It is important to remember that dream enactment and limb movements during sleep can occur in the healthy population, often in the context of heightened emotional states ( 1– 3). Here, individuals experience vivid dreams which they act out during sleep. Whilst isolated RSWA is frequently an incidental finding in sleep studies, it forms the substrate of the dream enactment behavior which defines RBD. This phenomenon is often referred to as REM Sleep without Atonia (RSWA). Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a non-familial sleep disorder, characterized by the loss of the inherent muscle atonia observed during normal REM sleep. We aim to raise awareness and develop a framework for best practice for RBD patient management. In this review, we summarize RBD pathology and differential diagnoses, diagnostic, and treatment guidelines as well as prognostic recommendations with a look to current research in the scientific field. Both clinicians and patients are therefore forced to deal with uncertain outcomes. There are no binary prognostic markers for RBD disease course and there are no clinical guidelines for neurodegeneration scaling or tracking in these patients. Uncertainty in patient management is further exacerbated by a lack of clinical guidelines for RBD patient care. The disease's low prevalence and the relatively limited awareness of the condition amongst medical professionals makes the diagnosis and treatment of RBD challenging. RBD patients also exhibit accelerated disease progression and a more severe phenotype than α-synucleinopathy sufferers without RBD. RBD patients have a high risk of developing one of the neurodegenerative α-synucleinopathy diseases: over 70% will develop parkinsonism or dementia within 12 years of their diagnosis. Individuals often present to clinic with complaints of injury to themselves or their bed-partner due to violent movements during sleep. REM Sleep Behavior Disorder (RBD) is a chronic sleep condition characterized by dream enactment and loss of REM atonia. 4Translational Health Sciences, University of Bristol, Bristol, United Kingdom.3Department of Neurology, Southmead Hospital, Bristol, United Kingdom.

2Rosa Burden Centre, Southmead Hospital, Bristol, United Kingdom.1School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom.

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