EEG: Sleep Behavior Disorder
Using EEG Testing to Diagnose REM Sleep Behavior Disorder
One of the primary clinical uses of electroencephalography (EEG) in New York and elsewhere is in the diagnosis of sleep disorders. REM sleep behavior disorder (RBD) is a sleep disorder in which a person behaves abnormally during REM sleep, often acting out their dreams. This is distinct from sleepwalking, which is clinically termed somnambulism and occurs during NREM sleep.
Symptoms and Causes of REM Sleep Behavior Disorder
REM sleep behavior disorder (RBD) is characterized by motor activity during REM sleep. Normally, this activity is naturally inhibited; when this fails to occur, the person may engage in motions ranging from small twitches to more complex, integrated actions that suggest that they may be acting out their dreams. This activity can often be decidedly violent in nature, involving kicking, screaming, punching, or jumping out of the bed. In extreme cases the person may accidentally injure themselves or their partner. Along with the lack of normal motor inhibition, RBD is characterized by more REM periods during sleep than is normal. REM sleep usually occurs in several intervals normally totaling 90-120 minutes per night. In RBD, REM sleep may total as much as four hours.
RBD can have one of two types of causes: idiopathic, meaning it occurs by itself, or symptomatic, meaning it is caused by another medical condition. Idiopathic RBD is thought to have a genetic basis. Symptomatic RBD, which is more common, often occurs as part of neurodegenerative diseases such as Parkinson’s disease, lewy body dementia, and multiple system atrophy.
Using EEG Testing in Diagnosing RBD
REM Sleep Behavior Disorder is usually diagnosed using a test called a polysomnogram, of which the EEG is a key component. In normal REM sleep, certain neurons in the brain stem inhibit the release of neurotransmitters, resulting in a phenomenon called “REM atonia” that causes a near-complete paralysis of the body. When REM atonia does not occur, RBD results as the person acts out their dreams. In normal REM sleep, EEG recordings are generally characterized by brief periods of alpha band frequencies, punctuated by structures called “saw tooth waves”, which have a “notched” appearance. EEG in REM sleep is also desynchronized as compared to NREM sleep. In cases of RBD, researchers have identified differences in EEG recordings. During REM sleep, people with RBD in New York often exhibit lower beta power in the occipital regions as compared with normal individuals. People with RBD also exhibit a general “slowing” of EEG signals during both sleep and wakefulness.
Treating REM Sleep Behavior Disorder
Fortunately, REM sleep behavior disorder is both rare and treatable. RBD in New York, as well as across the country, is often treated with low doses of the drug clonazepam (Klonapin), a benzodiazepine drug that has sedative, anticonvulsant, hypnotic, and anxiolytic effects. As an alternative to clonazepam, melatonin is also sometimes used. Melatonin is a hormone naturally produced by the body, which functions in regulating circadian sleep-wake cycles and is sometimes used as a natural treatment for insomnia. In fact, some studies have shown that melatonin is actually just as effective as clonazepam. Melatonin may be a safer, more natural treatment choice for RBD. Klonapin can cause adverse symptoms including a hangover effect involving headaches, drowsiness, sluggishness, and irritability after waking up the next day, whereas melatonin is not associated with adverse side effects