Materiały źródłowe

• #1 Current Treatment Options for REM Sleep Behaviour Disorder

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8624088/

  The symptomatic treatment of REM sleep behaviour disorder (RBD) is very important to prevent sleep-related falls and/or injuries. Though clonazepam and melatonin are usually considered the first-line symptomatic therapy for RBD, their efficiency has not been proven by randomized clinical trials. […] Despite the assumption that the first-line drugs in the therapy or RBD are clonazepam and melatonin, an ideal treatment has not been established. The aim of this narrative review is to provide a description of studies reported to date related to the treatment of this clinical entity. […] Surprisingly, despite clonazepam being considered a first-line therapy for RBD, its efficacy in the treatment of iRBD has apparently not been proven in randomized trials. […] In a study involving 36 patients diagnosed with RBD treated with clonazepam as the first-line therapy, 58% developed moderate to severe side-effects, the most frequent being daytime sedation, confusion, and cognitive impairment.

• #1 REM Sleep Behavior Disorder: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd

  Melatonin is a hormone your pineal gland naturally makes that’s essential for regulating your sleep cycle. However, there are also synthetic forms of melatonin. It’s considered the first-line medication for treating RBD, as it rarely causes side effects. Your provider will likely recommend starting at a baseline dose and then increasing the dose until your symptoms improve. […] Clonazepam is a sedative. Researchers aren’t sure why it helps treat RBD. Most people with RBD who take a low dose of clonazepam before they sleep have few or no nightmares, vocalizations or dream enactment behaviors. Clonazepam can cause unpleasant side effects. Because of this, your provider may only prescribe it if melatonin doesn’t help. […] Pramipexole is a dopamine agonist. Providers primarily prescribe it to treat Parkinson’s disease and restless leg syndrome, but recent research shows that it can help treat the symptoms of RBD. Researchers think this medication works because RBD may be a dopaminergic deficiency disorder.

• #1 REM sleep behaviour disorder More than just a parasomnia

  https://www.racgp.org.au/afp/2013/november/rem-sleep-behaviour-disorder

  Clonazepam is a long-acting benzodiazepine and should be used with caution as it can worsen concomitant obstructive sleep apnoea (OSA) and impair alertness, cognition and gait in older patients. Melatonin is a hormone secreted by the pineal gland that modulates sleep initiation and circadian rhythms in humans; it has few side effects and is very well tolerated. Exogenous melatonin is used to treat age-related insomnia and circadian disorder but is not indicated for the treatment of RBD. Some authors have postulated a possible correction of an endogenous circadian desynchrony, although the drug dose used for patients with RBD is much higher than for circadian disorders. To date only small case series or case reports support the efficacy of clonazepam and melatonin in RBD. The only randomised double-blind, crossover, controlled trial in RBD included just eight patients over 4 weeks treated with 3 mg nightly of melatonin. Seven patients responded to melatonin with benefit confirmed by patients, bed-partner and PSG. Recent best practice guidelines regard these treatments as Level B recommendations on the basis of limited evidence and clinical consensus. Clearly, further randomised controlled trials are needed to assess the use of clonazepam and melatonin in RBD.

• #1 Treatment of REM Sleep Behavior Disorder – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27752878/

  REM sleep behavior disorder (RBD) is a common parasomnia disorder affecting between 1 and 7 % of community-dwelling adults, most frequently older adults. […] The approach to RBD management is currently twofold: symptomatic treatment to prevent injury and prognostic counseling and longitudinal follow-up surveillance for phenoconversion toward overt neurodegenerative disorders. […] A sound evidence basis for symptomatic treatment of RBD remains lacking, and randomized controlled treatment trials are needed. Traditional therapeutic mainstays with relatively robust retrospective case series level evidence include melatonin and clonazepam, which appear to be equally effective, although melatonin is more tolerable. […] Melatonin dosed 3-12 mg at bedtime should be considered as the first-line therapy, followed by clonazepam 0.25-2.0 mg at bedtime if initial melatonin is judged ineffective or intolerable.

• #1 REM Sleep Behavior Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28330

  RBD occurs because of the failure to inhibit spinal motor neurons during REM sleep. […] Treatment consists of preventive measures while sleeping to avoid injury to the patient as well as the bed partner. In severe cases, the patient may be prescribed melatonin or clonazepam. […] The primary goal of treatment is to provide patients with a safe sleeping environment for them and their bed partners. Healthcare professionals can achieve this through non-pharmacologic approaches and pharmacotherapy if needed. […] Regarding pharmacotherapy, melatonin is now considered first-line therapy in the treatment of RBD. Its mechanism of action is unknown, but in doses between 6 to 18 mg, it augments REM atonia and improves RBD symptoms. Patients are typically started at doses of 3 mg, and then doses are increased in 3-mg increments until the RBD symptoms resolve.

• #1 SciELO Brasil – REM sleep behavior disorder: update on diagnosis and management REM sleep behavior disorder: update on diagnosis and management

  https://www.scielo.br/j/anp/a/NyW6ysTnXjDj8kRrWFKmyLp/

  Until now, few double-blind randomized trials have evaluated medication use for RBD. Most of the published papers on the subject had an observational design. Recently, a recommendation from the American Academy of Sleep Medicine was published, summarizing the selection of the main medications used. […] […] Two double-blind randomized trials evaluated immediate-release melatonin in RBD with positive results in reducing the dream-acting frequency and REM sleep without atonia. The evaluation used the Global Clinical Impression Scale and specific RBD scales, besides PSG. Other observational studies have also documented the effectiveness of this medication. The dosage ranged from 3 to 15 mg per day at bedtime. Higher dosages were not recorded. […] […] Clonazepam was the first medication used in RBD patients since its description in 1986. Several observational studies have documented improvements in RBD symptoms. A single double-blind, randomized trial did not show a difference between patients who used clonazepam from those who received a placebo. However, RBD diagnosis relied on a simple question, as this study did not use PSG as a diagnostic method. […]

• #1 REM Sleep Behavior Disorder

  https://www.webmd.com/sleep-disorders/rem-sleep-behavior-disorder-medications

  Clonazepam (Klonopin) is highly effective in the treatment of REM sleep behavior disorder (RBD), relieving symptoms in nearly 90% of patients with little evidence of tolerance or abuse. The response usually begins within the first week, often on the first night. The initial dose is 0.5 mg at bedtime, with some persons requiring a rapid increase to 1 mg. […] Other drugs, such as tricyclic antidepressants, may be effective in some persons with RBD. However, tricyclics are also known to precipitate RBD in some patients. […] The hormone melatonin is also often used to treat sleep disorders.

