Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam - PubMed (original) (raw)

. 2009 Jun 15;5(3):235-9.

Affiliations

Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam

Kirstie N Anderson et al. J Clin Sleep Med. 2009.

Abstract

Study objectives: REM sleep behavior disorder (RBD) is characterized by loss of the normal muscle atonia during REM sleep associated with disruptive motor activity related to the acting out of dreams. There is frequently injury to the patient or bed partner, and treatment is usually required. Clonazepam has been the first-line therapy for many years, with 2 large case series reporting efficacy with few side effects in the majority of patients. However, long-acting hypnotics in the elderly or those with cognitive impairment can be associated with adverse events especially unacceptable daytime sedation, confusion, and exacerbation of existing sleep apnea.

Methods: We reviewed 39 patients with confirmed RBD who were treated within our regional sleep center, assessing both efficacy and side effects of drug therapies.

Results: Adverse effects were reported by 58% of the patients using clonazepam, with 50% either discontinuing the drug or reducing the dose. This prompted us review the side effects of clonazepam in detail and to look for alternative therapies. We report several novel and effective therapies, in particular zopiclone, in a series of patients under long-term follow-up for RBD.

Conclusions: There are alternatives to clonazepam therapy for RBD which can be as effective and may be better tolerated.

PubMed Disclaimer

Figures

Figure 1a

Figure 1a

Flowchart representing patient treatment pathways.

Figure 1b

Figure 1b

Final therapy for patients with REM Sleep Behavior Disorder.

Similar articles

Cited by

References

    1. American Academy of Sleep Medicine. Westchester, IL: American Academy of Sleep Medicine; 2005. International classification of sleep disorders: second edition: diagnostic and coding manual.
    1. Schenck C, Mahowald M. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep. 2002;25:120–38. - PubMed
    1. Gagnon JF, Postuma RB, Mazza S, Doyon J, Montplaisir J. Rapid-eye-movement sleep behaviour disorder and neurodegenerative diseases. Lancet Neurol. 2006;5:424–32. - PubMed
    1. Postuma RB, Lang AE, Massicote-Marquez J, Montplaisir J. Potential early markers of Parkinson disease in idiopathic REM sleep behavior disorder. Neurology. 2006;66:845–51. - PubMed
    1. Massicotte-Marquez J, Décary A, Gagnon JF, et al. Executive dysfunction and memory impairment in idiopathic REM sleep behavior disorder. Neurology. 2008;70:1250–7. - PubMed

MeSH terms

Substances

LinkOut - more resources