The sleep disorder that puts people at a “very high risk” of developing Parkinson’s disease (and other synucleinopathies) is REM Sleep Behavior Disorder (RBD).
Here is a detailed explanation of the connection.
What is REM Sleep Behavior Disorder (RBD)?
Normally, during the REM (Rapid Eye Movement) stage of sleep—where most dreaming occurs—your brain paralyzes your muscles (a state called atonia). This prevents you from physically acting out your dreams.
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In RBD, this paralysis fails. Individuals literally act out their dreams, which are often vivid, intense, and violent. This can include:
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Punching, kicking, flailing, or jumping out of bed.
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Shouting, screaming, or talking.
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These actions can result in injury to themselves or their bed partners.
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The Powerful Link to Parkinson’s Disease
RBD is now recognized as one of the strongest early predictors of neurodegenerative diseases, specifically a group of disorders called synucleinopathies. These diseases are characterized by the abnormal clumping of a protein called alpha-synuclein in the brain.
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It’s a Prodromal Symptom: RBD is often a prodromal symptom, meaning it appears years or even decades before the classic motor symptoms of Parkinson’s (tremor, slowness, stiffness) or related conditions like Dementia with Lewy Bodies (DLB) or Multiple System Atrophy (MSA).
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Staggeringly High Risk: Research studies have shown that a very high percentage of people with idiopathic (unknown cause) RBD will eventually develop a neurodegenerative disease.
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Long-term studies have found that over 80% of people with RBD eventually develop Parkinson’s disease, Dementia with Lewy Bodies, or Multiple System Atrophy.
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The risk is so well-established that neurologists now consider RBD a major red flag and a key part of the “prodromal” phase of these diseases.
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The Biological Reason: The current scientific understanding is that the pathology of Parkinson’s (the misfolding and spread of alpha-synuclein) begins in lower parts of the brain, including the areas that control sleep (the brainstem), years before it reaches the areas that control movement. RBD is an early manifestation of this underlying disease process.
What Does This Mean? Key Implications
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Not Everyone with RBD Gets Parkinson’s: While the risk is extremely high, it is not 100%. However, the vast majority will.
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Not Everyone with Parkinson’s Had RBD: Only about half of Parkinson’s patients have a history of RBD. It is one of several prodromal symptoms, others include:
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Loss of smell (anosmia)
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Severe constipation (not due to other causes)
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Depression and anxiety
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What to Do If You Suspect RBD
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See a Sleep Specialist (Neurologist): Diagnosis typically requires a polysomnogram (an overnight sleep study) to confirm the loss of muscle atonia during REM sleep and rule out other sleep disorders like sleep apnea that can sometimes cause similar behaviors.
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Safety is the First Priority: The immediate goal of treatment is to prevent injury. This involves:
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Making the bedroom safe: Padding the floor, removing sharp objects and furniture near the bed, placing a mattress on the floor, and sometimes using bed rails.
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Medication: The most common and effective treatment is Clonazepam (Klonopin), a benzodiazepine, which is effective in about 90% of cases. Melatonin is also frequently used, often at high doses.
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Neurological Monitoring: A diagnosis of RBD should prompt ongoing monitoring by a neurologist. They can track for the emergence of other prodromal signs and begin interventions when appropriate.
REM Sleep Behavior Disorder (RBD) is much more than a sleep problem; it is a powerful early warning sign of brain disease. Its presence indicates a very high likelihood that an underlying synucleinopathy like Parkinson’s disease is already developing.
This discovery is crucial for two reasons:
- It allows for early injury prevention through treatment.
- It provides a critical window for future neuroprotective therapies. If scientists can develop drugs to slow or stop Parkinson’s, people with RBD would be the ideal group to treat before significant brain damage and debilitating symptoms occur.
Set a Sleep Schedule
Having a regular sleep schedule is the best way to promote better sleep. Set a bedtime and wake-up time to train your body. Be sure to strictly follow the times you have set for yourself to see the best results. Wake up as soon as you turn off your alarm and get in bed as quickly as possible. Allot seven or eight hours for your sleep and plan your sleep schedule around those hours.
Try to limit any naps to under an hour. Be sure to take naps at the same time of the day, or at least try to maintain the same nap schedule. Avoid taking naps after 3:00 PM.
Control Your Surroundings
Be sure to get enough sunlight during the day and stay in dark places at night, especially when heading to bed. Excess artificial lights may also affect your circadian rhythm, so try to schedule how much indoor light you expose.
Develop a Bedtime Routine
Your bedtime routine should help you prepare for bed. So be sure to follow it every evening. Essential tasks that every bedtime routine must have include:
- Having a Light Snack: Eat only light snacks if you get hungry before bed. Heavy meals before going to bed are unhealthy and can result in weight gain. Also, avoid snacks that might contain stimulant ingredients like alcohol and caffeine.
- Taking a Warm Bath: Bathing in warm water before bed may improve sleep quality. However, be sure not to spend too much time in the bath as it may wake up your body.
- Go to the Toilet: Be sure to finish your business in the bathroom before bed. Minimize your liquid intake at least three hours before bedtime to help avoid nocturia.
- Brush Your Teeth: Brushing your teeth right before bed helps prevent dental problems, including cavities and decay. Although it is indirectly related to better sleep, having this step in a bedtime routine is helpful.
Avoid Heavy Activities Before Bed
Don’t exercise for about six hours before going to sleep. As much as possible, prepare your body for sleep. Consider light, cool-down stretches if you must get physical exercise before bedtime.
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