• #1 REM Sleep Behavior Disorder: Treatment, Symptoms & Causes

  https://www.emedicinehealth.com/rem_sleep_behavior_disorder/article_em.htm

  Are There Home Remedies for REM Sleep Disorder? Because persons with REM sleep behavior disorder have a risk of injuring themselves and their sleep partners, the safety of the sleeping environment is very important. Remove potentially dangerous objects from the bedroom. Clear the floor of furniture and objects that could injure the person if he or she fell from the bed. Place the mattress on the floor, or place a cushion around the bed. Have the person sleep in a bedroom on the ground floor if possible, especially for people who leave the bed during an episode. The bedmate should sleep in another bed until the symptoms resolve. A bed with padded bedrails can be considered. […] What Are the Medications for REM Sleep Disorder? Clonazepam (Klonopin) is highly effective in the treatment of REM sleep behavior disorder (RBD), relieving symptoms in nearly 90% of patients with little evidence of tolerance or abuse. The response usually begins within the first week, often on the first night. The initial dose is 0.5 mg at bedtime, with some persons requiring a rapid increase to 1 mg. With continued treatment for years, moderate limb twitching with sleep talking and more complex behaviors can reemerge. The treatment should be continued indefinitely, as violent behaviors and nightmares promptly recur with discontinuation of medications in almost all persons with RBD. Other medications, such as tricyclic antidepressants, may be effective in some persons with RBD. However, tricyclics are also known to precipitate RBD in some patients.

• #1 Current Treatment Options for REM Sleep Behaviour Disorder

  https://www.mdpi.com/2075-4426/11/11/1204

  The aim of this narrative review is to provide a description of studies reported to date related to the treatment of this clinical entity. […] The improvement of RBD symptoms in patients treated with clonazepam (a benzodiazepine that enhances the neurotransmitter gamma-aminobutyric acid (GABA) via the modulation of the GABA receptor and has antiepileptic properties) was suggested in the first description of RBD by Schenck et al. […] Surprisingly, despite clonazepam being considered a first-line therapy for RBD, its efficacy in the treatment of iRBD has apparently not been proven in randomized trials. […] Most reports suggesting improvements of RBD with melatonin have been single case reports, open-label trials, or retrospective analyses of cohorts. […] The atypical antidepressant drug agomelatine acts as agonist of the melatonin receptors MT1 and MT2, and the antagonist of the serotonin (5-hydroxytryptamine or 5-HT) 5-HT2C and 5-HT2B receptors.

• #1 REM sleep behavior disorder – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/diagnosis-treatment/drc-20352925

  Treatment for REM sleep behavior disorder may include physical safeguards and medications. […] Your doctor may recommend that you make changes in your sleep environment to make it safer for you and your bed partner, including: Padding the floor near the bed, Removing dangerous objects from the bedroom, such as sharp items and weapons, Placing barriers on the side of the bed, Moving furniture and clutter away from the bed, Protecting bedroom windows, Possibly sleeping in a separate bed or room from your bed partner until symptoms are controlled. […] Examples of treatment options for REM sleep behavior disorder include: Melatonin. Your doctor may prescribe a dietary supplement called melatonin, which may help reduce or eliminate your symptoms. Melatonin may be as effective as clonazepam and is usually well-tolerated with few side effects. Clonazepam (Klonopin). This prescription medication, often used to treat anxiety, is also the traditional choice for treating REM sleep behavior disorder, appearing to effectively reduce symptoms. Clonazepam may cause side effects such as daytime sleepiness, decreased balance and worsening of sleep apnea. […] Doctors continue to study several other medications that may treat REM sleep behavior disorder. Talk with your doctor to determine the most appropriate treatment option for you.

• #1

  https://link.springer.com/article/10.1007/s11940-016-0433-2

  However, neither agent is likely to completely stop dream enactment behaviors, so choosing a moderate target dosage of melatonin 6 mg or clonazepam 0.5 mg, or the highest tolerable dosage that reduces attack frequency and avoids adverse effects from overtreatment, is currently the most reasonable strategy. […] Alternative second- and third-line therapies with anecdotal efficacy include temazepam, lorazepam, zolpidem, zopiclone, pramipexole, donepezil, ramelteon, agomelatine, cannabinoids, and sodium oxybate. […] A novel non-pharmacological approach is a bed alarm system, although this may be most useful in patients who also report sleep walking or a history of leaving their bed during dream enactment episodes. […] The benefit of hypnosis, especially in those with psychiatric RBD, also requires further study.

• #1 REM Sleep Behavior Disorder: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd

  The main goal of treatment for REM sleep behavior disorder (RBD) is to create a safe sleeping environment for you and your bed partner. This can involve certain strategies and medications. […] Steps to create a safer sleeping environment include: Removing sharp, glass and heavy objects away from your bed. Placing pillows between you and surrounding structures, such as the headboard or a nightstand. Placing a mattress on the floor next to your bed (in case you fall out of bed) or using padded bedside rails. Sleeping in a sleeping bag. […] If your symptoms are severe and safety measures aren’t enough to prevent injury, your healthcare provider may prescribe medication to manage your symptoms. While there aren’t any U.S. Food and Drug Administration (FDA)-approved medications specifically for RBD, studies have shown that melatonin, clonazepam and pramipexole can reduce symptoms in some cases.

