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Dr. Andrew Rynne

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What are symptoms of rapid eye movement behavior disorder?

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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 2681 Questions

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Posted on Wed, 27 Aug 2014 in Sleep Disorders
Question: Hello. I recently had a sleep study. I also was recently tapering a bit from my effexor 37.5 capsule. I stopped the taper 1-2 days before the sleep study but had been tapering for a week and a half by taking out 4-5 "spheres" a day from the capsule-Though the pieces vary in size of course. I also only had one meal the day of the study around 12:00 pm and the study began around 10:30 or so. Was also slightly dehydrated.
****I remember having a vivid dream and kicking someone attacking me and I remember actually physically kicking so I think I woke up at least that time. I also had a really bad night sweat and they had to fix some of the wire connections and put a blanket on top of my pillow. I had night terrors and sleepwalking all the time when I was a kid but not sure if that is at all relevant. Please let me know if this sounds like it is definitely RBD? I have read quite a bit about RBD and am confused it is a guarantee for 80-90% development of neuro-degenerative disease? Very concerned and will not have any answers for several days and need to know a bit more about my situation since I cannot speak with the doctor at this time. I have been startled out of sleep by a noise and have done a combat role into a ready position out of reflex too. I have had numerous Traumatic experiences in my life too. My father who adopted me also has PTSD and is a tripple purple heart and silver star from WWII (Sniper) so I have been close to that too on top of my own trauma. Been on effexor for around 8 years I think.If I do have RBD what is the probability that my doctors will ween me from effexor and atenolol? Or will they run other tests first? Also as a 39 year old on effexor and beta blocker is it likely that those compounds are the cause? Will RBD go away if those substances are discontinued and they are the cause or is the damage permanent still usually leading to PD and other Neurodegenerative diseases?
doctor
Answered by Dr. Ashok Kumar 14 hours later
Brief Answer:
I do not think this is RBD

Detailed Answer:
Dear XXXX
Thanks for using healthcaremagic.

I read your query word by word and understand your concern. From the available description it apperars to me that this is probably not RBD although for definite answer we need the report of sleep study.
The reason for my observation are
1. Your age- RBD generally occurs in older individuals but you are just 39.
2. We all remember some action during dreams or fighting or having a combat, but during rem sleep (in which dream occurs ) there is complete atonia and so no motor activity. The person who was doing sleep study must have reported some abnormal motor activity during sleep but that is lacking and what you are telling is present in all of us irrespective of RBD (remembering some action during sleep).

3.In your case you just mentioned about these things during sleep study but not on other days. Before complete appearance of RBD there is history of years. This is generally available from family members or bed partner. You did not mention same and I assumed that this is also absent.

4. Absence of family history of neuro denerative dissorder.

Having said this we need the sleep study report to get confirmation that there is no RBD as this is the only test which is able to diagnose the RBD.

In regard to your next question even Effexor is involved in RBD and that is completely reversible. You are right in saying that many of the person develop Parkinson disease or other neuro degenerative disorder after the RBD but the percentage is not that high. In series of studies only half of the patient progress to develop neuro degenerative disorder.

I do not think your doctor will need more test as sleep study with video recording of sleep is enough to diagnose RBD. Once they diagnose RBD in that case they may perform more tests to know status of neuro degenerative disorders.

'Hope I have answered your query. If you have any further questions I will be happy to help".
Thanks

Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Follow up: Dr. Ashok Kumar 2 hours later
I am still a bit confused. I did kick at least once during the study. I have a grandmother that had MS. If I am diagnosed with RBD--what does that mean since I am on effexor and beta blocker both of which can cause RBD? Is it more likely caused by effexor? What is the protocol in a situation with RBD when it is due to antidepressant, beta blocker or both? So does RBD from effexor have any connection to a neuro degenerative disease in the present or future?Why would many with PTSD have RBD? Is that leading to a degenerative disease also? It's very confusing. Is it because PTSD is often treated with antidepressants? Feel as though they are trying to maybe protect the drug companies especially since so much of the early onset RBD is related to use of antidepressants too. When/if I go off of effexor what is the alternative drugs to treating my anxiety etc. without use of an antidepressant?
doctor
Answered by Dr. Ashok Kumar 4 hours later
Brief Answer:
Drug induced RBD is reversible but .............

Detailed Answer:
Dear XXXX
Welcome back and thanks.

You are right in having your own conclusion but please make it clear that even if you kicked during sleep it may be during the non rem sleep which is normal phenomenon for someone who has sleep walking and sleep terror. Other than this the presence of kicking movement does not mean you are having RBD.
Please note that one of the diagnostic criteria for RBD is significant disruption in quality of life due to RBD which is probably absent in your case.
I generally look to the positive side unless otherwise proved. At this moment you are imagining worse and I am looking another flip of the story due to some valid points but i must acknowledge we can not make any conclusion till we get sleep study report.
MS is demyelinating disease and incidence of RBD in patients with MS is equal to general population which mean there is no significant risk of RBD due to MS and if RBD is found in a patient or family member of MS sufferer that is just coincidence so probably family history of MS is not relevant in your case.

RBD induced by use of some drugs is generally do not progress to degenerative disorder and remit once you stop the offending agent.

The mechanism of RBD in ptsd is not known exactly but it is hypothesized that it is due to inhibition of some neurons in pons area of brain which regulates the tone during sleep. It is not progressive and RBD clears once you treat the PTSD.

Its really confusing that both PTSD and drugs used to treat it are cause of RBD but there are other medicines like clonazepam which is used to treat the RBD and surprisingly around 90% of patients respond when they get benzodiazepines prescription particularly Klonopin.

Most of serotonergic drugs are implicated in RBD so that should be avoided. YOu can use Buspar, Mirtazapine or benzodiazepines to treat your anxiety.


"If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health".

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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