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. After years of continued treatment, moderate limb twitching with sleep talking and more complex behaviors can reemerge. The treatment should be continued for as long as your doctor says. If you decide to stop, the medicine should be slowly tapered, watching for signs of withdrawal such as nightmares or agitation.
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.