• #1 Current Treatment Options for REM Sleep Behaviour Disorder

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8624088/

  The search for appropriate treatments for RBD is important for preventing sleep-related injuries of both patients and their partners. […] However, the ideal therapy for RBD is not currently established. […] The possible efficacy of analogues of melatonin, levodopa, and dopamine agonists has not been established and is controversial, although a large retrospective cohort study suggested an improvement in 61.7% of iRBD non-responders to clonazepam with pramipexole therapy. […] Results of randomized clinical trials, most of them involving a limited number of patients, have shown the short-term efficacy of the anticholinesterase drugs rivastigmine and 5-hydroxytryptophan and the herbal medicine yokukansan, as well as the lack of efficacy of nelotanserin and cannabidiol. […] Finally, the possible improvements reported with sodium oxybate, desipramine, imipramine, fluvoxamine, paroxetine, agomelatine, trazodone, vortioxetine, carbamazepine, levetiracetam, and cannabidiol are limited to single case reports, short case series, or open-label studies.

• #1 SciELO Brasil – REM sleep behavior disorder: update on diagnosis and management REM sleep behavior disorder: update on diagnosis and management

  https://www.scielo.br/j/anp/a/NyW6ysTnXjDj8kRrWFKmyLp/

  Transdermal rivastigmine for RBD treatment in patients with PD and MCI has been documented in clinical trials. Its use for isolated RBD has yet to be evaluated. Rivastigmine is an acetylcholinesterase inhibitor, leading to increased acetylcholine in the central nervous system by inhibiting the enzyme responsible for its breakdown. The dosage varies from 4.6 to 13.3 mg in a transdermal patch, with replacement every 24 hours. […] […] Two studies showed divergent results on the effectiveness of pramipexole in RBD. An open-label study with 15 patients with isolated RBD showed improvement with doses of 0.125 to 0.375 mg/ day after a four-week trial. Another study in patients with PD and RBD did not show a difference after three months of medication use. A recent recommendation from AASM, from observational studies, suggests its use in patients with RBD and elevated periodic limb movement. […]

• #1 Current Treatment Options for REM Sleep Behaviour Disorder

  https://www.mdpi.com/2075-4426/11/11/1204

  The results of studies addressing the possible efficacy of dopaminergic drugs in the treatment of RBD are summarized. […] Sodium oxybate, also named sodium 4-hydroxybutyrate and sodium 4-hydroxybutanoate, is the sodium salt of γ-hydroxybutyric acid, and it is used for the treatment of sudden muscle weakness and excessive daytime sleepiness in patients with narcolepsy. […] The search for appropriate treatments for RBD is important for preventing sleep-related injuries of both patients and their partners. […] However, the ideal therapy for RBD is not currently established. […] The possible efficacy of analogues of melatonin, levodopa, and dopamine agonists has not been established and is controversial. […] Results of randomized clinical trials, most of them involving a limited number of patients, have shown the short-term efficacy of the anticholinesterase drugs rivastigmine and 5-hydroxytryptophan and the herbal medicine yokukansan, as well as the lack of efficacy of nelotanserin and cannabidiol. […] The combination of functional neuroimaging studies using different tracers, transcranial sonography, brain perfusion and glucose metabolism studies, functional MRI, and the detection of α-synuclein in certain tissues should be useful for this purpose.

• #1 Treatment of REM sleep behavior disorder with trazodone: report of three cases.

  https://scholarlyworks.lvhn.org/medicine/5875/

  Rapid eye movement sleep behavior disorder (RBD) is a sleep disturbance characterized by the absence of regular paralysis during REM sleep, accompanied by dream enactment behavior. […] We report three cases of isolated RBD improved with trazodone. Doses of trazodone 50-100 mg at bedtime over 4-6 months resulted in significant clinical improvement. […] These cases highlight that trazodone could serve as a treatment for isolated RBD that does not respond to traditional treatments at submaximal dosages.

• #1 SciELO Brasil – REM sleep behavior disorder: update on diagnosis and management REM sleep behavior disorder: update on diagnosis and management

  https://www.scielo.br/j/anp/a/NyW6ysTnXjDj8kRrWFKmyLp/

  Yokukansan (YKS) is an herbal treatment made up of seven herbal ingredients: Japanese Angelica root, Uncaria hook, Cnidium rhizome, Atractylodes lancea rhizome, Poria sclerotium, Bupleurum root, and Glycyrrhiza. Two retrospective observational studies demonstrated an improvement in the frequency of acting out during sleep episodes. […] […] Safinamide is an -aminoamide that has both dopaminergic and non-dopaminergic mechanisms of action, including inhibition of monoamine oxidase-B (MAO-B) sodium (Na + ) channel blockade and modulation of stimulated release of glutamate. A longitudinal, cross-over study registered a significant reduction of RBD symptoms in PD patients by questionnaire-Hong Kong-score (RBDQ-HS), mainly for two individual RBDQ-HK-items (dream-related movements and failing out of bed), and in REM sleep atonia, evaluated by PSG. […]

• #1 Mount Sinai Researchers Identify Potential New Treatment for Those Who Act Out Their Dreams While Sleeping | Mount Sinai – New York

  https://www.mountsinai.org/about/newsroom/2023/mount-sinai-researchers-identify-potential-new-treatment-for-those-who-act-out-their-dreams-while-sleeping

  Mount Sinai researchers have published what they say is the first study to identify a new form of treatment for rapid eye movement (REM) sleep behavior disorder. […] The paper also demonstrates for the first time that sleep medications known as dual orexin receptor antagonists—commonly used to treat insomnia, or difficulty falling and remaining asleep—can significantly reduce REM sleep behavior disorder. […] Researchers hope their findings will encourage future trials of dual orexin receptor antagonists to treat REM sleep behavior disorder in humans, given that the medication is already FDA approved and available to treat people with insomnia. […] It was even more surprising and exciting to observe that a dual orexin receptor antagonist could significantly minimize the dream enactment behaviors.

• #1 Researchers identify potential new treatment for those who act out their dreams while sleeping

  https://medicalxpress.com/news/2023-05-potential-treatment.html

  Mount Sinai researchers have published what they say is the first study to identify a new form of treatment for rapid eye movement (REM) sleep behavior disorder. […] The paper also demonstrates for the first time that sleep medications known as dual orexin receptor antagonists—commonly used to treat insomnia, or difficulty falling and remaining asleep—can significantly reduce REM sleep behavior disorder. Current therapeutic options for this disorder are primarily limited to melatonin and clonazepam, also known as Klonopin, so these findings suggest a promising new treatment with potentially fewer side effects. […] Researchers hope their findings will encourage future trials of dual orexin receptor antagonists to treat REM sleep behavior disorder in humans, given that the medication is already FDA approved and available to treat people with insomnia.

