Last updated April 13, 2023
Management of REM Sleep Behavior Disorder
Summary of Recommendations
ADULT PATIENTS WITH ISOLATED RBD
The AASM suggests that clinicians use clonazepam (vs no treatment) for the treatment of isolated RBD in adults. (Conditional)
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The AASM suggests that clinicians use immediate-release melatonin (vs no treatment) for the treatment of isolated RBD in adults. (Conditional)
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The AASM suggests that clinicians use pramipexole (vs no treatment) for the treatment of isolated RBD in adults. (Conditional)
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The AASM suggests that clinicians use transdermal rivastigmine (vs no treatment) for the treatment of isolated RBD in adults with mild cognitive impairment. (Conditional)
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ADULT PATIENTS WITH SECONDARY RBD DUE TO MEDICAL CONDITION
The AASM suggests that clinicians use clonazepam (vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (Conditional)
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The AASM suggests that clinicians use immediate-release melatonin (vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (Conditional)
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The AASM suggests that clinicians use transdermal rivastigmine (vs no treatment) for the treatment of secondary RBD due to medical condition (Parkinson disease) in adults. (Conditional)
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The AASM suggests that clinicians not use deep brain stimulation (DBS; vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (Conditional)
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ADULT PATIENTS WITH DRUG-INDUCED RBD
The AASM suggests that clinicians use drug discontinuation (vs drug continuation) for the treatment of drug-induced RBD in adults. (Conditional)
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GOOD PRACTICE STATEMENT
It is critically important to help patients maintain a safe sleeping environment to prevent potentially injurious nocturnal behaviors. In particular, the removal of bedside weapons, or objects that could inflict injury if thrown or wielded against a bed partner, is of paramount importance. Sharp furniture like nightstands should be moved away or their edges and headboard should be padded. To reduce the risk of injurious falls, a soft carpet, rug, or mat should be placed next to the bed. Patients with severe, uncontrolled RBD should be recommended to sleep separately from their partners, or at the minimum, to place a pillow between themselves and their partners. ()
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- DBS: Deep Brain Stimulation
- DLB: Dementia With Lewy Bodies
- PD: Parkinson Disease
- RBD: Rapid Eye Movement Sleep Behavior Disorder
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Title
Management of REM Sleep Behavior Disorder
Authoring Organization
American Academy of Sleep Medicine
Publication Month/Year
April 5, 2023
Country of Publication
US
Document Objectives
This guideline establishes clinical practice recommendations for the management of rapid eye movement sleep behavior disorder (RBD) in adults. The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. The task force provided a summary of the relevant literature and the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D020187 - REM Sleep Behavior Disorder
Keywords
sleep disorders, narcolepsy, REM Sleep, sleep behavior, sleep disorder, REM sleep behavior disorder, dream enactment, parasomnia
Source Citation
Howell M, Avidan AY, Foldvary-Schaefer N, Malkani RG, During EH, Roland JP, McCarter SJ, Zak RS, Carandang G, Kazmi U, Ramar K. Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2023 Apr 1;19(4):759-768. doi: 10.5664/jcsm.10424. PMID: 36515157; PMCID: PMC10071384.