REM Sleep Behavior Disorder

Treatment

Depending on the severity of episodes, treatment usually includes modifying the sleep environment to make it safer, lifestyle changes to decrease the likelihood of episodes, and possibly medication. Patients are also regularly monitored for any signs of a neurological disorder.

Physical safeguards

• Moving any objects that could cause injury away from the bedside
• Padding objects that are too heavy or impractical to move
• Padding the headboard
• Moving the bed away from windows
• Blocking windows with large objects such as dressers
• Placing padding on the floor next to the bed

Bed partners may also need to sleep separately until episodes are reduced.

Lifestyle Modifications

• Following a regular sleep schedule to prevent sleep deprivation
• Avoiding certain medications and alcohol
• Treating other sleep disorders

Medical Treatments

Clonazepam, a benzodiazapine (tranquilizer), has traditionally been considered the best medication option for REM sleep behavior disorder. It reduces or eliminates the behavior for most patients. This medication is not the best choice for all patients, however, due to potential side effects, such as worsening of obstructive sleep apnea, decreased balance, or continued sleepiness the next morning.

Melatonin, a dietary supplement, can reduce or eliminate REM sleep behavior disorder symptoms in some patients, without the side effects of other medications. A Mayo Clinic study of 14 people with REM sleep behavior disorder showed that 57 percent of participants found melatonin helpful, and two patients found it ineffective. Melatonin reduced participants' physical aggressiveness and the nightmarish quality of their dreams, decreasing the potential for injury. Additional studies are needed to more thoroughly understand melatonin's effectiveness.

Even though melatonin is available over-the-counter at drugstores, Mayo specialists do not advocate self-medicating for REM sleep behavior disorder. They recommend that patients confer with a sleep specialist to get a proper diagnosis prior to treatment.