REM sleep behaviour disorder: not just a bad dream

Elie Matar and Simon JG Lewis
Med J Aust 2017; 207 (6): . || doi: 10.5694/mja17.00321
Published online: 18 September 2017



  • Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterised by the loss of the normal atonia during the REM stage of sleep, resulting in overt motor behaviours that usually represent the enactment of dreams. Patients will seek medical attention due to sleep-related injuries or unpleasant dream content.
  • Idiopathic RBD which occurs independently of any other disease occurs in up to 2% of the older population. Meanwhile, secondary RBD is very common in association with certain neurodegenerative conditions. RBD can also occur in the context of antidepressant use, obstructive sleep apnoea and narcolepsy.
  • RBD can be diagnosed with a simple screening question followed by confirmation with polysomnography to exclude potential mimics.
  • Treatment for RBD is effective and involves treatment of underlying causes, modification of the sleep environment, and pharmacotherapy with either clonazepam or melatonin.
  • An important finding in the past decade is the recognition that almost all patients with idiopathic RBD will ultimately go on to develop Parkinson disease or dementia with Lewy bodies. This suggests that idiopathic RBD represents a prodromal phase of these conditions.
  • Physicians should be aware of the risk of phenoconversion. They should educate idiopathic RBD patients to recognise the symptoms of these conditions and refer as appropriate for further testing and enrolment into research trials focused on neuroprotective measures.


  • Elie Matar1,2
  • Simon JG Lewis1,2

  • 1 Brain and Mind Centre, University of Sydney, Sydney, NSW
  • 2 Royal Prince Alfred Hospital, Sydney, NSW



This work was conducted by the ForeFront project team and SJGL is supported by an NHMRC–ARC Dementia Research Development Fellowship (1110414). ForeFront is a large collaborative research group dedicated to the study of neurodegenerative diseases and is funded by grants from the National Health and Medical Research Council of Australia (1037746), Dementia Research Team (1095127), NeuroSleep Centre of Research Excellence (1060992), Australian Research Council Centre of Excellence in Cognition and its Disorders Memory Program (CE110001021) and the Sydney Research Excellence Initiative 2020. We thank Dr Negar Memarian for providing the polysomnography recording data shown in Box 2.

Competing interests:

No relevant disclosures.


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