It is known by many that dreaming tends to occur during REM sleep. What many people do not realize however, is that when we are in REM sleep our bodies are paralyzed so that we will not act out our dreams. It is a good thing that this happens because it allows us to remain peacefully in our beds as our dream plays out.

For some people however, their bodies are not paralyzed during REM sleep and they do act out their dreams. This is called REM Behaviour Disorder. It is often very dangerous and the individual with the disorder will usually injure themself. In one case study, we once saw a patient who dreamed that he was playing baseball. As he slid into home plate in his dream, he actually dove into his dresser head first in his bedroom. He immediately awoke in a pool of blood and ended up with about 39 stitches across his head.

People with REM Behaviour Disorder are often known to hurt their bedpartners. They have punched them, grabbed them, kicked them and even tried to strangle them. It is the bedpartner who is usually the first to notice these unsettling behaviours. The person with the disorder often has no recollection of the event in the morning. They may wake up in the morning with their feet on the pillow and their blankets in a mess, yet they do not remember how they got that way.

REM Behaviour Disorder is not the same thing as sleepwalking. Sleepwalking is most common in children and occurs during the deepest stages of sleep, stages 3 & 4, usually in the first-third of the night. Our bodies are not paralyzed during 3 & 4 and that is why we are able to get up and walk around. There is usually no dream recall when someone sleepwalks. With REM Behaviour Disorder on the other hand, there is associated dream recall. It occurs during REM sleep. REM is most prominent in the second half of the night. REM Behaviour Disorder is most common in elderly individuals, particularly males over the age of 60.

Some common themes that have been reported by REM Behaviour Disorder sufferers are dreams of fishing, shoveling snow, delivering a speech, and running away from something. Behaviours noted by bedpartners are talking, laughing, singing, chanting, reaching, yelling, jumping, swearing, sitting up, flailing the arms and kicking the legs. Imagine lying next to someone with REM Behaviour Disorder who was dreaming they were boxing, suddenly you are the opponent.

It is important to note that although they can be violent in their sleep, REM Behaviour Disorder sufferers are not usually violent individuals. The behaviours exhibited during sleep often conflict with the personality characteristics of the individual in their daily life.

Someone who suspects that they have this disorder should be referred to a sleep lab for proper diagnosis and treatment. Often times there is a disorder of the central nervous system involved which will need further investigation. There are medications which can help by inhibiting muscle activity during REM sleep. In the meantime, there are other precautions which one should take. It is important that the environment be secure. Try to move objects away from the bedside. Perhaps place a mattress on the floor next to the bed to help cushion any falls. Bedpartners should consider sleeping in another room for their own safety. Restraints have sometimes been used. Patients have used belts and/or rope to tie themselves into the bed. Still however, many manage to escape these restraints upon acting out their dreams.

A Typical Case study:

A Patient came to a local sleep laboratory because he was keeping his family awake all night with shouting and acting out his dreams. His wife was forced to sleep in a different room not only so she could get some sleep, but also because she feared for her own safety. The patient managed to fall out of bed on a nightly basis, often injuring himself in the process. He was a war veteran and would often dream he was trying to avoid enemy attack. Thinking that it would help, he purchased a hospital bed with railings. Still he managed to climb out over top of the railings and fall to the floor.

The patient then had to resort to sleeping on a mattress on the floor. When he was monitored in the sleep lab during overnight testing, and he entered REM sleep, muscle tone activity was detected when it should have been absent. Talking, laughing, shouting, flailing of the arms and kicking of the legs were all observed. He nearly fell head first out of the bed on several occasions. The patient has been prescribed a medication which will make his muscles relax during REM sleep so that he will no longer act out his dreams. To update, the patient is now doing fine and is sleeping in his own bed again.