Is Klonopin (clonazepam) or Restoril (temazepam) more effective?

Clonazepam vs. Temazepam for Sleep Disorders

Clonazepam (Klonopin) 0.25mg is generally more effective than temazepam (Restoril) for most sleep disorders, particularly for REM sleep behavior disorder (RBD), due to its longer duration of action and established efficacy in controlling abnormal sleep behaviors. 1

Pharmacological Differences

Clonazepam (Klonopin)

• Long-acting benzodiazepine with elimination half-life of 30-40 hours 1
• Rapid absorption with 90% bioavailability
• Maximum plasma concentrations reached within 1-4 hours
• Recommended dosage for RBD: 0.25-2.0mg taken 30 minutes before bedtime 1

Temazepam (Restoril)

• Intermediate-acting benzodiazepine with elimination half-life of 14.7 hours 2
• Mean time to peak concentration is approximately 3 hours
• Primarily indicated for transient or short-term insomnia 3
• Limited evidence for efficacy in RBD 1

Efficacy Comparison

For REM Sleep Behavior Disorder (RBD)

Clonazepam is clearly superior:

• First-line treatment for RBD with strong evidence (Level B recommendation) 1
• Effective in 80-90% of RBD patients 1
• Controls violent/vigorous behaviors and loud vocalizations more effectively
• Minimal dosage tolerance reported with long-term use 1

For General Insomnia

Temazepam shows some advantages:

• Specifically designed as a hypnotic 2
• Improves sleep maintenance and total sleep time 4
• Lower risk of next-day residual effects compared to longer-acting benzodiazepines 4
• Better for transient or short-term insomnia rather than chronic use 3

Side Effect Profiles

Clonazepam Concerns

• Morning sedation (common) 1
• Early morning motor incoordination
• Memory dysfunction
• Potential worsening of sleep apnea at doses of 0.5-1.0mg 1
• Risk of confusion and falls, especially at higher doses 1

Temazepam Concerns

• Drowsiness, dizziness, and lethargy 2
• Relatively low incidence of hangover effects at 15-30mg doses 2
• Potential for cognitive and psychomotor impairment at doses of 30mg or more 4

Decision Algorithm

1. If treating RBD: Choose clonazepam 0.25mg (can be titrated up to 2.0mg as needed)

   • Most effective for controlling abnormal behaviors during REM sleep
   • Established efficacy with minimal tolerance development

2. If treating simple insomnia without RBD:

   • For short-term/transient insomnia: Consider temazepam
   • For insomnia with any abnormal sleep behaviors: Prefer clonazepam

3. Special considerations:

   • Patients with sleep apnea: Use either with caution; clonazepam may worsen sleep apnea 1
   • Elderly patients: Both medications require lower dosing and careful monitoring 5
   • Patients with liver disease: Use with caution, particularly clonazepam 1

Important Precautions

• Both medications carry risks of dependence and withdrawal with long-term use 6
• Avoid combining with other CNS depressants due to potential for additive effects 5
• Benzodiazepines should generally be used for short courses (ideally 4 weeks maximum) 3
• Gradual tapering (approximately 25% every 1-2 weeks) is recommended when discontinuing 5
• Benzodiazepines can cause cognitive impairment, falls, and fractures in older adults 5

For most sleep disorders, particularly those involving abnormal behaviors during sleep like RBD, clonazepam 0.25mg is the more effective option with better established efficacy and safety data.