• #1 Study IDs Potential Treatment for REM Sleep Behavior Disorder

  https://sleepreviewmag.com/sleep-disorders/parasomnias/rem-parasomnias/surprising-study-identifies-potential-new-treatment-rem-sleep-behavior-disorder/

  Surprising Study Identifies Potential New Treatment for REM Sleep Behavior Disorder […] Mount Sinai researchers have published a study identifying a new form of treatment for rapid eye movement (REM) sleep behavior disorder. […] The paper also demonstrates for the first time, according to researchers, that sleep medications known as dual orexin receptor antagonistscommonly used to treat insomniacan significantly reduce REM sleep behavior disorder. […] These findings suggest a promising new treatment with potentially fewer side effects. […] We identify a novel model in which REM sleep behavior disorder can develop, due to neurodegeneration associated with accumulation of tau protein, and a novel therapy that could minimize REM sleep behavior disorder. […] Researchers hope their findings will encourage future trials of dual orexin receptor antagonists to treat REM sleep behavior disorder in humans, given that the medication is already FDA approved and available to treat people with insomnia. […] It was even more surprising and exciting to observe that a dual orexin receptor antagonist could significantly minimize the dream enactment behaviors.

• #1 REM Sleep Behavior Disorder | UPMC HealthBeat

  https://share.upmc.com/2023/12/rem-sleep-behavior-disorder-symptoms-causes-treatment/

  Some small changes may help calm your REM sleep behavior disorder symptoms. Maintain good sleep habits, such as: Avoid alcohol and nicotine, especially before bedtime. Develop a calming bedtime routine (i.e., yoga, light stretching, or soft music). Don’t eat a big meal late in the evening. Go to bed and wake up at the same time every day, including weekends. Keep your bedroom cool and dark. Limit screen time before bed.

• #1 Rapid eye movement sleep behavior disorder – Wikipedia

  https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep_behavior_disorder

  RBD is treatable (even when the underlying synucleinopathies are not). Melatonin and clonazepam are the most frequently used, and are comparably effective, but melatonin offers a safer alternative, because clonazepam can produce undesirable side effects. […] In addition to medication, it is wise to secure the sleeper’s environment by removing potentially dangerous objects from the bedroom and either place a cushion around the bed or move the mattress to the floor for added protection against injuries. […] Patients are advised to maintain a normal sleep schedule, avoid sleep deprivation, and keep track of any sleepiness they may have. Treatment includes regulating neurologic symptoms and treating any other sleep disorders that might interfere with sleep. Sleep deprivation, alcohol, certain medications, and other sleep disorders can all increase RBD and should be avoided if possible.

• #1 Rapid Eye Movement (REM) Sleep Behaviour Disorder | North Bristol NHS Trust

  https://www.nbt.nhs.uk/our-services/a-z-services/neuropsychiatry/rapid-eye-movement-rem-sleep-behaviour-disorder

  Melatonin, This is a hormone that exists naturally in the brain, which can be supplemented. It can help reduce the severity and frequency of REM parasomnia. It has fewer side effects than clonazepam. […] Some medications can cause or worsen REM sleep behaviours, and should be discussed at your initial appointment. Some examples of medications that might be having an effect include: Antidepressants, Beta blockers, Alzheimers medications.

• #1 REM Sleep Behavior Disorder – Sleep Education by the AASM

  https://sleepeducation.org/sleep-disorders/rem-sleep-behavior-disorder/

  How to treat REM sleep behavior disorder? Safety measures need to be addressed first. Some bedroom safety precautions include: Removing weapons from your bedroom. Moving objects away from your bedside, including nightstands, lamps, or other objects that could cause injury. Moving your bed away from windows. Placing a large object, like a dresser, in front of windows. Padding hard furniture near your bed, like your headboard. Using soft carpet in your bedroom or placing a soft mat or rug next to your bed. Sleeping with a pillow between you and your partner or sleeping separately from your partner. […] Any factors known to aggravate RBD symptoms should be avoided or treated. Your treatment plan may include: Maintaining a normal total sleep time. Sleep deprivation will increase RBD. Avoiding certain medications and alcohol. They can cause or increase RBD. Treating all other sleep disorders that disrupt your sleep and increase RBD. Untreated sleep apnea may worsen RBD symptoms. Regular monitoring for any neurologic symptoms, such as tremors or other Parkinson symptoms. […] RBD tends to respond to treatment with medications. Your sleep doctor can prescribe the medications that are appropriate for you.

• #1 A Case of Intractable REM Sleep Behavior Disorder Improved With Nasal Continuous Positive Airway Pressure Therapy

  https://www.e-jsm.org/journal/view.php?number=382

  Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment behavior and REM sleep without atonia and is traumatic for the patient and/or bedpartner. […] The standard treatment for RBD is the maintenance of a safe bedroom environment and medications, including clonazepam, immediate-release melatonin, and pramipexole. […] Although OSA is common in patients with RBD, the influence of comorbid OSA on RBD symptoms remains unclear. […] Several studies suggested OSA treatment with continuous positive airway pressure (CPAP) improved RBD symptoms and RWA on night polysomnography (PSG). […] The RBD symptoms improved with nasal CPAP therapy. […] Clinicians should be aware of concomitant OSA when patients have intractable RBD symptoms, and CPAP therapy may help improve RBD symptoms.

• #1 REM Sleep Behavior Disorder Treatment & Management: Medical Care, Long-Term Monitoring

  https://emedicine.medscape.com/article/1188651-treatment

  The neurologist may consult a sleep specialist for the proper diagnosis and treatment of rapid eye movement sleep behavior disorder (RBD). RBD is treated symptomatically with various medications. However, the response varies in individual cases; therefore, all available medications should be tried before considering the patient’s RBD as intractable. […] Clonazepam is highly effective in almost 90% of patients with RBD. It demonstrates a complete benefit in 79% of patients with the disorder and a partial benefit in 11% of patients. There is little evidence of tolerance or abuse of this drug. […] Symptoms relapse promptly on discontinuation of medications in almost all patients; therefore, pharmacologic treatment should be continued indefinitely. […] An important aspect of management of patients with RBD is environmental safety. Potentially dangerous objects should be removed from the bedroom, and the mattress should be placed on the floor or a cushion should be placed around the bed.

