What is the recommended treatment and management plan for REM (Rapid Eye Movement) behavioral disorder using melatonin?

Melatonin Informed Consent for REM Sleep Behavior Disorder (RBD)

Melatonin is recommended as an effective treatment for REM sleep behavior disorder with fewer side effects compared to alternative medications. 1

Medication Information

Melatonin is a hormone naturally produced by your pineal gland that helps regulate sleep-wake cycles. When used for RBD:

• Mechanism of Action: Melatonin suppresses REM sleep motor tone and helps normalize circadian features of REM sleep that are disrupted in RBD 1

• Dosage:

  • Starting dose: 3 mg taken at bedtime
  • May be titrated up in 3 mg increments to a maximum of 12-15 mg based on symptom control
  • Immediate-release formulation is recommended (prolonged-release has insufficient evidence) 1

• Administration:

  • Take at the same time each night, approximately 30-60 minutes before bedtime
  • Consistent timing is critical for effectiveness 2
  • Treatment should be continued for at least 6 months for optimal and lasting benefits 2

Expected Benefits

• Significant reduction in dream enactment behaviors within 1-4 weeks of starting treatment 2, 3
• Decreased risk of injury to yourself and bed partner 4
• Improved sleep quality and reduced sleep disruption
• Studies show melatonin can normalize REM sleep patterns on polysomnography 3
• Benefits may persist even after discontinuation if treatment is maintained for at least 6 months 2

Potential Risks and Side Effects

• Common side effects (generally mild):

  • Morning headache
  • Morning sleepiness
  • Vivid dreams 1, 5

• Rare but serious side effects:

  • Delusions/hallucinations (particularly in those with cognitive impairment)
  • Possible impaired glucose tolerance in some individuals 6

• Important considerations:

  • Melatonin is classified as a dietary supplement in the US with variable quality control
  • Look for products with USP (United States Pharmacopeia) verification to ensure stated dose accuracy 6

Alternative Treatments

• Clonazepam (0.25-2.0 mg) is an alternative treatment but has more side effects including:
  • Daytime sedation
  • Risk of falls, especially in older adults
  • Potential for worsening sleep apnea
  • Memory dysfunction 1

Monitoring and Follow-up

• Regular follow-up appointments will assess:
  • Effectiveness in controlling RBD symptoms
  • Need for dose adjustments
  • Presence of side effects
  • Development of any neurological symptoms (as RBD may be associated with neurodegenerative disorders) 1

By signing this consent, you acknowledge understanding of the benefits, risks, and alternatives of melatonin treatment for RBD. You may withdraw consent at any time and discuss alternative treatment options.