Diagnosis of RBD
In addition to polysomnography, which records activity levels during REM sleep, diagnosis of RBD is based on sleep history, testimony of sleep partners, and one or several overnight video recordings of REM sleep activity. Video recordings often present patients with an impressive and surprising revelation of their disorder.
Most cases of RBD are not associated with other disorders. It is, however, necessary to rule out myoclonic seizures, which are the product of neurological dysfunction and which may compromise health if not treated.
Also, RBD symptoms have been described in cases of degenerative neurological disorder, like brainstem lesions. In cases of severe RBD and perhaps those that do not respond to treatment, diagnosis with magnetic resonance imaging (MRI scan) may help physicians exclude or detect other conditions, such as:
- Subarachnoid hemorrhage (of the region where the spinal chord meets the brain)
- Parkinson's disease
- Olivopontocerebellar degeneration (of the pons, cerebellum, and olivary nucleus)
- Multiple sclerosis
- Guillain-Barre syndrome (destruction of peripheral nerves)
- Antidepressant use (including fluoxetine [Prozac] and tricyclics)
- Treated obstructive sleep apnea
RBD and Parkinson's Disease
There is some evidence to suggest that RBD precipitates Parkinson's disease. Parkinson's disease is caused by the continual death of dopamine-producing brain cells. Dopamine inhibits and regulates muscle control.
Parkinson's disease and RBD have been known to happen concurrently, but the relationship has not been proven. In one study, nearly 40 percent of men in their late 60s, who demonstrated RBD, later developed Parkinson's disease. Parkinson's disease affects as many women as it does men, but this isn't true of RBD.
Treatment for RBD
Clonazepam—Patients with RBD usually respond to treatment with clonazepam when taken nightly. Clonazepam is a benzodiazepine with anticonvulsant effects that has been shown to block neurotransmission in people with RBD, allowing them to achieve atonia and a state closer to REM paralysis. People with renal complications, pregnant women, and people who are taking other medications may not be good candidates for treatment with clonazepam.
Safety—People with RBD risk injuring themselves and their sleep partners. The frequency and intensity of RBD episodes are sometimes too much for a sleep partner to endure. This is often hard for those who suffer from RBD to understand, because they usually don't remember the episode because they sleep through it. Sleeping in a big bed can minimize the chance a sleep partner will be injured, but sleep partners often end up sleeping in different beds or even in different rooms.
A ground floor bedroom is recommended, especially for people who actually leave the bed during an episode. Placing heavy drapes over the windows to make going through them difficult, removing sharp objects from the room, padding the bed and nearby furniture, and clearing the floor around of furniture are all steps that can be taken to prevent injury.
Withdrawal from certain medications (e.g., tricyclics, monoamine oxidase inhibitors), alcohol, caffeine, and illicit drugs can cause acute episodes of RBD. Sudden discontinuation of controlled medication should be avoided under all circumstances.