From the Guidelines
Clonazepam is the most commonly prescribed medication for sleepwalking, typically starting at a low dose of 0.25-1.0 mg administered at bedtime, due to its effectiveness in reducing dream enactment and promoting GABAergic inhibition. The American Academy of Sleep Medicine clinical practice guideline recommends clonazepam as a first-line treatment for isolated REM sleep behavior disorder (RBD), which is often associated with sleepwalking 1. This guideline also suggests that melatonin, pramipexole, and rivastigmine may be considered as alternative treatments, but clonazepam remains the most widely used and studied medication for this condition.
Some key points to consider when prescribing clonazepam for sleepwalking include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for potential side effects, such as drowsiness, dizziness, and dependence
- Being cautious when prescribing clonazepam to older adults or those with dementia, gait disorders, or concomitant obstructive sleep apnea (OSA)
- Combining medication with good sleep hygiene practices, such as maintaining a regular sleep schedule and ensuring a safe sleeping environment
It's also important to note that sleepwalking can sometimes be triggered by other sleep disorders or medical conditions, and a thorough evaluation by a healthcare provider is necessary to determine the underlying cause and develop an effective treatment plan 1. Additionally, melatonin may be considered as an alternative treatment for sleepwalking, particularly for those who cannot take clonazepam or have concerns about its potential side effects 1.
From the Research
Medication for Sleep Walking
- Sleep walking, also known as somnambulism, is a condition that can be managed with medication, particularly in cases where it poses a risk of injury to oneself or others 2.
- The most commonly used medications for sleep walking are benzodiazepines, such as clonazepam, as well as tricyclic antidepressants and serotonin selective re-uptake inhibitors 2.
- Treatment of underlying causes, such as obstructive sleep apnea, upper airway resistance syndrome, restless legs syndrome, and periodic limb movements, is also an effective approach in eliminating somnambulism in children and adults 2.
Types of Medications Used
- Benzodiazepines, such as clonazepam, have been shown to be effective in managing sleep disorders, including sleep walking 2, 3.
- Tricyclic antidepressants, such as doxepin, have also been found to improve sleep quality and reduce sleep walking episodes 4.
- Selective serotonin re-uptake inhibitors (SSRIs) may also be used to manage sleep walking, although the evidence for their effectiveness is limited 4.
Potential Risks and Side Effects
- Benzodiazepines, such as zolpidem, have been identified as potential triggers for sleep walking, and their use should be carefully considered 5.
- Long-term use of benzodiazepines can also lead to health problems, such as complete obstructive sleep apnea in heavy snorers or short repetitive central sleep apnea in patients with recent myocardial infarction 6.
- The use of antidepressants, such as trazodone, for insomnia has been found to have uncertain effects on sleep quality and tolerability, and their use should be carefully monitored 4.