1175 Alternative Treatment for REM-Sleep Behavior Disorder

Abstract Introduction Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a parasomnia occurring during REM sleep, characterized by loss of normal REM sleep atonia and dream enactment behaviors. The majority of patients diagnosed with idiopathic RBD will develop an alpha-synucleinopathy neurodegenerative disease, which can complicate the treatment of RBD. First-line treatment with high-dose melatonin or clonazepam can have side effects of daytime sleepiness, dizziness, or nightmares, which can increase risk of harm to patients. This has led some patients to seek alternative treatments. We report a patient who successfully treated symptoms of RBD with edible tetrahydrocannabinol (THC) gummies. Report of case(s) A 67-year-old man presented to sleep clinic with symptoms of daytime sleepiness and dream enactment behavior including yelling, punching and kicking. He underwent a diagnostic polysomnogram that revealed moderate obstructive sleep apnea (OSA) but did not confirm dream enactment behavior or RSWA. He was diagnosed with RBD based on clinical criteria and started CPAP and melatonin 10 mg with initial reduction of dream enactment. At a subsequent visit he reported increased frequency of dream enactment behaviors with morning grogginess which caused him to stop melatonin and start marijuana gummies with 4.2 mg of THC purchased over-the-counter. Since starting this, his wife had reported complete resolution of dream enactment behavior. Conclusion Current first-line medications used to treat symptoms of RBD can cause unfavorable side effects of dizziness and daytime sleepiness which can negatively impact patients’ quality of life and compound progressive symptoms of neurodegeneration. Recent studies involving cannabinoids for RBD trialed the use of Cannabidiol (CBD), but showed no reduction in frequency of dream enactment symptoms. Our case illustrates an example of successfully using THC as an alternative treatment for dream enactment behavior, which may be more well-tolerated than first-line agents and is readily available over-the-counter in many states. A possible mechanism for the improvement in symptoms may be related to THC-predominant cannabis mediated reduction in total REM sleep and REM density. More studies are needed to determine if THC can be used as a viable alternative for treatment of RBD. Support (if any)