep study to monitor various physiological parameters during sleep.
  • Managing RBD involves ensuring a safe sleep environment and using medications like clonazepam and melatonin to reduce dream enactment behaviors and improve sleep quality.
  • Regular follow-ups with healthcare providers are essential for individuals managing both RBD and PD to adjust treatments and monitor overall health.
  • A strong support system, including caregivers and support groups, is vital for managing the daily challenges associated with RBD and PD. It provides practical assistance and emotional support.


  1. Diaconu, Ș., Falup-Pecurariu, O., Țînț, D., & Falup-Pecurariu, C. (2021). REM sleep behaviour disorder in Parkinson’s disease (Review). Experimental and therapeutic medicine, 22(2), 812. https://doi.org/10.3892/etm.2021.10244
  2. Schenck, C. H., & Mahowald, M. W. (2002). REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep, 25(2), 120–138. https://doi.org/10.1093/sleep/25.2.120
  3. Neikrug, A. B., Avanzino, J. A., Liu, L., Maglione, J. E., Natarajan, L., Corey-Bloom, J., Palmer, B. W., Loredo, J. S., & Ancoli-Israel, S. (2014). Parkinson’s disease and REM sleep behavior disorder result in increased non-motor symptoms. Sleep medicine, 15(8), 959–966. https://doi.org/10.1016/j.sleep.2014.04.009