AAN 2022 | Treatment of parasomnias
Alberto Ramos, MD, FAAN, University of Miami, Miller School of Medicine, Miami, FL, discusses the treatment options for parasomnias. Dr Ramos states that the utmost priority is that the patient is safe; parasomnias, by definition, are abnormal behaviors during sleep, which could ultimately cause harm. Therefore, it is vital to ensure that patients are in a safe and comfortable environment. Dr Ramos describes methods of ensuring safety by installing bed railings, lowering the bed to floor level, or removing potentially hazardous items and furniture that a patient could fall into. Concerning treatment for non-REM sleep parasomnias, the most common type of medication are benzodiazepines, particularly clonazepam. However, there have not been any randomized clinical trials showing that one medication is superior to the other, and treatment selection is based on observational and case-control studies. Dr Ramos states that the two primary medications utilized for REM sleep parasomnias are melatonin and clonazepam. These medications help minimize abnormal behaviors during sleep. This interview took place at the American Academy of Neurology 2022 Congress in Seattle, WA.
Transcript (edited for clarity)
There are multiple options or treatments available. The first things that we would like to do, make sure that the patient is safe because the parasomnias by definition are abnormal behaviors during sleep, where the person can get out the room, can actually try to hit a bed partner in some occasion or they can fall out of bed or even do some other behavior, it can be potentially dangerous. We want to make sure that first, they are in a safe environment...
There are multiple options or treatments available. The first things that we would like to do, make sure that the patient is safe because the parasomnias by definition are abnormal behaviors during sleep, where the person can get out the room, can actually try to hit a bed partner in some occasion or they can fall out of bed or even do some other behavior, it can be potentially dangerous. We want to make sure that first, they are in a safe environment. And then there are different ways to do that, that consist from either using bed railings so they don’t get out of the bed or even at times putting the bed at the level of the floor. So you minimize any falls or making sure that you remove anything that is close to the bed, such as either desk or lamps or things along those lines.
Now in terms of medications for the non-REM parasomnias, the ones that usually occur in non-REM sleep. One of the mainstays of therapy depending on the type, but most commonly people tend to use benzodiazepines, different types of benzodiazepines, most commonly clonazepam but those seem to be the one that is most commonly used. Now there are different treatment options, but that’s the most common one. Albeit there’s no big trials or randomized clinical trials to show that one treatment is better than the other. This is really based on large studies or observational studies or more like case-control studies over time. For REM parasomnia, we use two main medications. One is melatonin that you can actually buy over the counter. And also you can use clonazepam. The same benzodiazepine, those are the two ones that have most data to be used in that type of parasomnia. What they do is they suppress or minimize the behaviors during sleep so the person doesn’t act out their dreams.
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