The Difference A Sleep Disorder Makes: Parkinson’s Disease With REM Behavior Disorder

It is now a well-established fact that REM Behavior Disorder (RBD) often occurs in association with PD. But it has never been clear to anyone how the presence of RBD affected the other symptoms of PD. REM Behavior Disorder emerges when the normal muscle suppression that occurs during REM sleep is abolished by disease. Patients with RBD end up acting out their dreams as there is no muscle suppression to keep them from doing so when they enter REM sleep. Acting out one’s dreams can sometimes be dangerous if the patient gets out of bed or sees a bed partner as a stranger of some kind! In a recent report published in the respected Journal of Neurology Neurosurgery and Psychiatry Postuma and colleagues looked at clinical differences of two PD groups: those with and those without RBD. They assessed motor symptoms, disease severity, response to drug therapy and sleep patterns of 21 patients with, and 15 patients without RBD. Even though both patient groups were similar in terms of background variables like age, mental status and severity of PD, patients with RBD had an increased frequency of falls, poorer response to drug therapy and greater involvement of ‘axial’ (i.e.,, the trunk) motor systems than patients without RBD. These findings suggest that it is vitally important to diagnose and treat a sleep disorder like RBD in order to prevent serious problems like falls and poor response to drug therapy. If you are having sleep problems, discuss them with your doctor. Treating the sleep problems may actually help with the parkinsonian symptoms you cope with everyday.

Postuma RB, Gagnon JF, Vendette M, et al.. REM sleep behaviour disorder in Parkinson’s disease is associated with specific motor features. J Neurol Neurosurg Psychiatry 2008;79:1117–