• #1 REM Sleep Behavior Disorder Treatment & Management: Medical Care, Long-Term Monitoring

  https://emedicine.medscape.com/article/1188651-treatment

  Because rapid eye movement sleep behavior disorder (RBD) has strong relationships with many neurodegenerative disorders, such as Parkinson disease, multiple system atrophy, and dementia, the neurologist always should explore the possibility of RBD in these conditions. […] RBD symptoms may be the first manifestations of these disorders and may precede the onset of other typical symptoms and signs by several years. Therefore, careful follow-up is needed to assess the risk of neurodegenerative disorder development, for patient counseling, and to plan for potential neuroprotective trials. […] Howell M, Avidan AY, Foldvary-Schaefer N, Malkani RG, During EH, Roland JP, et al. Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline. […] Boeve BF, Silber MH, Ferman TJ. Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients.

• #1 Current Treatment Options for REM Sleep Behaviour Disorder

  https://www.mdpi.com/2075-4426/11/11/1204

  The symptomatic treatment of REM sleep behaviour disorder (RBD) is very important to prevent sleep-related falls and/or injuries. Though clonazepam and melatonin are usually considered the first-line symptomatic therapy for RBD, their efficiency has not been proven by randomized clinical trials. […] The development of potential preventive therapies against the phenoconversion of isolated RBD to synucleinopathies should be another important aim of RBD therapy. The design of long-term, multicentre, randomized, placebo-controlled clinical trials involving a large number of patients diagnosed with isolated RBD with polysomnographic confirmation, directed towards both symptomatic and preventive therapy for RBD, is warranted. […] Despite the assumption that the first-line drugs in the therapy or RBD are clonazepam and melatonin, an ideal treatment has not been established.

• #1 Clinical trials in REM sleep behavioural disorder: challenges and opportunities | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/91/7/740

  An important note of discussion is whether these trials used the best endpoints for evaluating RBD severity. […] For RBD occurring with overt neurodegenerative diseases, placebo-controlled studies have shown that rivastigmine and memantine are effective, although outcome measures were not optimal in these studies also. […] Clearly, clinical trials that can overcome factors that have hampered development of better symptomatic RBD treatments are needed, and we outline recommendations for such trials in the following sections. […] There are currently no disease-modifying treatments for RBD. […] However, there is an obvious need for clinical trials for disease-modifying treatments, and if feasible, patients should be referred to registries of patients with RBD and resources where they can obtain up-to-date information on any clinical trials that arise.

• #1 New AASM Guideline Advises on Management of REM Sleep Behavior Disorder

  https://consultqd.clevelandclinic.org/new-aasm-guideline-advises-on-management-of-rem-sleep-behavior-disorder

  Maintaining a safe sleeping environment for patients with rapid-eye movement (REM) sleep behavior disorder (RBD) and their bed partners is critically important to prevent injury from falling out of bed, thrashing limbs or even unknowingly using a readily available weapon. Fortunately, evidence indicates that, in addition to environmental changes that patients can make, medications may help remediate the condition. […] For the first time, the task force used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process. Guidance recommendations were classified as either strong (based on good evidence and indicating that they are advisable under most circumstances) or conditional (based on weak evidence and indicating they should be considered in tandem with clinical judgement and patient input). Although 45 interventions are presented in the guideline, no drug treatment reached the level of a strong recommendation due to lack of evidence from randomized controlled trials.

• #1 AASM Management of REM Sleep Behavior Disorder Guideline Summary

  https://www.guidelinecentral.com/guideline/2722821/

  The AASM suggests that clinicians use clonazepam (vs no treatment) for the treatment of isolated RBD in adults. (Conditional) […] The AASM suggests that clinicians use immediate-release melatonin (vs no treatment) for the treatment of isolated RBD in adults. (Conditional) […] The AASM suggests that clinicians use pramipexole (vs no treatment) for the treatment of isolated RBD in adults. (Conditional) […] The AASM suggests that clinicians use transdermal rivastigmine (vs no treatment) for the treatment of isolated RBD in adults with mild cognitive impairment. (Conditional) […] The AASM suggests that clinicians use clonazepam (vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (Conditional) […] The AASM suggests that clinicians use immediate-release melatonin (vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (Conditional)

• #1 AASM Management of REM Sleep Behavior Disorder Guideline Summary

  https://www.guidelinecentral.com/guideline/2722821/

  The AASM suggests that clinicians use transdermal rivastigmine (vs no treatment) for the treatment of secondary RBD due to medical condition (Parkinson disease) in adults. (Conditional) […] The AASM suggests that clinicians not use deep brain stimulation (DBS; vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (Conditional) […] The AASM suggests that clinicians use drug discontinuation (vs drug continuation) for the treatment of drug-induced RBD in adults. (Conditional)

• #1 Pharmacological Treatment for Rapid Eye Movement Sleep Behavior Disorder

  https://www.chronobiologyinmedicine.org/journal/view.php?number=87

  Although several clinical observations and case series have demonstrated the efficacy of clonazepam and melatonin, existing evidence is lacking. […] Some alternative agents might be useful for patients with RBD who are resistant to first-line treatment. […] More RCTs with objective outcome measures are needed to assess both short- and long-term effects of these medications and their efficacy in RBD.

• #1 Treatment of REM Sleep Behavior Disorder – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27752878/

  However, neither agent is likely to completely stop dream enactment behaviors, so choosing a moderate target dosage of melatonin 6 mg or clonazepam 0.5 mg, or the highest tolerable dosage that reduces attack frequency and avoids adverse effects from overtreatment, is currently the most reasonable strategy. […] Alternative second- and third-line therapies with anecdotal efficacy include temazepam, lorazepam, zolpidem, zopiclone, pramipexole, donepezil, ramelteon, agomelatine, cannabinoids, and sodium oxybate. […] A novel non-pharmacological approach is a bed alarm system, although this may be most useful in patients who also report sleep walking or a history of leaving their bed during dream enactment episodes. […] RBD is an attractive target for future neuroprotective treatment trials to prevent evolution of overt parkinsonism or memory decline, but currently, there are no known effective treatments and future trials will be necessary to determine if RBD is an actionable time point in the evolution of overt synucleinopathy.

