Clonazepam: The Double-Edged Sword for Treatment of REM Sleep Behavior Disorder (RBD)

​Clonzepam (Klonpin®) is one of the main medications for treatment of REM Sleep Behavior Disorder (RBD). ‪@andyberkowskimd‬ of ReLACS Health describes why this medication, though often effective, can be a double-edged sword and the decision to start on this medication should be well thought out.

Normally, the body's muscles are nearly paralyzed during REM sleep so that one does not act out dreams. In RBD, there a problem with the switch in the brain to shut off the muscle movement, and one can become un-paralyzed and begin acting out dreams. This can lead to talking, yelling, conversation, fighting, and other behaviors that can be dangerous to a spouse in bed or the individual themself.

To learn more about RBD, watch this video:
   • What is REM Sleep Behavior Disorder (RBD)?  

Treatment primarily involves safety precautions in the bedroom, including mitigating injury to the spouse or the individual themself (e.g. lowering the bed, padding the ground, moving the nightstand away from the bed, sleeping in a separate bed from the bedpartner, etc.). High-dose melatonin is often used first if behaviors are disruptive enough to warrant medications, but if ineffective, stronger prescription drugs like clonazepam or other benzodiazepines are often used and have the most evidence for effectiveness.

This video discusses the details about melatonin in the treatment of RBD:
   • Melatonin is the Best Treatment for REM Sl...  

Unfortunately, clonazepam is a long-acting benzodiazepine and can last more than a day or two in the body, leading to a build up of the drug. Because benzodiazepines are sedative-hypnotics, they slow the brain down and can lead to symptoms of drowsiness, impaired cognition, and unsteadiness. The condition is often associated with conditions like Parkinson disease or similar neurological disorders so adding a drug that causes impairment can be counterproductive or dangerous. Moreover, clonazepam can lead to chemical dependence, in which the brain gets acclimated to the medication and with long-term use, it may take weeks or months to taper out without significant withdrawal symptoms including anxiety or insomnia.

RBD does not improve the underlying condition causing RBD or the course of RBD itself, so it should only be used if absolutely needed for safety or if the effects of the dream enactment are extremely distressful to the patient or loved ones. Safety precautions always come first but sometimes medications can aid in calming down the behaviors and reducing risk of injury. This is a difficult decision for most patients as the drug generally has effectiveness in controlling the nighttime behaviors.

To read more in depth about sleep and sleep conditions, read A ReLACSing blog:
https://www.relacshealth.com/blog

These videos are for general medical information only, but for those who live in or near Michigan, Ohio, or Florida, you can hire ‪@andyberkowskimd‬ of ReLACS Health for consultation regarding your own personal sleep health including dream enactment, RBD, or other sleep conditions that require a little more time and attention. Go to https://www.relacshealth.com/ for more information.