title: A novel therapy for REM sleep behavior disorder (RBD).
abstract: OBJECTIVE
  RBD may result in sleep related injury (SRI) particularly if a patient exits the bed during dream enactment behavior (DEB). The complex auditory processing and low arousal threshold of REM sleep offers a therapeutic window to halt behavior prior to SRI. We evaluated whether a recorded message prevents SRI in medically refractory RBD.
  
  
  METHODS
  Case Series.
  
  
  METHODS
  Sleep disorders center.
  
  
  METHODS
  Four consecutive RBD patients with continued SRI despite both clonazepam and melatonin therapy.
  
  
  METHODS
  A pressurized bed alarm customized with a familiar voice to deliver a calming message during vigorous DEB.
  
  
  RESULTS
  The RBDQ-HK evaluated RBD symptoms, and SRI was further quantified with a new clinical tool, the Minnesota Parasomnia Injury Scale. All patients reported a decrease in RBD symptoms and SRI. No injuries occurred post-intervention. Pre-treatment: 5 serious events (SE), 80 minor events (ME), and 193 near events (NE) were noted over 66 patient-months (4.21 events/pt-mo). Post-treatment: 0 SE, 0 ME, and 3 NE were noted after a follow up period of 63 pt-months (0.05 event/pt-mo). There were 176 total bed alarm interventions (2.79 interventions/pt-mo). No adverse effects were reported, and all 4 patients described a minimal burden of treatment. RBD symptoms improved as the average RBDQ-HK score decreased from 68 (range: 53-80) to 54 (range 42-65).
  
  
  CONCLUSIONS
  A customized bed alarm may be an effective method to prevent SRI in RBD. This intervention is most suitable for cases of medically refractory RBD and/or for those patients who are unable to tolerate medical therapy.
authors.affiliation: Department of Neurology, University of Minnesota, Minneapolis, MN 55414, USA. howel020@umn.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Howell
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Arneson
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Schenck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy / Q000379:methods*; D056902:Clinical Alarms / Q000706:statistics & numerical data*; D002998:Clonazepam / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008550:Melatonin / Q000627:therapeutic use; D008875:Middle Aged; D020187:REM Sleep Behavior Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D012720:Severity of Illness Index; D013637:Tape Recording; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002998:Clonazepam; D008550:Melatonin