• #2 Treatment of REM Sleep Behavior Disorder – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27752878/

  REM sleep behavior disorder (RBD) is a common parasomnia disorder affecting between 1 and 7 % of community-dwelling adults, most frequently older adults. […] The approach to RBD management is currently twofold: symptomatic treatment to prevent injury and prognostic counseling and longitudinal follow-up surveillance for phenoconversion toward overt neurodegenerative disorders. […] A sound evidence basis for symptomatic treatment of RBD remains lacking, and randomized controlled treatment trials are needed. Traditional therapeutic mainstays with relatively robust retrospective case series level evidence include melatonin and clonazepam, which appear to be equally effective, although melatonin is more tolerable. […] Melatonin dosed 3-12 mg at bedtime should be considered as the first-line therapy, followed by clonazepam 0.25-2.0 mg at bedtime if initial melatonin is judged ineffective or intolerable.

• #2 REM Sleep Behavior Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28330

  RBD occurs because of the failure to inhibit spinal motor neurons during REM sleep. […] Treatment consists of preventive measures while sleeping to avoid injury to the patient as well as the bed partner. In severe cases, the patient may be prescribed melatonin or clonazepam. […] The primary goal of treatment is to provide patients with a safe sleeping environment for them and their bed partners. Healthcare professionals can achieve this through non-pharmacologic approaches and pharmacotherapy if needed. […] Regarding pharmacotherapy, melatonin is now considered first-line therapy in the treatment of RBD. Its mechanism of action is unknown, but in doses between 6 to 18 mg, it augments REM atonia and improves RBD symptoms. Patients are typically started at doses of 3 mg, and then doses are increased in 3-mg increments until the RBD symptoms resolve.

• #2 Common Sleep Disorders in Adults: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0400/p397.html

  REM sleep behavior disorder is diagnosed by polysomnography and treated with melatonin or clonazepam. […] Treatment of REM sleep behavior disorder focuses on reducing the injury potential for the patient and bed partner using behavior modification as a first-line intervention. Methods to decrease the potential for injury include creating a safe sleep environment by padding or removing furniture, lowering the mattress to the floor, and using a bed alarm. […] If these methods are not successful, the use of pharmacologic therapy with melatonin or clonazepam (Klonopin) may be necessary. Melatonin should be initiated at a dose of 3 mg at bedtime and titrated up by 3 mg every two weeks to the desired effect with a ceiling of 12 mg nightly. […] There are more adverse events associated with benzodiazepine use; however, if used, clonazepam can be administered at doses between 0.25 mg and 2.0 mg at bedtime.

• #2 REM Sleep Behavior Disorder Treatment & Management: Medical Care, Long-Term Monitoring

  https://emedicine.medscape.com/article/1188651-treatment

  The neurologist may consult a sleep specialist for the proper diagnosis and treatment of rapid eye movement sleep behavior disorder (RBD). RBD is treated symptomatically with various medications. However, the response varies in individual cases; therefore, all available medications should be tried before considering the patient’s RBD as intractable. […] Clonazepam is highly effective in almost 90% of patients with RBD. It demonstrates a complete benefit in 79% of patients with the disorder and a partial benefit in 11% of patients. There is little evidence of tolerance or abuse of this drug. […] Symptoms relapse promptly on discontinuation of medications in almost all patients; therefore, pharmacologic treatment should be continued indefinitely. […] An important aspect of management of patients with RBD is environmental safety. Potentially dangerous objects should be removed from the bedroom, and the mattress should be placed on the floor or a cushion should be placed around the bed.

• #2 REM Sleep Behavior Disorder: Treatment, Symptoms & Causes

  https://www.emedicinehealth.com/rem_sleep_behavior_disorder/article_em.htm

  Are There Home Remedies for REM Sleep Disorder? Because persons with REM sleep behavior disorder have a risk of injuring themselves and their sleep partners, the safety of the sleeping environment is very important. Remove potentially dangerous objects from the bedroom. Clear the floor of furniture and objects that could injure the person if he or she fell from the bed. Place the mattress on the floor, or place a cushion around the bed. Have the person sleep in a bedroom on the ground floor if possible, especially for people who leave the bed during an episode. The bedmate should sleep in another bed until the symptoms resolve. A bed with padded bedrails can be considered. […] What Are the Medications for REM Sleep Disorder? Clonazepam (Klonopin) is highly effective in the treatment of REM sleep behavior disorder (RBD), relieving symptoms in nearly 90% of patients with little evidence of tolerance or abuse. The response usually begins within the first week, often on the first night. The initial dose is 0.5 mg at bedtime, with some persons requiring a rapid increase to 1 mg. With continued treatment for years, moderate limb twitching with sleep talking and more complex behaviors can reemerge. The treatment should be continued indefinitely, as violent behaviors and nightmares promptly recur with discontinuation of medications in almost all persons with RBD. Other medications, such as tricyclic antidepressants, may be effective in some persons with RBD. However, tricyclics are also known to precipitate RBD in some patients.

• #2 REM Sleep Behavior Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28330

  Low-dose clonazepam (0.5 to 1 mg at bedtime) has been traditionally used to control RBD symptoms. Its mechanism of action is not clear either but may help suppress unpleasant dreams. […] Patients may be advised to stop SSRI and tricyclic antidepressants that are known to cause or exacerbate RBD. […] In proper clinical settings, brain imaging with MRI and EEG may be recommended to evaluate for a secondary cause of RBD. This is the only parasomnia where polysomnography is required to diagnose RBD and rule out severe OSA as a cause of pseudo RBD. Patients may be advised to create a safer environment in the bedroom to avoid injuries. Melatonin is the first-line treatment, and in refractory cases, clonazepam in lower doses may be tried.

