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Management of REM Behaviour Sleep Disorder

What to do if you suspect you have RBD…

REM sleep behavior disorder is strongly associated with certain neurologic diseases including Parkinson’s disease. In fact it can precede the development of this illness by several years. The symptoms can usually be described as dream enacting behaviors which include often violent movements and loud vocalizations that can prove to be injurious to the patient or bed partner. If you or your loved one is suspicious that you may have RBD, here are some guidelines to follow.

(1) Keep a sleep diary. For about two weeks prior to your visit with your physician, you and your bed partner should record your sleep patterns for each night. It is important to note the time at which you slept and awoke, any difficulty falling asleep, how many times you woke up during the night and when, vivid dreams, whether you were vocalizing (talking or yelling), any acting out behaviors your partner recalls, any apneic episodes (when you’re not breathing for an extended period of time), snoring, whether you feel rested in the morning, daytime sleepiness and so forth.

(2) When you go see your physician, bring a list of all medications you are currently taking both prescribed and over the counter. This is important because some medications including some of the newer antidepressants have been associated with the development of RBD.

(3) If diagnosed with RBD or if you are having symptoms suggestive of this disorder, it is important to take precautions to ensure your safety as well as that of your bed partner. In fact until your symptoms subside, it may be safer for your bed partner to sleep elsewhere or in a separate space within the same room.

(4) Place a mattress or cushion on the floor in case your movement causes you to fall out of bed. A bed rail can be used for the same purpose but can be dangerous if you are prone to getting out of bed during your sleep episodes as climbing over a bed rail can lead to falling.

(5) Remove any dangerous or sharp objects or weapons (fairly logical!) from the area.

(6) Protect doors and windows as well as stairs in case of sleepwalking.

(7) You may try or your physician may recommend a trial of melatonin (3 – 6 mg at bedtime) which has been shown to be successful for some.

(8) Ask your physician about medication. Luckily almost 90% of cases respond to a specific medication – clonazepam. This improvement or resolution of symptoms occurs almost immediately. However the behaviors return just as quickly once the medication has stopped so medication is necessary on a long-term basis. If clonazepam is not effective, then your physician may consider another medication such as tricyclic antidepressants (although one must be careful as these drugs may actually worsen RBD at times) or Levodopa itself which may be successful in controlling this disorder if adjusted.

(9) Continue to monitor treatment and adjust medications accordingly. With long-term treatment, some vocalization and limb movement can recur. However the violent nature of the behavior rarely returns.

RBD can be a difficult and intrusive complication of Parkinson’s disease but with careful and diligent intervention, can be managed resulting in an improved quality of sleep both for yourself and your bed partner.

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