Pathophysiologic mechanisms in REM sleep behavior disorder

Mark W. Mahowald, Carlos H. Shenck, Michel A. Cramer Bornemann

Research output: Contribution to journalReview articlepeer-review

61 Scopus citations


REM sleep behavior disorder (RBD) is a fascinating experiment in nature predicted by animal studies in 1964. A defining feature of REM sleep is active paralysis of all somatic musculature (sparing the diaphragm to permit respiration). RBD is characterized by the absence of REM atonia, permitting the appearance of dream-enacting behaviors. These oneiric behaviors may be violent or injurious. RBD typically affects men over the age of 50 years. Longitudinal follow-up has shown that the majority of individuals with RBD will eventually develop additional signs and symptoms of a number of neurodegenerative disorders, most notably one of the synucleinopathies (Parkinson's disease, dementia with Lewy body disease, multiple system atrophy, or pure autonomic failure), often after a prolonged interval lasting more than 10 years. RBD is also a common manifestation of narcolepsy. RBD may be induced by medications, especially the tricyclic antidepressants and serotonin-specific reuptake inhibitors. In most cases, clonazepam is a highly effective treatment.

Original languageEnglish (US)
Pages (from-to)167-172
Number of pages6
JournalCurrent neurology and neuroscience reports
Issue number2
StatePublished - Mar 2007
Externally publishedYes


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