Patient discussions
Patient education includes explaining how predisposing factors (such as sleep deprivation and stress) may precipitate parasomnias and that these should be avoided or corrected if possible.
Patients receiving benzodiazepines are cautioned about the potential for daytime drowsiness. They are advised not to drive, operate heavy machinery, or engage in activities that entail risk when they are somnolent. The addition of alcohol or other central nervous system depressant drugs to benzodiazepines increases the risk of drowsiness and sedation, and patients must be cautioned about this potential for interaction. They should also be warned about the harmful effects of prolonged use.
Patients should be advised that topiramate may be associated with somnolence, dizziness, and in some cases anorexia and a decrease in weight. Memory problems have also been described with topiramate in some patients.
Pramipexole and ropinirole therapy have been reported to cause sudden sleep in patients even while they are engaged in activities during the day. Patients must be warned about the potential for this adverse effect, especially with regard to driving and operating heavy machinery. They should also be warned that hypotension, especially orthostatic hypotension, can occur with these therapies.
Given the high lifetime risk of neurodegenerative disease in patients with isolated RBD, disclosure of this risk should be offered in a patient-centered manner, considering the values and desires of the patient and the risks and benefits of such disclosure. In general, disclosure of risk allows the patient to plan for their future and consider participation in research. However, disclosure may result in anxiety for a diagnosis that may not occur, particularly when there is currently no proven disease modifying or preventative strategy. Yet, withholding disclosure may negatively impact the provider-patient relationship if the patient learns of the risk on their own, such as on the internet.[37][96]
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