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Treating REM Sleep Behavior Disorder: Best Practices

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  • REM Sleep Behavior Disorder

American Academy of Sleep Medicine  |  Mar 16, 2010
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People with REM sleep behavior disorder act out vivid, action-packed dreams while remaining asleep. They may shout, punch, kick, run and even jump out a window.

RBD was first reported in the journal Sleep in 1986. Sixteen years later a follow-up report was published by the same research team.

Recently the AASM reviewed all of the current research and developed a best practice guide for the treatment of RBD. It was published last month in the Journal of Clinical Sleep Medicine.

The guide recommends two steps in the treatment of RBD. The first step is injury prevention. The second step is the ongoing use of medication to control the symptoms.

People with RBD often injure themselves or their bedpartner during sleep. So it is important to create a safe sleeping environment.

The bedpartner may need to sleep in another room. Other examples of how to modify the sleep environment include:

  • Placing your mattress on the floor
  • Using a sleeping bag
  • Moving furniture away from the bed
  • Adding soft padding to the corners of furniture
  • Securing and blocking windows
  • Removing weapons and sharp objects from the bedroom

These methods of injury prevention should be continued while taking medication. One drug that is suggested for the treatment of RBD is clonazepam.

A typical dose is 0.25 mg to 2.0 mg, taken 30 minutes before bedtime. But a dose as high as 4.0 mg has been reported.

There can be significant side effects when taking clonazepam. These may include morning sleepiness, confusion and memory problems. It should be used with caution in people with dementia.

Clonazepam also can increase the severity of obstructive sleep apnea. So it should be used with caution in people with OSA.

Melatonin also is suggested for the treatment of RBD. The effective dose may range from 3 mg to 12 mg at bedtime.

An advantage of melatonin is that there are few side effects. Dose-related side effects may include morning headache, morning sleepiness and hallucinations.

A variety of other medications may be useful in treating RBD. But the evidence is limited.

Treatment for RBD should be supervised by a board-certified sleep specialist. You can get help from a board-certified sleep specialist at an AASM-accredited sleep center near you.

1 Comment

  1. 1 Duane Anderson 22 May
    I have REM sleep disorder very serious on 4 mg of clonazepam plus other medication have  Tremors and have been tested for Parkinson's. However the test really only shows there is less than 30% of damage done to your receptors or that another neurodegenerative issue may be taking place.  So it sometimes feels like my REM sleep disorder is basically incurable. I have had no luck with alpha or beta blockers. The only thing that has really helped is learning how to meditate and listening to music with theta waves. I think it is very important that a person with REM sleep disorder have people around that understand it's not just that they're tired all the time or lazy but actually have a condition. It's very easy for loved ones two  miss this even though they love you very very much. After having a sit-down talk with my family they all understood better.