“Rapid Eye Movement Sleep Disorder”
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Powerful Sleep aid book: Rapid eye movement sleep is recurring sleep state during which dreaming occurs.
Sleep is a periodic state of rest during which consciousness of the world is suspended.
The most significant characteristic of sleep, which differentiates it from the waking state, is the interruption of perception; a sleeping person does not see or hear.
Additionally, sleep is marked by:
Slowed-down metabolism,
Active and complex brain wave patterns and
Decreased movement of the skeletal muscles.
What are the stages of sleep?
Normal sleep has 2 distinct states: non–rapid eye movement (NREM) and rapid eye movement sleep (REM sleep). There are five stages of sleep: stages 1, 2, 3, 4 and Rapid eye movement (REM sleep).
NREM sleep is divided into 4 stages. These stages progress in a cycle from stage 1 to Rapid eye movement sleep, then the cycle starts over again with stage 1. Each stage represents a different physical and mental state of the body during sleep.
During some stages, the body is in a lighter sleep and can be awakened more easily, while others indicate a very deep sleep.
We spend almost 50 percent of our total sleep time in stage 2 sleep, about 20 percent in Rapid eye movement sleep, and the remaining 30 percent in the other stages.
Infants, by contrast, spend about half of their sleep time in Rapid eye movement sleep.
The descriptions of five sleep stages are:
Stage 1 (Light Sleep) – During the first stage of sleep, we're half awake and half asleep. We drift in and out of sleep for about 5 to 10 minutes and can be awakened easily. Our eyes move very slowly and muscle activity slows. People awakened from stage 1 sleep often remember fragmented visual images.
Stage 2 (True Sleep) – Our eye movement stops and our brain waves (fluctuations of electrical activity that can be measured by electrodes) become slower, with occasional bursts of rapid waves called sleep spindles. The breathing pattern and heart rate start to slow down.
Stages 3 and 4 (Deep Sleep) – Slow brain waves called delta waves, a type of wave that is large (high amplitude) and slow (low frequency) begin to appear, interspersed with smaller, faster waves. Rhythmic breathing and limited muscle activity characterize stage four. By Stage 4 the brain produces delta waves almost exclusively. It is very difficult to wake someone during stages 3 and 4, which together are called deep sleep. There is no eye movement or muscle activity. People awakened during deep sleep do not adjust immediately and often feel groggy and disoriented for several minutes after they wake up. Some children experience bedwetting, night terrors, or sleepwalking during these stages.
Rapid eye movement – The first rapid eye movement (REM) sleep period usually begins about 70 to 90 minutes after we fall asleep. We have around three to five Rapid eye movement sleep episodes a night. During Rapid eye movement sleep, our breathing becomes more rapid, irregular, and shallow, our eyes jerk rapidly in various directions, and our limb muscles become temporarily paralyzed. Our heart rate increases, our blood pressure rises, and males develop penile erections. People dream during this stage. Although we are not conscious, the brain is very active - often more so than when we are awake. This is the period when most dreams occur. Our eyes dart around (hence the name), breathing rate and blood pressure rise. However, our bodies are effectively paralysed, said to be nature's way of preventing us from acting out our dreams. After REM sleep, the whole cycle begins again.
The first cycles of the night will tend to have shorter Rapid eye movement sleep periods and longer periods of deep sleep. This trend reverses as the night goes on. The later cycles have longer Rapid eye movement sleep periods and shorter deep sleep periods.
Infants are unique in that they spend approximately 50 percent of their sleep time in Rapid eye movement sleep. By morning, most sleepers spend almost all of their time in stages 1, 2 and Rapid eye movement sleeps with very little or no deep sleep (stages 3 and 4).
The average length of time for a complete sleep cycle is 90-110 minutes. About 50 percent of sleep time is spent in stage 2 and about 20 percent in Rapid eye movement sleep. The remaining 30 percent is split among the other stages.
On average, a person will cycle through the stages 4 or 5 times in an eight-hour period. After a person falls asleep, the first Rapid eye movement sleep period generally happens 70-90 minutes later.
REM Sleep Disorder – Causes, Symptoms, Diagnosis, Treatment and Self Care
REM Sleep Disorder causes:
The exact cause of REM sleep behavior disorder (RBD) is unknown; although the REM sleep behavior disorder may occur in association with various degenerative neurological conditions such as multisystem atrophy, diffuse Lewy body dementia, Parkinson disease and Shy-Drager syndrome.
