Correct!
2. Gabapentin

Melatonin, Clonazepam, and Pramipexole are all conditional recommendations for management of isolated RBD. If the patient continues to demonstrate dream enactment behavior it would be reasonable to try melatonin, or a benzodiazepine to reduce symptoms. For intractable and persistent symptoms, a Dopamine agonist would be warranted as the most appropriate next step.

This case highlights the complex management of a 31-year-old male with a history of seizure disorder, SVT, severe OSA, and excessive daytime sleepiness. The patient's response to CPAP therapy, along with the presence of dream enactment behavior, raises suspicion of Rapid Eye Movement Behavior Disorder (RBD). Discontinuation of SSRIs with regular follow-up and monitoring will ensure ongoing management and adjustment of the treatment plan as necessary.

References

1. Troester MM, Quan SF, Berry RB, et al; for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 3. Darien, IL: American Academy of Sleep Medicine, 2023. Available at: https://aasm.org/clinical-resources/scoring-manual/ (free for members $70 for nonmembers).
2. Howell M, Avidan AY, Foldvary-Schaefer N, Malkani RG, During EH, Roland JP, McCarter SJ, Zak RS, Carandang G, Kazmi U, Ramar K. Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2023 Apr 1;19(4):759-768. [CrossRef] [PubMed]