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Continuum (Minneapolis, Minn.) Aug 2020This article discusses the clinical manifestations, diagnosis and differential diagnosis, pathophysiology, and management of parasomnias occurring in non-rapid eye... (Review)
Review
PURPOSE OF REVIEW
This article discusses the clinical manifestations, diagnosis and differential diagnosis, pathophysiology, and management of parasomnias occurring in non-rapid eye movement (REM) sleep.
RECENT FINDINGS
Disorders of arousal are characterized by dissociated sleep, with wake and sleep phenomena intermingling, and local sleep, in which different areas of the brain exist simultaneously in different states of wakefulness or sleep. The frequency of arousals from slow-wave sleep with delta or mixed-frequency activity has a high sensitivity but relatively low specificity for the diagnosis of arousal parasomnias.
SUMMARY
Disorders of arousal (sleepwalking, sleep terrors, and confusional arousals) are characterized by incomplete awakenings from slow-wave sleep, limited recall of imagery, and partial or complete amnesia. They occur most frequently in childhood. Management includes correction of precipitating factors, attention to safety, behavioral techniques, and medications. Sleep-related eating disorder is a variant of arousal disorders and may be associated with the use of short-acting hypnotics and restless legs syndrome. Complex nocturnal visual hallucinations can occur with visual loss, dementia with Lewy bodies, use of β-adrenergic receptor antagonists, and anxiety. Exploding head syndrome occurs at wake-sleep transition or on waking during the night, is usually benign, and requires treatment only if significant sleep disruption occurs.
Topics: Humans; Parasomnias; Sleep Stages
PubMed: 32756230
DOI: 10.1212/CON.0000000000000877 -
Current Psychiatry Reports Jul 2017Little is known about the presence of parasomnias such as nightmare disorder, sleep paralysis, REM sleep behavior disorder (RBD), and sleep-related eating disorders... (Review)
Review
PURPOSE OF REVIEW
Little is known about the presence of parasomnias such as nightmare disorder, sleep paralysis, REM sleep behavior disorder (RBD), and sleep-related eating disorders (SRED) in people with mental illness. A predominant view suggests that psychotropic medications might be contributing to parasomnias. This article summarizes knowledge regarding the relationships between psychiatric disorders and parasomnias, and possible confounds. A systematic search of the literature in the past 10 years identified 19 articles.
RECENT FINDINGS
There were significantly elevated rates of parasomnias in psychiatric disorders (average prevalence of nightmares was 38.9%, sleep paralysis 22.3%, SRED 9.9%, sleepwalking 8.5%, and RBD 3.8%). Medication usage was only one of many risk factors (other sleep disorders, medical comorbidities, and substance abuse) which were associated with parasomnias. A strong association exists between mental illness and parasomnias which is not fully explained by medications. Prospective longitudinal studies are needed to develop a better understanding of the unique and shared variance from multiple risk factors.
Topics: Humans; Mental Disorders; Parasomnias; Prospective Studies
PubMed: 28534293
DOI: 10.1007/s11920-017-0789-3 -
Revista de Neurologia Nov 2020Sleep-related movement and behaviour disorders may have an impact on sleep quality and lead to daytime symptoms. These groups of conditions include diseases such as... (Review)
Review
Sleep-related movement and behaviour disorders may have an impact on sleep quality and lead to daytime symptoms. These groups of conditions include diseases such as restless legs syndrome, periodic leg movements, and REM and NREM parasomnias. The knowledge of their clinical features and management is of utmost importance for the neurologist and sleep specialist. Frequently, these patients are referred to such specialists and it is relevant to know that certain sleep disorders may be associated with other neurological conditions.
