From the Guidelines
Clonazepam for Night Terrors and REM Sleep Behavior Disorder
Clonazepam is a viable treatment option for night terrors and REM sleep behavior disorder, but its use should be approached with caution due to potential side effects and risks.
- A typical dose of 0.5-2 mg taken 30 minutes before bedtime may be prescribed, with treatment duration and dosage adjusted based on individual response and tolerance 1.
- The medication has been shown to reduce dream enactment and improve symptoms in patients with REM sleep behavior disorder, although the exact mechanism of action is unknown 1.
- However, clonazepam can have adverse effects, such as dependence, cognitive impairment, and increased risk of falls, particularly in older adults 1.
- Alternative treatments, such as melatonin and pramipexole, may also be considered, and lifestyle modifications, such as establishing a safe sleep environment, should be explored under medical supervision 1.
- It is essential to consult a healthcare professional for a thorough evaluation and guidance, as clonazepam is generally recommended for short-term use 1.
- The American Academy of Sleep Medicine suggests using clonazepam for the treatment of isolated REM sleep behavior disorder in adults, considering the age of the patient and potential sedating side effects 1.
From the Research
Clonazepam and REM Sleep Behavior Disorder
- Clonazepam has been used as a first-line therapy for REM sleep behavior disorder (RBD) for many years, with studies reporting its efficacy in reducing symptoms 2, 3, 4.
- However, clonazepam can have adverse effects, such as daytime sedation, confusion, and exacerbation of existing sleep apnea, particularly in the elderly or those with cognitive impairment 2, 4.
- Alternative therapies, such as melatonin, have been found to be effective and may be better tolerated than clonazepam 3, 4, 5.
Clonazepam and Night Terrors
- There is limited direct evidence on the use of clonazepam for night terrors, but it is sometimes used off-label for this condition.
- Studies on RBD may provide some insight, as night terrors can be related to REM sleep disorders, but more research is needed to fully understand the effectiveness of clonazepam for night terrors.
Comparison with Other Treatments
- Melatonin has been found to be equally effective as clonazepam in some studies, and may be a better option for patients who are at risk of falls or have cognitive impairment 3, 5.
- Other alternative therapies, such as zopiclone, temazepam, and lorazepam, have also been found to be effective in some cases 2, 3.
- A comparative study found that clonazepam improved RWA and RBD symptoms more than prolonged-release melatonin, but with increased depressive symptoms and daytime sleepiness 5.