• #2 Rapid Eye Movement (REM) Sleep Behaviour Disorder | North Bristol NHS Trust

  https://www.nbt.nhs.uk/our-services/a-z-services/neuropsychiatry/rapid-eye-movement-rem-sleep-behaviour-disorder

  Management of REM sleep behaviour disorder includes providing physical safeguards in your sleep environments, and some medications which may be offered to help with the condition. […] Some examples of adjustments that may be suggested to keep you and your bed partner safe include: Padding near the bed, Soft barriers at the side of the bed, Moving clutter and sharp-edged furniture away from the bed, Some partners put a large pillow between them during the night. […] Medication is not always needed, but may be used if the condition is severe, distressing or causing injuries. The most common medications that may be offered are: Clonazepam, This acts as a sedative in order to help reduce arousal during the night. However there may be side effects such as daytime tiredness, impaired balance and slower breathing during the night.

• #2 Current Treatment Options for REM Sleep Behaviour Disorder

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8624088/

  The symptomatic treatment of REM sleep behaviour disorder (RBD) is very important to prevent sleep-related falls and/or injuries. Though clonazepam and melatonin are usually considered the first-line symptomatic therapy for RBD, their efficiency has not been proven by randomized clinical trials. […] Despite the assumption that the first-line drugs in the therapy or RBD are clonazepam and melatonin, an ideal treatment has not been established. The aim of this narrative review is to provide a description of studies reported to date related to the treatment of this clinical entity. […] Surprisingly, despite clonazepam being considered a first-line therapy for RBD, its efficacy in the treatment of iRBD has apparently not been proven in randomized trials. […] In a study involving 36 patients diagnosed with RBD treated with clonazepam as the first-line therapy, 58% developed moderate to severe side-effects, the most frequent being daytime sedation, confusion, and cognitive impairment.

• #2 AASM Management of REM Sleep Behavior Disorder Guideline Summary

  https://www.guidelinecentral.com/guideline/2722821/

  The AASM suggests that clinicians use clonazepam (vs no treatment) for the treatment of isolated RBD in adults. (Conditional) […] The AASM suggests that clinicians use immediate-release melatonin (vs no treatment) for the treatment of isolated RBD in adults. (Conditional) […] The AASM suggests that clinicians use pramipexole (vs no treatment) for the treatment of isolated RBD in adults. (Conditional) […] The AASM suggests that clinicians use transdermal rivastigmine (vs no treatment) for the treatment of isolated RBD in adults with mild cognitive impairment. (Conditional) […] The AASM suggests that clinicians use clonazepam (vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (Conditional) […] The AASM suggests that clinicians use immediate-release melatonin (vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (Conditional)

• #2 SciELO Brasil – REM sleep behavior disorder: update on diagnosis and management REM sleep behavior disorder: update on diagnosis and management

  https://www.scielo.br/j/anp/a/NyW6ysTnXjDj8kRrWFKmyLp/

  Ramelteon is a melatoninergic agonist acting on MT1 and MT2 receptors. Two separate studies evaluated the effect of this medication on RBD. In one multicenter, open-label study conducted on patients with PD, there was a reduction in the frequency of RBD symptoms, as assessed by scales. On the other hand, the other open-labeled trial involving patients with isolated RBD did not show any difference in symptoms or REM sleep atonia. […]

• #2 REM Sleep Behavior Disorder: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd

  The main goal of treatment for REM sleep behavior disorder (RBD) is to create a safe sleeping environment for you and your bed partner. This can involve certain strategies and medications. […] Steps to create a safer sleeping environment include: Removing sharp, glass and heavy objects away from your bed. Placing pillows between you and surrounding structures, such as the headboard or a nightstand. Placing a mattress on the floor next to your bed (in case you fall out of bed) or using padded bedside rails. Sleeping in a sleeping bag. […] If your symptoms are severe and safety measures aren’t enough to prevent injury, your healthcare provider may prescribe medication to manage your symptoms. While there aren’t any U.S. Food and Drug Administration (FDA)-approved medications specifically for RBD, studies have shown that melatonin, clonazepam and pramipexole can reduce symptoms in some cases.

• #2 REM sleep behavior disorder: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/247730

• #2 REM Sleep Behavior Disorder – Sleep Education by the AASM

  https://sleepeducation.org/sleep-disorders/rem-sleep-behavior-disorder/

  How to treat REM sleep behavior disorder? Safety measures need to be addressed first. Some bedroom safety precautions include: Removing weapons from your bedroom. Moving objects away from your bedside, including nightstands, lamps, or other objects that could cause injury. Moving your bed away from windows. Placing a large object, like a dresser, in front of windows. Padding hard furniture near your bed, like your headboard. Using soft carpet in your bedroom or placing a soft mat or rug next to your bed. Sleeping with a pillow between you and your partner or sleeping separately from your partner. […] Any factors known to aggravate RBD symptoms should be avoided or treated. Your treatment plan may include: Maintaining a normal total sleep time. Sleep deprivation will increase RBD. Avoiding certain medications and alcohol. They can cause or increase RBD. Treating all other sleep disorders that disrupt your sleep and increase RBD. Untreated sleep apnea may worsen RBD symptoms. Regular monitoring for any neurologic symptoms, such as tremors or other Parkinson symptoms. […] RBD tends to respond to treatment with medications. Your sleep doctor can prescribe the medications that are appropriate for you.

• #2 REM Sleep Behavior Disorder | UPMC HealthBeat

  https://share.upmc.com/2023/12/rem-sleep-behavior-disorder-symptoms-causes-treatment/

  Some small changes may help calm your REM sleep behavior disorder symptoms. Maintain good sleep habits, such as: Avoid alcohol and nicotine, especially before bedtime. Develop a calming bedtime routine (i.e., yoga, light stretching, or soft music). Don’t eat a big meal late in the evening. Go to bed and wake up at the same time every day, including weekends. Keep your bedroom cool and dark. Limit screen time before bed.

