Diagnosis

To diagnose REM sleep behavior disorder, your doctor reviews your medical history and your symptoms. Your evaluation may include:

• Physical and neurological exam. Your doctor conducts a physical and neurological exam and evaluates you for REM sleep behavior disorder and other sleep disorders. REM sleep behavior disorder may have symptoms similar to other sleep disorders, or it may coexist with other sleep disorders such as obstructive sleep apnea or narcolepsy.
• Talking with your sleeping partner. Your doctor may ask your sleeping partner whether he or she has ever seen you appear to act out your dreams while sleeping, such as punching, flailing your arms in the air, shouting or screaming. Your doctor may also ask your partner to fill out a questionnaire about your sleep behaviors.
• Nocturnal sleep study (polysomnogram). Doctors may recommend an overnight study in a sleep lab. During this test, sensors monitor your heart, lung and brain activity, breathing patterns, arm and leg movements, vocalizations, and blood oxygen levels while you sleep. Typically, you'll be videotaped to document your behavior during REM sleep cycles.

Diagnostic criteria

To diagnose REM sleep behavior disorder, sleep medicine physicians typically use the symptom criteria in the International Classification of Sleep Disorders, Third Edition (ICSD-3).

For a diagnosis of REM sleep behavior disorder, criteria include the following:

• You have repeated times of arousal during sleep where you talk, make noises or perform complex motor behaviors, such as punching, kicking or running movements that often relate to the content of your dreams
• You recall dreams associated with these movements or sounds
• If you awaken during the episode, you are alert and not confused or disoriented
• A sleep study (polysomnogram) shows you have increased muscle activity during REM sleep
• Your sleep disturbance is not caused by another sleep disturbance, a mental health disorder, medication or substance abuse

REM sleep behavior disorder can be the first indication of development of a neurodegenerative disease, such as Parkinson's disease, multiple system atrophy or dementia with Lewy bodies. So if you develop REM sleep behavior disorder, it's important to follow up with your doctor.