Melatonin Can Treat REM Behavior Disorder

Rapid eye movement sleep behavior disorders and melatonin

man sleeping
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REM (rapid eye movement) sleep behavior disorders can be annoying if not dangerous and have been frustrating to treat. What have we learned about the role of melatonin supplements in treating these disorders?

REM Behavior Disorders (RBD)

You may not have heard about REM behavior disorders (RBDs), but many people are familiar with some common examples. If you know of someone who was dreaming about being attacked by a human or animal and woke up punching their husband, you have heard an example.

If you or someone you know has acted out due to your dreams (while still asleep), it may be a condition known as RBD.

Sleep and RBD

During a normal night of sleep, we go through different stages of sleep. REM sleep (with REM standing for rapid eye movement sleep) the brain is very active. It is this stage of sleep that is usually associated with dreams. While in REM sleep we are usually unable to use our muscles, with the exception of eye muscles and of course our diaphragm (so we keep breathing). If our other muscles are not paralyzed during this type of sleep, we may have the ability to act out our dreams. These actions are referred to as REM behavior disorders.

Most people experience REM sleep around every 90 minutes. Early in a typical night's sleep these periods are short but become progressively longer as we near awakening in the morning. Most REM sleep occurs in the last third of a night's sleep.

Common REM Sleep Disorder Behaviors

Unfortunately, most of the dreams associated with RBD are unpleasant and involve an intrusion or attack of some form. When these dreams are translated into actions, behaviors may include punching, kicking, falling out of bed, talking, or yelling. When these actions occur they can result in injury to either the person experiencing RBD or their bed partners.

RBD affects roughly 1 in 200 people and is more common in middle-aged men, It has been associated with Parkinson's disease and other neurological conditions, as well as alcohol withdrawal, and may also occur as an adverse reaction to medications such as antidepressants. It has also been seen in young people with narcolepsy.

RBD can be dangerous. In one study, 32 to 64 percent of individuals suffering from RBD caused an injury to either themselves or their bed partner. In 7 percent this involved a broken bone. Very rarely, RBD has resulted in strangulation or a traumatic brain injury. While severe injuries are the exception, even RBD without injuries can cause great distress to both the person affected and to their bed partner.

Melatonin and Sleep

Melatonin is a naturally occurring hormone that is available over-the-counter. It has been used widely used to treat circadian rhythm disorders, undiagnosed sleep problems, jet lag, and menopausal symptoms. It has also been researched for its effect on Alzheimer's disease, and even for its potential in preventing and treating cancer.

Melatonin is produced naturally in the pineal gland of the brain during sleep. Greater levels are secreted in darkness and this is the reason behind the recommendation to sleep in a dark room with the lights off.

In addition to light at night, illness and age can reduce the amount naturally secreted. Melatonin secretion begins in the evening and peaks in the middle of the night (between 2 and 4 am.)

Does melatonin have an unexpected role in treating REM behavior disorder (RBD)?

Effectiveness of Melatonin for REM Sleep Behavior Disorders

Melatonin has been researched for its role in treating RBD, and in fact, is now recommended the first line (before anything else) for the treatment of this sleep disorder. It appears to have a more direct effect on the disorder than Klonopin (clonazepam), the previously recommended first-line treatment.

Not only does melatonin work better, it is safer and more tolerable than Klonopin.

In studies, melatonin reduced muscle tone during REM sleep (people moved less during this stage of sleep) which means a decreases ability to enact dreams. This is evident in studies which have found that melatonin clearly decreases REM behaviors.

Of note is that doses of melatonin used to treat RBD are usually higher than those used as a sleep aid, with doses of 3 mg to 12 mg used in studies noted.

Melatonin supplements also appear to be successful in people with Parkinson's disease, Lewy body dementia, and multiple system atrophy—all conditions that commonly coexist with RBD.

How Might Melatonin Work to Treat RBD and Sleep Disorders?

Despite its effectiveness in reducing REM behavior disorders, we aren't entirely sure how melatonin works. Melatonin seems to be a signal in our bodies that coordinate our sleep and wakefulness to the patterns of light and dark in our environment.

Melatonin may help to synchronize sleep patterns to promote sleep. It also appears to improve sleep efficacy. On a molecular level, GABAergic inhibition (inhibition of one of the neurotransmitters in the brain) may play a role.

Advantages of Melatonin

One of the major advantages of melatonin use is that it has few side effects. Compared with Klonopin, melatonin has fewer side effects. It is also less likely to interact with other medications a person is taking.

Disadvantages and Side Effects of Melatonin

As noted earlier, the doses of melatonin used in studies evaluating their use in REM behavior disorders have been higher than those used for insomnia or jet lag. The most common side effects found at these doses have included morning sleepiness (29 percent), trouble thinking (12 percent), balance problems (8 percent), nausea (8 percent) and sexual dysfunction (8 percent).

Bottom Line on the Use of Melatonin for REM Sleep Behavior Disorders

Melatonin appears to be a safer and more tolerable option for the treatment of REM behavior disorders than Klonopin, though Klonopin has been well demonstrated to be effective. Melatonin also appears to work better, and likely gets to the root of the abnormality rather than simply treating the symptoms. Many people diagnosed with RBD are age 50 and older, with other medical conditions, and melatonin is less likely to interact with other medications than Klonopin. Overall, the use of melatonin offers an effective and relatively safe means of treating the concerning problem of rapid eye movement sleep behavior disorders.

Sources:

Howell, M., and C. Shenk. Rapid Eye Movement Sleep Behavior Disorder. UpToDate. Updated 07/24/17.

McGrane, I., Leung, J., St Louis, E., and B. Boeve. Melatonin Therapy for REM Sleep Behavior Disorder: A Critical Review of Evidence. Sleep Medicine. 2015. 16(1):19-26.

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