In 55% of persons the REM sleep behavior disorder cause is unknown, and in 45%, the cause is associated with alcohol or sedative-hypnotic withdrawal, tricyclic antidepressant (such as imipramine), or serotonin reuptake inhibitor use (such as fluoxetine, sertraline, or paroxetine) or other types of antidepressants (mirtazapine).
REM Sleep Disorder Symptoms:
The main symptom of REM sleep behavior disorder is dream-enacting behaviors, sometimes violent, causing self-injury or injury to the bed partner.
The dream-enacting behaviors are usually nondirected and may include kicking, leaping, punching or jumping from bed while still asleep.
1. Brain waves are small and irregular, with big bursts of eye activity. The brain wave activity at this time resembles waking more than it does sleeping.
2. Breathing becomes irregular and oxygen consumption increases.
3. The four NREM phases are characterized by progressive relaxation. But during REM sleep phase, the body's activity perks up considerably.
4. Pulse rates during REM sleep increase in an irregular way.
5. Blood pressure may increase drastically.
6. The sleeper with cardiac problems faces the greatest risk of heart attack at this time.
7. The body seems to have abandoned its effort to regulate its temperature during the REM sleep phase.
8. The sleepers' large muscles are literally paralyzed. They cannot move their torsos, arms, or legs.
The people with REM sleep disorder may be awakened or may wake spontaneously during the attack and vividly recall the dream that corresponds to the physical activity.
REM Sleep Disorder diagnosis:
Seek medical care if unusual behaviors, such as violent thrashing and kicking, occur during sleep.
REM - Polysomnography:
Polysomnographic video recording is the single most important diagnostic test in persons with REM sleep behavior disorder. This test is usually conducted in a sleep study center. The person undergoing testing is required to sleep at the center while the following parameters are monitored:
Multiple electromyography (EMG) channels utilizing chin, bilateral extensor digitorum, and tibialis anterior muscles
Electrical activity of the brain (electroencephalogram [EEG])
Eye movements (electrooculogram)
Respiratory movements
Electrical activity of the heart (electrocardiogram [ECG])
In persons with REM sleep behavior disorder, the polysomnogram shows an increase in the muscle tone associated with the EEG pattern of REM sleep, whereas in healthy persons, the EEG pattern of REM sleep is associated with an absence of muscle tone (atonia).
These parameters are monitored as the person passes through the various sleep stages. Characteristic patterns from the electrodes are recorded while the person is awake and during sleep.
Continuous video recording is done to observe behaviors during sleep. Additionally, the video recording shows body movements coinciding with the EEG pattern of Rapid eye movement sleep.
REM Neurologic Exanination:
The neurologic examination is often normal. However, symptoms and signs of Parkinson disease, such as hand tremor at rest, slowness in movement, and muscle stiffness (rigidity) that may suggest an underlying neurologic cause of REM sleep behavior disorder (RBD), should be considered.
REM Sleep Disorder Treatment:
The treatment of REM sleep behavior disorder can be challenging in some patients with underlying neurodegenerative conditions.
Clonazepam (Klonopin) is highly effective in the treatment of REM sleep behavior disorder (RBD), relieving symptoms in nearly 90% of patients with little evidence of tolerance or abuse. The initial dose is 0.5 mg at bedtime, with some persons requiring a rapid increase to 1 mg.
A persistent benefit was shown with melatonin with and without low dose of clonazepam beyond 1 year of therapy in 57%. The effective dose of melatonin was 3-6 mg. only 36% experienced side effects, which resolved with decreased dosing.
Other medications, such as tricyclic antidepressants, may be effective in some patients of REM sleep behavior disorder.
However, tricyclics are known to precipitate RBD. Levodopa may be very effective in patients in whom REM sleep behavior disorder is the harbinger of Parkinson disease.
In addition, anecdotal reports exist of responses to carbamazepine, clonidine, and L-tryptophan.
REM Self care:
Because persons with REM sleep behavior disorder have a risk of injuring themselves and their sleep partners, safety of the sleeping environment is very important.
The bedmate should sleep in another bed until the symptoms resolve.
Clear the floor of furniture and objects that could injure the person if he or she fell from bed.
Remove potentially dangerous objects from the bedroom.
Have the person sleep in a bedroom on the ground floor if possible, especially for people who leave the bed during an episode.
A bed with padded bedrails can be considered
Sleep Aid Disorders Guide A comprehensive information guide about sleep disorders. Descriptions, symptoms, causes, treatments of various sleep aid tips for disorders like sleep apnea, insomnia, snoring, restless legs and narcolepsy. http://www.sleepdisordersguide.com/sleep-apnea.html
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