Treatment of violent behaviors in sleep depends on the underlying condition and a correct identification of the causative disorder is mandatory. After eliminating possible precipitating factors, pharmacological treatment is often required to control violent sleep behaviors. Although no drugs are specifically approved for the treatment of
parasomnias and placebo-controlled trials are lacking in these patient populations,
clonazepam is considered the
drug of choice in the management of both Non-REM and REM
parasomnias.
Benzodiazepines may cause unwanted side effects especially in older individuals and tolerance is sometime observed.
Melatonin and
pramipexole may represent alternative options in
REM sleep behavior disorder.
Hypnosis therapy may be considered in arousal disorders when pharmacological treatment is contraindicated or ineffective. Management of nocturnal
frontal lobe epilepsy include a first-step pharmacological approach with
antiepileptic drugs (eg,
carbamazepine,
oxcarbazepine or other drugs effective on
partial seizures), but surgical options may be considered in
drug refractory patients. The published evidence for the efficacy of various treatments relies mostly upon case series or case reports.