Rapid eye movement, or REM, sleep is important to a person’s overall health. A valuable part of the sleep cycle, REM sleep is the period in which people experience dreams, and when many important maintenance functions happen in the brain. Some people experience REM sleep behavior disorder (RBD) in which they physically act out their dreams.
Disruptions to REM sleep can cause various symptoms, such as drowsiness during the day, trouble thinking clearly and mood disorders such as depression or anxiety. In many cases, REM sleep behavior disorder progresses to much more serious diseases, such as Parkinson’s disease. Proper treatment is important to maintain a healthy sleep cycle and avoid the worst of the symptoms.
Clonazepam (Klonopin) is currently the most effective medication for RBD. About 90% of cases of RBD respond well to clonazepam treatment. It is a type of benzodiazepine that suppresses the central nervous system. Because clonazepam is a benzodiazepine, it is not recommended for people with substance use disorders or people who are at risk of drug interactions.
Melatonin is nearly as effective as clonazepam for RBD and has fewer risks and side effects. It works well as a general REM sleep medication for people with a variety of conditions that affect REM sleep, including jet lag, shift work and insomnia.
Various medications can disrupt REM sleep and make RBD worse. People who have RBD have to work carefully with medical professionals to make sure that the medications they are taking for other conditions do not interfere with their sleep or cause their RBD symptoms to worsen.
Medications that suppress REM sleep include the following:
- Stimulant drugs and medications
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitor (MAOI) antidepressants
- Selective serotonin reuptake inhibitor (SSRI) antidepressants
The reason that antidepressants affect REM sleep is not fully understood, though it is most likely due to their effects on levels of serotonin and natural sleep hormones. All classes of stimulants cause surges of adrenaline and dopamine that interfere with sleep. Though the reasons are different, all of these drugs and medications have the same result: people spend less time in REM sleep.
There are several behaviors that a person can practice to improve their REM sleep quality. Many of these can help with sleep in general. Some are natural ways to improve REM sleep, while others are ways to avoid injury during an episode of REM sleep behavior disorder.
- Avoid consuming alcohol and caffeine
- Get plenty of daily exercise
- Sleep on the ground floor of an apartment building and away from windows, if possible
- Place a mattress on the floor and place cushions around the bed
- Place the bed against a wall or install guard rails
- Remove furniture with sharp corners and potentially dangerous objects from the bedroom
- Sleep in a separate room from bed partners until episodes have subsided
Treating REM Sleep Behavior Disorder and Co-Occurring Conditions
Frequently, RBD co-occurs with drug and alcohol addictions and other mental health conditions, such as depression and anxiety. Since these conditions can aggravate RBD, they need to be treated at the same time, which is a treatment approach known as dual-diagnosis care.
The treatment for these conditions may vary, and can include medications and psychotherapy. However, since certain medications, such as some classes of antidepressants, can make RBD symptoms — and ultimately depressive symptoms — worse, care must be taken to treat these other disorders in ways that do not worsen RBD.
Substance abuse can often lead to sleep disorders such as RBD. If you or a loved one are struggling with alcohol or drug dependence and poor sleep, specialized help is available. Contact The Recovery Village today to learn about how our co-occurring disorders treatment can help you.
National Sleep Foundation. “REM Sleep Behavior Disorder.” (n.d.) Accessed May 25, 2019. American Academy of Sleep Medicine. “REM Sleep Behavior Disorder- Diagnosis and Treatment.” (n.d.) Accessed May 25, 2019. Nordqvist, C. “What is REM sleep behavior disorder?” Medical News Today, October 9, 2018. Accessed May 25, 2019.
National Sleep Foundation. “REM Sleep Behavior Disorder.” (n.d.) Accessed May 25, 2019.
American Academy of Sleep Medicine. “REM Sleep Behavior Disorder- Diagnosis and Treatment.” (n.d.) Accessed May 25, 2019.
Nordqvist, C. “What is REM sleep behavior disorder?” Medical News Today, October 9, 2018. Accessed May 25, 2019.