To investigate how positive redirection of dreams provided by the caregiver can help improve symptoms associated with rapid eye movement (REM) sleep behavior disorder.

RBD is characterized by the loss of skeletal muscle atonia in REM sleep that results in vocalizations and dream enactment behavior. It is commonly seen in alpha-synuclein neurodegenerative diseases, such as Parkinson’s disease and Lewy Body Dementia. It can often lead to sleep related injury (SRI) in the patient and the bed partner. In this case, we highlight the role of the bed partner and whether positive verbal redirection during dream enactment can minimize the intensity of violent episodes.

There is limited literature on non-pharmacological treatment methods for RBD. We present a case study of a 62-year-old white male with a history of mild LBD and RBD accompanied by nightmares and dream enactment for eleven years. The patient’s aggressive episodes included speaking, kicking and reaching for objects in his sleep. For the last five years, his bed partner has been redirecting the plot of his dreams to a safe setting, such as the library, and selecting reading materials that he enjoys, such as chess, poetry and photography. With the help of sensory descriptions and tactile stimulation, the bed partner is able to construct a safe environment in the patient’s mind while he is sleeping. As a result of the bed partner's efforts, the patient has experienced a reduction in the frequency and severity of violent RBD episodes.

Patients with RBD who experience violent dream enactment behavior may benefit from verbal redirection provided by their bed partner during sleep. Paying attention to the role of the bed partner in managing the symptoms of RBD may prove to be beneficial for medically refractory cases, help prevent SRI and improve the quality of sleep.