REM sleep suppression linked to longer survival in ALS patients

During REM sleep, the body enters a state of paralysis. This can pose a danger for patients with weakened diaphragms due to neuromuscular diseases. Now new research published at the ATS 2025 International Conference has shown that antidepressants that suppress REM sleep are associated with improved survival in people with amyotrophic lateral sclerosis (ALS).

The findings could support the use of medication to inhibit REM sleep in patients with ALS, and potentially other neurodegenerative diseases. It's the first study to examine the role of REM sleep in ALS progression and outcomes.

This lends credence to the question of whether pharmacotherapy to inhibit REM sleep can improve the lives of patients with neuromuscular diseases, ALS in particular, who are prone to sleep disordered breathing."

Cosmo Fowler, MD, first author, a sleep medicine fellow, Emory University

Neuromuscular diseases like ALS can weaken the diaphragm muscles, so people rely on extra support from surrounding muscles to breathe. These patients are especially vulnerable during REM (rapid eye movement), a phase of sleep associated with dreaming, because the body suppresses muscle activity. This can cause disrupted sleep, resulting in problems like daytime sleepiness and drowsy driving. In more extreme cases, it can cause serious breathing problems, ranging from hypercarbia (high carbon dioxide levels) and hypoxic respiratory failure, to full respiratory arrest and even death.

While some research has been done on how REM affects other forms of disordered breathing like obstructive sleep apnea, little was understood about its impact on neuromuscular diseases like ALS.

For the new, retrospective study, researchers analyzed a large patient database to study outcomes for ALS patients who had been prescribed antidepressants. They compared patients who received REM-suppressing antidepressants with those whose medications did not interact with REM sleep. They found that two-year survival was significantly higher for patients in the REM-suppressed group.

"I found it surprising that a clear difference in survival was so readily apparent," Dr. Fowler said. He added that researchers had expected to find differences in more short-term negative clinical outcomes, but thought that survival differences would be more difficult to tease out.

The findings are especially significant considering the shortage of treatment options that are effective in altering the course of ALS, he noted; current treatments are largely aimed at improving quality of life, not increasing survival.

More research, including a prospective clinical trial, is needed to support offering REM-suppressing therapies to patients with ALS, Dr. Fowler said.