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PD RBD – Melatonin — SCE Neurology MCQ

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HardSleep DisordersPD RBD – MelatoninSCE Neurology

A 73-year-old with Parkinson’s disease has polysomnography-confirmed REM sleep behaviour disorder despite withdrawal of a precipitating antidepressant and bedroom-safety measures. They have recurrent falls, mild cognitive impairment and obstructive sleep apnoea. Which drug strategy is most defensible?

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Correct answer: B — Consider immediate-release melatonin, reserving clonazepam for an individualised later decision

NICE permits clonazepam or melatonin after medication review. The AASM specialist guideline specifically supports immediate-release melatonin and clonazepam for secondary RBD, but older people can be particularly susceptible to clonazepam-related sedation, postural instability and cognitive effects; obstructive sleep apnoea adds further concern. Immediate-release melatonin is therefore the more defensible first trial here. Dream enactment is not psychosis, and it is not an indication to increase dopaminergic treatment.

Reference: NICE NG71: Parkinson’s disease in adults — recommendations. https://www.nice.org.uk/guidance/ng71/chapter/Recommendations AASM clinical practice guideline: management of REM sleep behavior disorder. https://pmc.ncbi.nlm.nih.gov/articles/PMC10071384/