The American Academy of Sleep Medicine has now released a new clinical guideline with suggestions for adult people with REM sleep behavior disorder on how to manage it.
The recommendation updates earlier advice from the AASM that was released in 2010. The paper is accessible to everyone online in the Journal of Clinical Sleep Medicine.
The recommendations are further supported by a number of clinical trials that were carried out in the last 10 years.
Dr. Michael Howell, the study’s lead author, explains that “REM sleep behavior disorder is common, affecting more than 80 million people worldwide. This clinical practice guideline provides specialists with insight on how to best prevent sleep related injury and how to provide patients with a proper risk assessment for neurological disease. The task force assembled by the AASM reviewed thousands of clinical studies in order to provide an up to date guideline for clinicians managing REM sleep behavior disorder.”
Parasomnia is a category of sleep disorders that includes adverse physical occurrences during different sleep stages including falling asleep, sleeping and waking up.
Rapid eye movements and dream activity are key features of REM sleep, which typically includes skeletal paralysis.
In REM sleep behavior disorder, this paralysis, also known as muscle atonia, is lost, which causes sufferers to act out dreams with possibly harmful movements that can lead to injury.
The dreamer is typically confronted, pursued or even attacked by strange people or animals in these unpleasant, action-packed, or aggressive dreams.
The signs of REM sleep behavior disorder are frequently disregarded for years, generally until the dreamer or their partner sustains harm.
An underlying neurological condition, such as dementia, Parkinson’s disease, narcolepsy, or stroke, frequently causes REM sleep behavior disorder.
The guideline now offers suggestions for certain drugs that doctors should take into account when treating individuals with REM sleep behavior disorder, including clonazepam and immediate-release melatonin.
However, all of the advice is conditional, therefore the appropriate course of action must be determined by the physician based on professional expertise and experience as well as careful consideration of the patient’s unique preferences.
The kind of REM sleep behavior disorder—isolated, related to another medical illness, or drug-induced—also affects the treatment possibilities.
The recommendation underlines that patients must maintain a secure sleeping environment to avoid accidents while they are asleep.
More precisely, they are required to take away any items from the nightstand that might easily hurt them or their bed partner during sleep.
A soft rug or mat should also be put close to the bed in case of unexpected falls; sharp furnishings should be moved far away or have their edges dull, rounded or even padded.
Furthermore, those with severe sleep behavior disorder should be recommended to sleep apart from their spouses or partners until cured, just to lower the injury risks as much as possible.
The AASM decided to hire a task team of sleep medicine professionals with experience in sleep behavior disorders to deliver these guidelines.
The team developed the clinical practice recommendations after doing a thorough evaluation of the evidence available by using the GRADE method, taking into account the strength of proof, of the positive and negative consequences, patient preferences and values, and the use of resources.
The International RBD Study Group, Wake Up Narcolepsy and Project Sleep all supported this new guideline.
