Sleep Fighting

Woman disturbed by sleeping man

Sleep fighting, also known as REM Behavior Disorder (RBD), is a rare sleep condition that occurs predominantly in middle-aged and older men. Up to five percent of the population may be diagnosed with RBD.

How Sleep Fighting Occurs

During the rapid eye movement (REM) stage of sleep, most people are temporarily in a paralytic state because it is in this phase of sleep that people dream. Falling into a paralytic state is the body's way of protecting itself during REM sleep. People with RBD do not have this natural self-defense mechanism, and thus, often end up acting out their dreams. They may not only talk aloud and toss and turn while they continue to sleep, but they may even hit, kick, punch, or otherwise injure their bed partners or themselves.

Causes of Sleep Fighting

The cause of sleep fighting remains largely unknown in most cases. Although some incidences of sleep fighting occur as a result of withdrawal from alcohol, sedatives, or antidepressants, most people who have RBD do not know why. What is known is that RBD can be a precursor for neurodegenerative diseases like Parkinson's and specific types of dementia. About 50 percent of people who have RBD go on to develop some type of neurodegenerative disorder years, or even decades, later.

Few large scale studies exist that have examined this phenomenon, and at present there are no known preventative measures that people with RBD can take to reduce the likelihood of developing a neurological disorder. However, doctors do recommend RBD patients see a neurologist annually so any indicators or symptoms of neurological issues can be diagnosed and treated at the earliest possible time.


Although it may seem self-evident that a person has RBD, there are other sleep disorders that may have similar symptoms, so it is very important to get an accurate diagnosis from a sleep specialist. An accurate diagnosis will involve a full sleep study conducted in a lab. Generally, a single night of evaluation will reveal the characteristic activity associated with REM sleep without the accompanying paralysis that normal sleep entails.

Characteristics Specific to RBD

Sleep fighting, unlike sleepwalking, generally does not cause the person to walk around, leave the room or consume food or beverages while asleep. One way to differentiate between sleepwalking and RBD is that sleepwalkers are not easily awakened, and they may be disoriented. SBD patients, on the other hand, awaken alert and able to recall the details of their dream.

Since sleep fighting occurs during REM sleep, a person can experience up to four episodes of sleep fighting a night. However, they may only have an episode weekly or monthly.

Effects of Sleep Fighting

Sleep fighting in and of itself does not usually lead to daytime sleepiness, but it often occurs in conjunction with other sleep disorders, like sleep apnea, which can leave a person feeling sleepy and out-of-sorts during the day. The symptoms are much more likely to affect a bed partner adversely by interrupting their sleep. Often, cases of RBD are only diagnosed when a bed partner is awakened by the person's thrashing or shouting. The behaviors associated with sleep fighting can cause couples dismay if the person is unaware they have this disorder. It is important to keep in mind that RBD is a medical condition and not a psychological one, and the affected person is unaware of their actions. During wake times, most people with SBD respond to situations and people with friendliness just like anyone else.

Treatments for RBD

The medication clonazepam is the treatment of choice for SBD patients. About 90 percent of SBD patients respond to this treatment. There are few adverse effects from taking the drug, even for long periods of time. Another advantage is that people don't usually build up a tolerance and therefore won't need a higher dose over time. If clonazepam doesn't work, then physicians may recommend an antidepressant or melatonin.

Even if a treatment is working effectively, it is a good idea to 'injury proof' the bedroom by removing breakable objects near the bed or other items that could cause harm.

Getting Help

Considerably more research is needed to understand this rare sleep disorder fully, particularly the link between SBD and neurological conditions. In the meantime, people affected by SBD may find considerable relief by taking advantage of medication management and by learning more about this condition. If you suspect you or a loved one may have SBD, talk with your family physician right away so you can receive an accurate diagnosis and proper treatment.

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