★★★★★
Recently I was having a discussion with a forum member regarding sleep issues caused from RBD. In RBD, the person afflicted with it may lash out with a punch or a kick or fall off of the bed from thrashing about while sleeping or worse yet, punch, kick, hit or knock their mate onto the floor. Yelling out while asleep is also typically seen in RBD. Not too horrible if you are in bed alone, but quite dangerous if your mate is also in bed with you.
A standard medication for RBD is low dose Clonazepam, but Clonazepam comes with a significant list of potential side effects and withdrawal from this drug can take many months or a year or more, making a safer option highly desirable. Melatonin of late, similarly to Clonazepam is considered a front line treatment for RBD. Side effects from Clonazepam :
https://www.drugs.com/clonazepam.html#side-effects
Call your doctor at once if you have:
- new or worsening seizures;
- severe drowsiness;
- weak or shallow breathing;
- unusual changes in mood or behavior;
- confusion, paranoia, nightmares, hallucinations;
- thoughts of suicide or hurting yourself;
- unusual or involuntary eye movements.
- Drowsiness or dizziness may last longer in older adults. Use caution to avoid falling or accidental injury.
Common clonazepam side effects may include:
- drowsiness, dizziness;
- feeling tired or depressed;
- memory problems; or
- problems with walking or coordination.
After you stop using clonazepam, get medical help right away if you have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, suicidal thoughts or actions.
Some withdrawal symptoms may last up to 12 months or longer after stopping this medicine suddenly. Tell your doctor if you have ongoing anxiety, depression, problems with memory or thinking, trouble sleeping, ringing in your ears, a burning or prickly feeling, or a crawling sensation under your skin.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Interestingly, this July 2021 study that I showed to this forum member had some very interesting results :
https://onlinelibrary.wiley.com/doi/10.1111/jpi.12759
Here are some important study quotes :
' Melatonin is recommended as a first-line treatment in isolated REM sleep behavior disorder (iRBD), although no large patient group has been reported. '
' With melatonin, RBD symptom severity gradually improved over the first 4 weeks of treatment (Ikelos-RS: 6.1 vs. 2.5; CGI Severity: 5.7 vs. 3.2) and remained stably improved (mean follow-up 4.2 ± 3.1years; range: 0.6-21.7years). '
' When melatonin was discontinued after 6 months, symptoms remained stably improved (mean follow-up after discontinuation of 4.9 ± 2.5years; range: 0.6-9.2). When administered only 1-3 months, RBD symptoms gradually returned. Without any melatonin, RBD symptoms persisted and did not wear off over time. '
So the study results showed that melatonin improved RBD symptoms initially and then after four weeks the improvements stabilized and held steady.
If melatonin was discontinued in the first month to third month, RBD symptoms gradually returned.
If melatonin was discontinued after six months of melatonin use, the symptom improvements remained for years. This to me suggests that longer term use of melatonin must be somehow improving the cause of the disease or performing some type of repairs to whatever is causing the RBD symptoms and I find this fact very impressive and should make melatonin as a first choice over Clonazepam.
Also impressive in these study results is that these benefits were seen with melatonin at just two milligrams per night given at the same time each night.
So after reading this study the other forum member wrote me back to say that he was already taking one milligram of melatonin per night and had not noticed any benefit for his RBD. He went on to say that he was going to try the two milligram study dosage and let me know if he found any benefit for his RBD at that dose. He also noted that he was only using 1 mg per night because 3 mg or 5 mg per night caused a next day hangover feeling for him.
That was around Christmas, 2023. I just recently heard back from him 3 days ago and this is what he had to say :
' Hi Art, I just wanted to thank you for the info you shared a while back about RBD and melatonin, specifically the report about using 2mg per day for six months etc. On 29 December I switched from 1mg melatonin per night to 2mg. The effect was phenomenal. The next day my entire mood changed - improved tremendously - and I felt like my old self again. Was also very energized and clear headed. This effect continued in the days ahead. The other notable thing: Since October, I was averaging about one RBD dream every 5 1/2 days or so, and the dream contents were those typically violent scenarios that lead to waking up from sudden, jerky movements. I had one more dream-enactment like that about a week after starting the 2mg regiment. That was on January 5th. I almost fell out of the bed and awoke in a sitting position, right at the edge of the bed. But the funny thing was, while I was still asleep I suddenly realized that it was an RBD dream and woke myself up -- without falling. Since then, however, a significant change: I have not had any violent dreams. Although I might still act out a dream, the intensity of the act is greatly diminished, and the frequency is also diminished. For ex., instead of punching or kicking, I dreamed of pushing a button (arm movement led to waking up); petting a dog; and pointing, on three separate night. And instead of a 5 1/2 day average of dream enactment, in January I went for two straight weeks without being awoken from a dream. There was also a change of symptoms: talking softly while asleep instead of acting out violent movements or cursing loudly (as I've experienced in the past). I subsequently experimented with different doses of melatonin, from 2 to 2.5; 3; 3.5; and 4mg. However if I use more than 2.5 I get the "hangover effect." I also experimented with Magnolia extract. I had no problems with it if taken early in the day, along with a second dose with dinner. But taking it right before bed actually led to sleep disturbance, and it greatly diminished my mental clarity the next day. (I later read that it should only be taken with food.) I'm a writer, so I immediately noticed how it was interfering with my editing process. Have you tried it yourself? Anyway, I thought you might find some of this of interest. And thanks again for your help! Your posts are greatly appreciated.
So his results at just 2 mg/night of melatonin for his RBD were quite good. He plans to stick with it and I told him it will be interesting to see if he is able to replicate the study results of quitting melatonin after 6 months of use, but still retain the benefits brought on by melatonin in the first place. Hopefully he will remember to update me at that time.
Even though RBD is not very common, it can be devastating for couples who sleep together. Often times the mate of the person with RBD can end up with a black eye or broken ribs from being kicked or end up falling on the floor after literally being kicked right out of bed. Being able to make life more livable for such couples is a very good thing and to be able to do this with just 2 mg of melatonin at the same time each night, makes it even better!
In any case, I just wanted to share this useful information with the EC community!
Art
