Alberto Ramos, MD, FAAN, University of Miami, Miller School of Medicine, Miami, FL, shares an overview of what is understood about the pathophysiology of REM sleep behavior disorder (RBD). RBD is a sleep disorder in which patients physically and vocally act out vivid dreams. When it occurs in middle-aged and older adults is often associated with α-synucleinopathies such as Parkinson’s disease or dementia with Lewy bodies. Early deposition of α-synuclein in the brain stem damages certain nuclei and doesn’t allow REM atonia to persist in REM sleep – allowing patients to act out their dreams. Besides being associated with α-synucleinopathies, RBD is also observed in patients with severe sleep apnea or narcolepsy. This interview took place at the American Academy of Neurology 2022 Congress in Seattle, WA.