• #2 New AASM Guideline Advises on Management of REM Sleep Behavior Disorder

  https://consultqd.clevelandclinic.org/new-aasm-guideline-advises-on-management-of-rem-sleep-behavior-disorder

  Dr. Foldvary-Schaefer highlights several takeaways from the guideline: […] Try medications for situations involving high risk for injury. Clonazepam, immediate-release melatonin and transdermal rivastigmine are conditionally recommended for either isolated or secondary RBD. Evidence also indicates that pramipexole may be effective for isolated RBD. […] If possible, discontinue implicated medications for drug-induced RBD. Likely culprits are beta-blockers and selective serotonin reuptake inhibitors. […] Don’t treat RBD with deep brain stimulation. Although it is effective for Parkinson’s disease, there is no evidence that deep brain stimulation improves RBD, so it should not be considered for this indication. […] The guidelines lack of strong recommendations underscore that more randomized controlled studies are needed, including direct comparisons of the currently used drugs.

• #2 REM Sleep Behavior Disorder: Treatment, Symptoms & Causes

  https://www.emedicinehealth.com/rem_sleep_behavior_disorder/article_em.htm

  What Is the Follow-up for REM Sleep Disorder? Because REM sleep behavior disorder (RBD) may occur in association with neurodegenerative disorders, such as Parkinson’s disease, multiple system atrophy, and dementia, consult a neurologist to rule out these conditions. RBD symptoms may be the first manifestations of these disorders, so careful follow-up is needed.

• #2

  https://link.springer.com/article/10.1007/s11940-016-0433-2

  RBD is an attractive target for future neuroprotective treatment trials to prevent evolution of overt parkinsonism or memory decline, but currently, there are no known effective treatments and future trials will be necessary to determine if RBD is an actionable time point in the evolution of overt synucleinopathy. […] This case series of 45 REM sleep behavior disorder patients remains the largest comparative study between melatonin and clonazepam to date, finding through survey based patient reported outcomes that both treatments were approximately equally effective at reducing RBD frequency and severity, while melatonin was better tolerated. […] This article comprehensively assessed available literature through 2010 concerning REM sleep behavior disorder treatment, and as the present review, concentrated on clonazepam and melatonin but also examining then published alternative, and also provided evidence level ratings for various treatments, reporting Level A evidence for safety measures, Level B for clonazepam and melatonin, and Level C for other alternatives such as pramipexole, zopiclone, benzodiazepines other than clonazepam, Yi-Gan San, desipramine, clozapine, carbamazepine, and sodium oxybate. […] This report in four medication refractory REM sleep behavior disorder patients showed evidence for decreased injury and symptoms, offering a novel approach to therapy without adverse effects.

• #2 AASM Management of REM Sleep Behavior Disorder Guideline Summary

  https://www.guidelinecentral.com/guideline/2722821/

  The AASM suggests that clinicians use transdermal rivastigmine (vs no treatment) for the treatment of secondary RBD due to medical condition (Parkinson disease) in adults. (Conditional) […] The AASM suggests that clinicians not use deep brain stimulation (DBS; vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (Conditional) […] The AASM suggests that clinicians use drug discontinuation (vs drug continuation) for the treatment of drug-induced RBD in adults. (Conditional)

• #2

  https://link.springer.com/article/10.1007/s11940-016-0433-2

  However, neither agent is likely to completely stop dream enactment behaviors, so choosing a moderate target dosage of melatonin 6 mg or clonazepam 0.5 mg, or the highest tolerable dosage that reduces attack frequency and avoids adverse effects from overtreatment, is currently the most reasonable strategy. […] Alternative second- and third-line therapies with anecdotal efficacy include temazepam, lorazepam, zolpidem, zopiclone, pramipexole, donepezil, ramelteon, agomelatine, cannabinoids, and sodium oxybate. […] A novel non-pharmacological approach is a bed alarm system, although this may be most useful in patients who also report sleep walking or a history of leaving their bed during dream enactment episodes. […] The benefit of hypnosis, especially in those with psychiatric RBD, also requires further study.

• #2 Mount Sinai Researchers Identify Potential New Treatment for Those Who Act Out Their Dreams While Sleeping | Mount Sinai – New York

  https://www.mountsinai.org/about/newsroom/2023/mount-sinai-researchers-identify-potential-new-treatment-for-those-who-act-out-their-dreams-while-sleeping

  Mount Sinai researchers have published what they say is the first study to identify a new form of treatment for rapid eye movement (REM) sleep behavior disorder. […] The paper also demonstrates for the first time that sleep medications known as dual orexin receptor antagonists—commonly used to treat insomnia, or difficulty falling and remaining asleep—can significantly reduce REM sleep behavior disorder. […] Researchers hope their findings will encourage future trials of dual orexin receptor antagonists to treat REM sleep behavior disorder in humans, given that the medication is already FDA approved and available to treat people with insomnia. […] It was even more surprising and exciting to observe that a dual orexin receptor antagonist could significantly minimize the dream enactment behaviors.

• #3 REM Sleep Behavior Disorder | UPMC HealthBeat

  https://share.upmc.com/2023/12/rem-sleep-behavior-disorder-symptoms-causes-treatment/

  REM Sleep Behavior Disorder Treatment […] Your doctor may recommend a combination of approaches to treat your REM sleep behavior disorder. […] Your doctor may recommend medicine to treat your sleep disorder. Medicines include: Clonazepam this prescription drug is often used to treat anxiety. It also reduces symptoms in many people with REM sleep behavior disorder. Side effects may include sleepiness, forgetfulness, impaired balance, and worsening of sleep apnea. […] Melatonin this popular over-the-counter supplement signals that its time for your body to get ready for sleep. But the amount you need to treat REM sleep behavior disorder is different from the amount needed to help you fall asleep. Your doctor can help you choose the right dosage. […] It’s important to keep your environment safe. People with REM sleep behavior disorder are at risk for bruises, cuts, fractures, blunt trauma, and head trauma. If you sleep with a partner, you may want to sleep in separate bedrooms until your symptoms are under control. […] To keep your bedroom safe, you should: Add padded bedrails to the side of the bed. Add padding or blankets to the floor. Move furniture, lamps, fans, and any clutter away from the bed. Pad the corners of furniture in the room. Remove any weapons from the bedroom. Remove sharp objects from the bedroom.

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