Medications and Factors That Decrease REM Sleep

Antidepressant and Benzodiazepine Medications

Desipramine has been used specifically for its ability to suppress both phasic and tonic components of REM sleep 1
Clonazepam (0.25-2.0 mg at bedtime) is recommended as a first-line treatment for REM sleep behavior disorder due to its REM-suppressing effects, according to the American Academy of Sleep Medicine 2
Clonazepam works through GABAergic inhibition by increasing the frequency of chloride channel opening, effectively suppressing REM sleep, as suggested by the American Academy of Sleep Medicine 2
Other benzodiazepines like temazepam, triazolam, and alprazolam also decrease REM sleep through similar mechanisms, as reported by the American Academy of Sleep Medicine 1

Melatonin (3-15 mg at bedtime) suppresses REM sleep motor tone and normalizes circadian features of REM sleep, according to Praxis Medical Insights 2
L-DOPA may promote REM sleep behavior disorder in some patients, suggesting it affects REM sleep regulation, as found by the American Academy of Sleep Medicine 3
Acetylcholinesterase inhibitors like donepezil and rivastigmine may affect REM sleep patterns in patients with neurodegenerative disorders, as reported by the American Academy of Sleep Medicine 1
Angiotensin-converting enzyme inhibitors (ACEIs) like enalapril, perindopril, or ramipril may contribute to sleep apnea and disrupt normal REM sleep patterns in some patients, according to the British Journal of Pharmacology 4

Stress can significantly disrupt normal REM sleep patterns by activating the hypothalamic-pituitary-adrenal axis, which has inhibitory effects on REM sleep, as suggested by Praxis Medical Insights 5
Addressing underlying stress factors should be prioritized in patients experiencing stress-related REM sleep disruptions, according to Praxis Medical Insights 5

When prescribing REM-suppressing medications, monitor for potential side effects such as daytime sedation, cognitive impairment, and falls, particularly in elderly patients, as recommended by the American Academy of Sleep Medicine 6
For patients with REM sleep behavior disorder, the REM-suppressing effects of medications like clonazepam can be therapeutic by reducing dream enactment behaviors, according to the American Academy of Sleep Medicine 7
Use clonazepam with caution in patients with dementia, gait disorders, or concomitant obstructive sleep apnea, as advised by the American Academy of Sleep Medicine 7
Some antidepressants may paradoxically induce or worsen REM sleep behavior disorder symptoms in certain patients, according to Praxis Medical Insights 2