Treatment of parasomnias: medication, sleep hygiene and psychotherapy

When starting treatment for parasomnias, it is most important to correctly identify the disorder and diagnose any organic, neurological or psychiatric diseases, medications or drugs that may be causing the parasomnias.

Generally accepted treatment strategies for both non-REM and REM sleep disorders are as follows:

• Maintaining habits of so-called sleep hygiene:
  • Regular sleep that lasts 7 to 9 hours during the night.
  • turning off lights, television and electronic devices
  • bedroom temperature should be approximately 18-22 °C
  • avoiding caffeine and physical exertion for at least a few hours before bedtime
  • maintaining a regular sleep and wakefulness routine even on days off, weekends, holidays and vacations
  • avoiding the use of alcohol and recreational drugs
  • regular use of medication prescribed by a neurologist or psychiatrist

Therapy for non-REM sleep disorders:

Patients who suffer from non-REM parasomnias are usually not prescribed medication.

However, if the physician decides to medicate, drugs from the benzodiazepine group are usually the first choice. Sometimes tricyclic antidepressants may also be used.

Some individuals find individual psychological approaches such as hypnosis, relaxation therapy or cognitive behavioural therapy or psychotherapy very helpful.

REM sleep disorder therapy:

For the treatment of REM sleep parasomnias, the drug of choice is clonazepam, which is administered approximately 30 minutes before bedtime. It is a very effective drug. Approximately 79% of patients are completely free of parasomnias and 90% of patients experience relief from the disorder. However, it is important to take it regularly every night. The parasomnias return almost immediately after discontinuation.

Another alternative drug is melatonin. It has the advantage of excellent tolerability and almost zero incidence of side effects in patients. However, its efficacy is slightly lower than that of clonazepam.

Precautions

One aspect of the treatment of patients with parasomnias is well-chosen precautions that should not be underestimated.

Some advice for bedside security

• removing dangerous or sharp objects from the bedroom
• safe small table lamps on the bedside table
• placing a pad or mattress on the floor under the bed to prevent injury in a fall
• securing sharp edges on bedside furniture
• water on the bedside table should be in a plastic bottle or plastic cup
• alarms on windows and doors to wake the partner if the sleepwalker opens them
• separate beds if the person with parasomnia is aggressive, hitting or kicking while sleeping

Treatment of parasomnia in a paediatric patient

Non-REM parasomnias are common in children. They begin in infancy and usually end during adolescence.

Medications are rarely prescribed for children. However, when they are needed, treatment is short, usually three to six weeks.

The drugs of choice, as with adults, are benzodiazepines or anti-anxiety medications.