Pharmacological Treatment for Rapid Eye Movement Sleep Behavior Disorder

Abstract

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by abnormal movement during REM sleep. Violent motor behaviors correlated with dreams commonly result in sleep-related injuries, which are sometimes life-threatening, to patients and their bed partners. The current guidelines for RBD treatment include counseling, modifying the sleep environment to prevent sleep-related injury, and pharmacological therapy. This paper focuses on current pharmacotherapy options for the treatment of RBD, including clonazepam and melatonin, which represent the mainstay of RBD therapy. Acetylcholinesterase inhibitors and dopamine-agonists have been used, as RBD is usually associated with other neurodegenerative diseases, with encouraging results in preliminary clinical trials. More randomized controlled trials with objective outcome measures are needed to assess both short-term and long-term effects of these medications and their efficacy in RBD. Understanding the exact mechanisms involved in decreasing RBD symptoms could provide future approaches in new drug development.