REM Sleep Behaviour Disorder in a 61-Year-Old Man: An Early Warning Sign of Parkinson's Disease

Condition

The patient was brought in by his wife, who described over two years of increasingly alarming nighttime behaviour: shouting, cursing, and thrashing his arms and legs while apparently still asleep. On several occasions he had struck the headboard, knocked items off the nightstand, and once fallen out of bed. When woken, he could often recall a vivid, action-packed or aggressive dream, such as being chased or fighting off an attacker, that matched the movements his wife had witnessed.

There were no symptoms during the day. He walked normally, had no tremor, no stiffness, and no slowing of movement that either he or his wife had noticed. His family physician had initially treated this as a nonspecific sleep disturbance with a short, unsupervised sedative trial, which did not resolve the episodes and was stopped.

By the time he was referred to Dr. Guruprasad Hosurkar, a Neurologist in Bangalore with a dedicated interest in neurological sleep disorders and movement disorders, the pattern, older male, dream-enactment behaviour, preserved dream recall, and absence of daytime motor symptoms, was already suggestive of REM Sleep Behaviour Disorder, a condition well recognised as an early, sometimes decades-early, marker of Parkinson’s disease and related neurodegenerative conditions.

Emotional and Psychological Impact

The couple had started sleeping in separate rooms out of fear that he might injure his wife during an episode, which both described as isolating after more than three decades of sharing a bed. His wife carried a quiet, constant worry that something serious was developing, without having a name for it. Once RBD was explained as a recognised marker that can precede Parkinson’s disease, the emotional weight shifted from vague fear to a more concrete, manageable concern. The initial consultation focused on setting realistic expectations: RBD itself could be managed safely, and structured monitoring, not panic, was the right response to its link with future Parkinsonism.

Why This Approach Was Chosen

The clinical picture, dream-enactment behaviour with preserved dream recall in a man over 50, was classic for RBD, but the diagnosis could not be confirmed on history alone. Video-polysomnography is the only test that objectively demonstrates REM sleep without atonia, the physiological hallmark of RBD, and rules out other causes of nocturnal movement such as obstructive sleep apnoea or nocturnal seizures. Because a large proportion of patients with idiopathic RBD go on to develop Parkinson’s disease, dementia with Lewy bodies, or multiple system atrophy over subsequent years, the treatment plan was built around two parallel goals: making his nights safe in the near term, and establishing a structured, long-term surveillance schedule to catch early motor or non-motor signs of Parkinsonism as early as possible, tying his sleep disorder care directly into the Parkinson’s Disease Treatment and Movement Disorders programme rather than treating the sleep symptom in isolation.

“REM Sleep Behaviour Disorder is one of the most powerful prodromal markers we have in neurology. A patient can look completely normal in the daytime, walk normally, have no tremor, and still be years away from the first motor signs of Parkinson’s disease. Confirming RBD on a sleep study is not just about stopping injury at night, it is an opportunity to start watching for Parkinsonism early, before it becomes obvious, and to counsel the family on what to look for.” — Dr. Guruprasad Hosurkar.

Treatment Facts