Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam

J Clin Sleep Med. 2009 Jun 15;5(3):235-9.


Study objectives: REM sleep behavior disorder (RBD) is characterized by loss of the normal muscle atonia during REM sleep associated with disruptive motor activity related to the acting out of dreams. There is frequently injury to the patient or bed partner, and treatment is usually required. Clonazepam has been the first-line therapy for many years, with 2 large case series reporting efficacy with few side effects in the majority of patients. However, long-acting hypnotics in the elderly or those with cognitive impairment can be associated with adverse events especially unacceptable daytime sedation, confusion, and exacerbation of existing sleep apnea.

Methods: We reviewed 39 patients with confirmed RBD who were treated within our regional sleep center, assessing both efficacy and side effects of drug therapies.

Results: Adverse effects were reported by 58% of the patients using clonazepam, with 50% either discontinuing the drug or reducing the dose. This prompted us review the side effects of clonazepam in detail and to look for alternative therapies. We report several novel and effective therapies, in particular zopiclone, in a series of patients under long-term follow-up for RBD.

Conclusions: There are alternatives to clonazepam therapy for RBD which can be as effective and may be better tolerated.

MeSH terms

  • Adjuvants, Anesthesia / therapeutic use
  • Aged
  • Azabicyclo Compounds / therapeutic use*
  • Central Nervous System Depressants / therapeutic use
  • Clonazepam / adverse effects
  • Clonazepam / therapeutic use*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • GABA Modulators / adverse effects
  • GABA Modulators / therapeutic use*
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Male
  • Melatonin / therapeutic use
  • Piperazines / therapeutic use*
  • Polysomnography
  • REM Sleep Behavior Disorder / drug therapy*
  • Retrospective Studies
  • Severity of Illness Index
  • Sodium Oxybate / therapeutic use
  • Surveys and Questionnaires
  • United Kingdom


  • Adjuvants, Anesthesia
  • Azabicyclo Compounds
  • Central Nervous System Depressants
  • GABA Modulators
  • Hypnotics and Sedatives
  • Piperazines
  • zopiclone
  • Clonazepam
  • Sodium Oxybate
  • Melatonin