1199 A Novel Approach to REM Sleep Behavior Disorder Safety Measures

Abstract Introduction Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a parasomnia occurring during REM sleep, characterized by loss of normal REM sleep atonia and dream enactment behaviors. Behaviors include yelling, punching, kicking, and complex or violent movements causing a fall out of bed and result in injury to the patient or their partner. The American Academy of Sleep Medicine recommends maintaining a safe environment for patients. For patients with uncontrolled severe symptoms, recommendations include having partners sleep separately from patients. This may not be practical for small living spaces, may result in loss of intimacy between partners, or delay response to injuries caused by RBD. We present the case of a patient devised novel approach to keep their partner safe while maintaining close-proximity while sleeping. Report of case(s) A 63-year-old man with a past medical history of moderate obstructive sleep apnea (OSA) on CPAP presented to sleep clinic with symptoms of dream enactment. Behaviors included yelling, punching, and kicking. He had kicked his wife and had fallen out of bed resulting in an injury. He underwent a polysomnogram that showed REM sleep without atonia and was diagnosed with RBD. He was advised on safety precautions and started high dose melatonin. Clonazepam was added, but symptoms were not eliminated. He and his wife did not want to sleep separately, so he pushed two twin beds together and separated them with a large sheet of plexiglass. He reported he had hit the plexiglass many times without inuring himself and prevented injury to his wife. The patient’s wife was able to safely sleep near him which helped maintain their sense of intimacy. Conclusion We report a novel approach to create a safe environment for patients with RBD while maintaining partner proximity and intimacy. As patients struggle with progressive neurodegenerative disease, it is important to have their partners nearby overnight when patients are at risk for falling and self-injury. With two twin beds separated by plexiglass, a patient can safely sleep next to their partner and significantly reduce the risk of injuring them. This may be a useful technique for patients with severe, refractory symptoms of RBD. Support (if any)