Rapid eye movement sleep behavior disorder is characterized by repeatedly waking up after REM sleep, which may include vocalizations or complex motor behaviors. The “complex motor behaviors” are in reaction to events occurring in one’s dream state, and are often called “dream enacting behaviors.” For instance, a person might move one’s arms in a fighting manner because of fighting that is occurring within one’s dream. Other behaviors might include running, punching, thrusting, hitting, kicking, or falling out of bed due to physical movements.

This is a rare disorder and occurs in less than 0.5 percent of the population.

Specific Symptoms of Rapid Eye Movement Sleep Behavior Disorder

1. Repeated episodes of arousal during sleep, associated with vocalization and/or complex motor behaviors.

2. These behaviors arise during rapid eye movement (REM) sleep and therefore usually occur more than 90 minutes after sleep onset. They are more frequent during the later portions of the sleep period. While they may occur during daytime naps, it is uncommon.

3. Upon awakening from these episodes, the individual is completely awake, alert and not confused or disoriented.

4. Either of the following:

  • REM sleep without atonia on polysomnographic recording.
  • A history suggestive of REM sleep behavior disorder and an established synucleinopathy diagnosis (e.g., Parkinson’s disease, multiple system atrophy).

5. The behaviors cause clinically significant distress or impairment in social, occupational or other important areas of functioning (which may include injury to self or the bed partner).

6. The disturbance is not attributable to the physiological effects of a substance or another medical condition.

7. Co-existing mental and medical disorders do not explain the episodes.

New to the DSM-5. Code: 327.42 (G47.52)