Disorder 101, Episode 2
Last month we reviewed the definition and characteristics of REM Behavior Disorder. This month we will address how RBD is treated and managed.
Since RBD involves involuntary movements that are often violent, there is great potential for injury to occur to both the patient and their bed partner. People with RBD have been known to fall out of bed, punch walls/furniture, and kick or punch their bed partners. Therefore, it is recommended that bed partners sleep separately until the disorder is under control. For the patient, the bed should be placed away from anything that can cause injury, such as windows, night stands, lamps and firearms/weapons.
RBD is treated with medication, and for the majority of patients it is effective in the control of the movements and associated dreams. Clonazepam is usually the first choice of medication and it is usually well tolerated. Melatonin is also used in conjunction with clonazepam. Clonazepam can have side effects such as morning sleepiness and motor impairment. Melatonin can cause morning sleepiness as well. Doses of both medications must be carefully monitored by a physician.
Certain common medications are known to trigger and/or worsen RBD. These medications include all antidepressants except bupropion and beta-blockers. When these types of medications are discontinued, there is usually a reduction in RBD episodes. However, it is often not in the best interest of the patient to stop an antidepressant or beta-blocker that is working well for them. Changes to any of these medications should be closely monitored by the treating physician(s).
Stay tuned next month for our third episode of REM Behavior Disorder 101 when we look at this disorder and its link to neurodegenerative disorders.
Reviewed by Robert Hooper, MD