Klonopin and REM Sleep Behavior Disorder

February 16th, 2012
By Dr. James Pendleton, Psychotropic News Contributor

Rapid eye movement (REM) sleep behavior disorder is characterized by physical disturbances during certain phases of sleep. During normal REM sleep, there is little or no muscle tone. The sleeper is therefore unable to get up, walk around, or engage in typical waking activities. With REM sleep behavior disorder (RBD), sleepers thrash their arms and legs, kick, punch, talk, shout, or make grabbing motions with their hands. These disturbances may happen several times each night. If the gestures are violent, then sleepers may unintentionally harm themselves or their sleep partner. This is of particular concern in the elderly population, where weakened bones and poor balance often result in serious injuries. Elderly people with RBD who fall out of bed and break a hip are almost destined for a poor outcome and impaired quality of life.

Doctors think that there is a relationship between RBD and degenerative neurologic conditions such as dementia and Parkinson’s disease. People with RBD are more likely to develop a brain disease in the near future. At the same time, people with diagnosed neurologic conditions often exhibit disturbed REM sleep. Despite the obvious connection between the state of REM and neurologic health, researchers are still far from understanding its significance. Because RBD has only recently been identified, diagnosis and treatment are still in their early stages. Historically, changes to sleep environment and the anti-anxiety/anti-seizure medication Klonopin (clonazepam) have been the two preferred treatment options.

A multicenter study attempted to determine some basic guidelines for the treatment of RBD. An overwhelming conclusion of the study was that proper diagnosis is essential for treatment. Of course that has always been the case, but it’s especially so with newly recognized diseases. Early identification of RBD may entail quicker, more significant improvement to quality of life. The second recommendation was that, in many cases, Klonopin is an appropriate pharmaceutical remedy for the worst manifestations of RBD. Klonopin has been used successfully for many years in the treatment of seizure disorders. The sedative effects of the medication reduce motion during all phases of sleep. However, patients with sleep apnea, movement disorders, or signs of a worsening cognitive impairment should usually not be treated with Klonopin. There is a risk that this medication could lead to serious side effects or negatively affect cognitive health.

RBD is still largely a mystery. For patients without certain complications, Klonopin is an effective remedy, at least in the short term. Regardless of whether treatment is effective, RBD still predicts later neurologic decline in many cases. More research is necessary so that doctors can understand exactly what causes RBD and what medications may reverse the course of the disease.

References

Aurora, R. N., Zak, R. S., Maganti, R. K., Auerbach, S. H., Casey, K. R., Chowdhuri, S., et al. (2010). Best practice guide for the treatment of REM sleep behavior disorder (RBD). Journal of Clinical Sleep Medicine, 6(1), 85-95.
PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Clonazepam. Retrieved April 30, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000635/
Mayo Clinic. (n.d.). REM sleep behavior disorder. Retrieved April 30, 2012, from http://www.mayoclinic.org/rem-sleep-behavior-disorder/

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