Clonazepam (Klonopin). This prescription medication, often used to treat anxiety, is also the traditional choice for treating REM sleep behavior disorder, appearing to effectively reduce symptoms. Clonazepam may cause side effects such as daytime sleepiness, decreased balance and worsening of sleep apnea.
Melatonin (preferred) — Melatonin is our preferred first-line therapy in patients with frequent, disruptive or injurious behaviors (algorithm 1). It tends to be better tolerated than the alternative first-line therapy, clonazepam, especially in older adults with neurodegenerative disorders [114,121].
Recent evidence suggests that there may also be several specific environmental or personal risk factors for REM sleep behavior disorder, including occupational pesticide exposure, farming, smoking or a previous head injury.
RBD can cause serious injury to you and/or your bed partner, so it's important to seek treatment. People who have RBD in addition to a neurological condition often have a poor prognosis.
These studies demonstrate a strong link between having RBD and later being diagnosed with Parkinson's or related conditions such as dementia with Lewy bodies or multiple system atrophy, which have PD symptoms. Not everyone with RBD goes on to develop PD, though.
RBD is marked by the acting out of dreams that are vivid, intense, and violent. Dream-enacting behaviors include talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing. An acute form may occur during withdrawal from alcohol or sedative-hypnotic drugs.
Treatment. The treatment of RBD falls into two categories: pharmacological and behavioral. Unfortunately, as no cure for the disorder exists, management remains symptomatic, with highest priority placed on controlling the extreme and potentially injurious motor behaviors.
RBD is a disorder that can get worse over time. This can put you or your bed partner in danger. RBD also tends to be linked to other medical problems.
Myth #1: RBD is primarily a psychiatric condition
In actuality, the DSM-5 contains many physical health and mental health disorders, especially when physical health disorders connect to psychological symptoms like depression and anxiety. The DSM-5 lists many sleep-wake disorders including: Insomnia.
While REM sleep behavior disorder may occur in conjunction with, or as a predecessor to, certain neurological disorders such as Parkinson's disease, it can also result from medication usage.
Less than one percent of people are estimated to have REM sleep behavior disorder. View Source . It usually begins after age 50, and the disease is associated with other neurodegenerative disorders, including Parkinson's disease, Lewy body dementia, and multiple system atrophy.
Research indicates that anxiety and pre-sleep rumination may affect rapid eye movement (REM) sleep, which involves the most vivid dreaming. Anxiety may provoke more disturbing dreams and create a higher likelihood of sleep disruptions.
OSA behaviors mimic RBD symptoms since patients carry a history of limb and body movements associated with dream mentation and dreams that appear to be “acted out.”25 Moreover, demographic factors such as age, sex, and older male predominance are also similar to those in RBD.
The first and most distinct consequence of daily mild stress is an increase in rapid-eye-movement (REM) sleep, a new study reports. The research also demonstrated that this increase is associated with genes involved in cell death and survival.
Medication Summary
Clonazepam has proven to be a highly successful treatment for RBD. It is effective in nearly 90% of patients (complete benefit in 79% of patients and partial benefit in another 11% of patients), with little evidence of tolerance or abuse.
RBD has been associated with antidepressant use as well as narcolepsy. The strongest correlation exists between RBD and comorbid neurodegenerative alpha-synucleinopathies (i.e., Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy).
Unlike sleepwalkers, once awakened, people with RBD can recall vivid details of their dreams.
The prognosis of RBD depends on its etiology. In idiopathic cases, the symptoms are controlled with medications. In secondary cases, the prognosis depends on the underlying primary disease. No deaths have been reported in idiopathic cases of RBD; however, patients and bed partners may experience serious injury.
Acute onset RBD is almost always induced or exacerbated by medications (especially Tri-Cyclic Antidepressants, Selective Serotonin Reuptake Inhibitors, Mono-Amine Oxidase Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors,26 Mirtazapine, Selegiline, and Biperiden) or during withdrawal of alcohol, barbiturates, ...
Dementia with Lewy bodies (DLB) is the third most common cause of dementia, and the typical clinical presentation is rapidly progressive cognitive impairment. RBD is one of the core features of DLB and may occur either in advance or simultaneously with the onset of DLB.
More than 80 percent of people with rapid eye movement sleep behavior disorder (RBD), as the condition is known, go on to develop certain neurodegenerative maladies such as Parkinson's disease, multiple system atrophy or dementia with Lewy bodies, studies have found.
In REM sleep, brain activity picks up rapidly, which is why this stage is associated with more intense dreaming. Each stage plays a role in brain health, allowing activity in different parts of the brain to ramp up or down and enabling better thinking, learning, and memory.
A person with RBD may show the following symptoms:
Movement during sleep, including kicking, punching, arm flailing or jumping from bed. Talking, laughing, crying, cursing, or emotional outbursts during sleep. The ability to recall a dream if awakened during an episode.