This condition causes involuntary movements while sleeping.
As a general rule, people’s sleep cycles can be divided into several phases, specifically five. Four first phases characterized by different patterns of sleep waves and the last phase known as REM sleep. This occupies between 15 and 20% of the natural sleep cycle and in it most of the daydreams take place, as well as muscular atony.
However, there are occasions when an alteration in this cycle occurs, as in the case of conduct disorder during REM sleep. Throughout this article we will talk about the characteristics of this condition, as well as its symptoms, causes and treatments that can alleviate the effects of this disorder.
What is REM sleep conduct disorder?
The conduct disorder during REM sleep was described for the first time in 1986 by Dr. and researcher Carlos H. Schenck, a specialist in sleep disorders and behaviors. He defined it as a REM sleep parasomnia; that is to say, a group of behaviors or abnormal phenomena that appear during this phase of sleep.
This type of sleep disorder or parasomnia is distinguished by affecting both the development of sleep and the motor system of the person. Causing the appearance of episodes of intense motor activity which affects various muscle groups.
These movements are manifested in the form of leg shaking, kicking, punching the fists and arms, and even verbal manifestations such as screaming. Which can harm the person who accompanies you in your sleep hours.
The patient may even get out of bed, walk or walk in response to the dream activity that he is experiencing at that very moment. The violence of these motor activities finds its explanation in the content of dreams, which are often described as unpleasant, aggressive and virulent.
The incidence of this disorder among the population is really low, being reduced to only 0.5% of it. However, on many occasions this is masked by other syndromes with similar clinical pictures. On a large number of occasions it is misdiagnosed as a nocturnal seizure disorder, consisting of a rare variety of obstructive sleep apnea syndrome.
In addition, this disorder is much more frequent in men, representing 90% of RCD cases and usually appearing between 50 and 60 years of age.
What types are there?
REM sleep conduct disorder can manifest itself in two different categories: acutely, idiopathically, or chronically.
The acute type of this disorder tends to be associated with periods of alcohol withdrawal. Especially in those with a history of years of alcohol abuse. Likewise, certain drugs or medications such as hypnotic sedatives, anticholinergics or fat-soluble blocking drugs, can also cause this type of sleep disturbance.
Likewise, two more types of CRT have been identified. One of them is an idiopathic form of the disorder; that is, in which CRT consists of a disease by itself not associated with other alterations or lesions and which can evolve over time, becoming a form of neurodegenerative disease.
Regarding the chronic typology of RCR, it is caused or is part of the clinical picture of a series of neurodegenerative diseases such as Parkinson’s disease, Lewy body dementia, multisystemic atrophy or, to a lesser extent, in supranuclear palsy , Alzheimer’s disease, corticobasal degeneration and spinocerebellar ataxias. In the same way, it can be associated with disorders such as narcolepsy, lesions of the brainstem, tumor formations and cerebrovascular accidents.
The symptoms of this parasomnia
Within the clinical picture of conduct disorder during sleep, we find a state of lack of muscle atony that manifests itself in the form of sudden and violent movements that appear at the beginning of the REM sleep phase and are maintained throughout it. These movements are an involuntary response to the content of the dreams that the patient lives, which he describes as vivid, unpleasant and aggressive.
In most cases, patients describe their dreams as an extremely unpleasant experience in which all kinds of fights, arguments, chases and even accidents or falls are represented.
In a percentage of the patients, specifically in 25%, behavioral alterations during sleep have been determined prior to the onset of the disorder. These behaviors include sleepwalking, screaming, twitching, and seizures of the limbs.
In the case of the behavioral or motor symptoms of this disorder, there are:
- Cursing or insulting.
- Agitation of the extremities.
- Jumping or jumping out of bed.
Due to the aggressiveness with which these behaviors appear, it is common for the patient to end up hurting or hitting the person next to him, as well as causing self-harm. Damages inflicted on both the companion and oneself include lacerations, subdural hematomas, and even fractures.
What is known about its causes?
Information about the causes of REM sleep conduct disorder is quite limited. In more than half of the cases, the cause of this condition is related to the future appearance of some type of neurodegenerative disease.
However, recent studies carried out with animal models point to the possibility of a dysfunction in the brain structures of the pontine tegmentum, the locus coeruleus and the pedunculopontine nucleus; which are the main ones in charge of regulating muscle tone during sleep.
Is there a treatment?
Fortunately, there is a treatment for REM sleep behavior disorder based on daily doses of clonazepam. With a dose of between 0.5 and 1 mg, administered before sleeping, and provided that the doctor so indicates, it is very likely that the person will experience greater control of sleep disturbances, including a decrease in the amount and intensity aggressive behavior and violent dreams.
In patients who do not respond to clonazepam or who have some type of contraindication, the use of melatonin, pramipexole or donepezil can be used for the cases described as refractory.
Regarding the prognosis of the disease, it is expected that with the pharmacological treatment an absolute remission of the symptoms will be achieved. However, there is no definitive cure for TCR, so if the dose is lowered or treatment is stopped, symptoms can reappear even more strongly.
It is necessary to specify that in those cases where TCR is caused by a neurodegenerative disease, treatment with clonazepam is not effective, and the patient has to follow a specific treatment for the main disease.