Melatonin therapy for REM sleep behavior disorder

Abstract

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia with clinical symptoms that include punching, kicking, yelling and leaping out of bed in sleep. Polysomnographic (PSG) finding showed REM sleep without muscle atonia. Clonazepam is generally used for treating RBD symptoms but melatonin was reported to be effective so we reconfirmed the effect of melatonin on RBD patients in the present study. We used melatonin (3-9 mg/day) which could ameliorate problem sleep behaviors remarkably, as well as %tonic activity in PSG variables. In the present study, melatonin was reconfirmed to be effective in RBD symptoms, especially for patients with low melatonin secretion, while its mechanism was not clearly known in the present study.

Seeking Good Alternatives to Clonazepam: Suggestions for Future Treatment Trials in REM Sleep Behavior Disorder

“…Accordingly, further prospective studies using well-defined measurement techniques are required. As an objective measurement of treatment efficacy, reduction in REM sleep without atonia (RWA) measured by polysomnography (PSG) was reported in previous melatonin studies 4,5 ; however, the results of our present study of ramelteon and a previous study of pramipexole indicate their efficacy in treating RBD may be independent of reduced RWA. 6,7 The RBD severity scale (RBDSS) represents a further objective measure of the severity of RBD using video-PSG; however, measurements of RBDSS differed in 60% of patients between nights 1 and 2 in the original report.…”

Impaired GABA and Glycine Transmission Triggers Cardinal Features of Rapid Eye Movement Sleep Behavior Disorder in Mice

“…Long-term melatonin treatment is used to alleviate RBD symptoms (Takeuchi et al, 2001;Boeve et al, 2003;Kunz and Mahlberg, 2010). To chronically treat wild-type and transgenic mice, a melatonin (Sigma-Aldrich) solution was prepared in ethanol and dissolved in the drinking water (12.5 g/ml tap water, in 0.07% ethanol) for 2-4 weeks.…”

Beneficial Effects of Ramelteon on Rapid Eye Movement Sleep Behavior Disorder Associated with Parkinson's Disease - Results of a Multicenter Open Trial

“…Because the striatal dopamine circuit also regulates sleep quality (30), increased striatal L-dopa bioavailability by melatonin may modulate sleep in patients with PD. In terms of clinical studies, four reports of studies using polysomnography (PSG) have described that melatonin decreases RWA (6)(7)(8)(9). Furthermore, compared with clonazepam, melatonin may significantly lessen the risk of falls and injury in patients with PD (10).…”

“…To date, only one randomized controlled trial has reported beneficial effects of melatonin on RBD (6). Several open and retrospective trials (7)(8)(9)(10)(11) have also suggested that melatonin has beneficial effects on idiopathic and/or secondary RBD. Moreover, Nomura et al (12) reported that ramelteon was effective in treating patients with secondary RBD complicated by PD or MSA.…”