Topics: Adult; Humans; Parasomnias; Restless Legs Syndrome; Sleep; Sleep Wake Disorders
PubMed: 33145749
DOI: 10.33588/rn.7110.2020365 -
Revue Neurologique Oct 2023Nocturnal agitation refers to a broad spectrum of symptoms from simple movements to aggressive behaviors with partial or complete loss of awareness. An accurate... (Review)
Review
Nocturnal agitation refers to a broad spectrum of symptoms from simple movements to aggressive behaviors with partial or complete loss of awareness. An accurate identification of its etiology is critical for appropriate therapeutic intervention. In children and young adults, distinguishing between non-rapid eye movement (NREM) sleep parasomnias and psychogenic non-parasomniac manifestations, a condition known as sleep-related dissociative disorder (SRDD), can be challenging. This review aims to summarize current clinical, neurophysiological, and epidemiological knowledge on NREM parasomnia and SRDD, and to present the pathophysiological hypotheses underlying these nocturnal manifestations. Sleepwalking, sleep terror and confusional arousals are the three main presentations of NREM parasomnias and share common clinical characteristics. Parasomniac episodes generally occur 30minutes to three hours after sleep-onset, they are usually short, lasting no more than few minutes and involve non-stereotyped, clumsy behaviors with frequent amnesia. The prevalence of NREM parasomnia decreases from 15-30% in children to 2-4% in adults. Parasomniac episodes are incomplete awakening from the deepest NREM sleep and are characterized by a dissociated brain activity, with a wake-like activation in motor and limbic structures and a preserved sleep in the fronto-parietal regions. SRDD is a less known condition characterized by dramatic, often very long episodes with frequent aggressive and potentially dangerous behaviors. SRDD episodes frequently occur in quiet wakefulness before falling asleep. These dissociative manifestations are frequently observed in the context of psychological trauma. The pathophysiology of SRDD is poorly understood but could involve transient changes in brain connectivity due to labile sleep-wake boundaries in predisposed individuals. We hypothesize that SRDD and NREM parasomnia are forms of sleep-related dissociative states favored by a sleep-wake state dissociation during sleep-onset and awakening process, respectively.
Topics: Child; Young Adult; Humans; Parasomnias; Sleep Arousal Disorders; Dissociative Disorders; Movement; Sleep
PubMed: 37625976
DOI: 10.1016/j.neurol.2023.07.003 -
Zeitschrift Fur Gerontologie Und... Mar 2020Parasomnias are characterized by abnormal experiences, dreams, movements and behavior during sleep. They may occur in the middle of the sleep during REM (rapid eye... (Review)
Review
Parasomnias are characterized by abnormal experiences, dreams, movements and behavior during sleep. They may occur in the middle of the sleep during REM (rapid eye movement) or NREM (non-rapid eye movement), during falling asleep or waking up. Characteristically for REM behavior disorder is an increased muscle tone although usually REM is defined by an absence of muscle tone. For these forms aggressive dreams may lead to violating bed partners or self-injury of the sleeping person. Even killing bed partners has been described. Many of the patients develop a kind of Parkinson's disease (synucleinopathies). The rate of phenoconversion is more than 30% in 5 years and nearly 100% after 15 years. There are several recommendations regarding a safe sleeping environment. Medicinal treatment consists of either melatonin or clonazepam.
Topics: Humans; Movement; Parasomnias; Parkinson Disease; REM Sleep Behavior Disorder; Sleep, REM; Synucleinopathies
PubMed: 32140765
DOI: 10.1007/s00391-020-01714-5 -
Chronobiology International Oct 2021Shift work is increasingly common in industrialized countries but is associated with numerous health problems, especially sleep disorders. This study compared the...
Shift work is increasingly common in industrialized countries but is associated with numerous health problems, especially sleep disorders. This study compared the frequency of NREM (confusional arousal, sleep terrors, sleepwalking, sleep-related eating disorder), REM parasomnias (REM sleep behavior disorder, nightmare disorder), and isolated symptoms/normal variants (sleeptalking) between shift workers and daytime workers. A total of 1473 participants in 3 different professional groups and working different shift schedules (daytime, night, or rotating shifts) were included. Participants completed a questionnaire consisting of 132 questions about parasomnia, occupational stress, history of occupational and traffic accidents, depression, and other sleep disorders. The lifetime parasomnia prevalence was 43.7% and the 1-year parasomnia prevalence was 24.4% overall. The 1-year parasomnia prevalence was 27.5% among shift workers and 13% among daytime workers. This rate was highest among rotating shift workers (27.9%), followed by night shift workers (21.2%), and lowest in daytime workers (13%) ( < .001). The most common parasomnias reported were sleep terrors, confusional arousals, and sleeptalking. Parasomnia prevalence rates among workers with and without a history of occupational accidents were 43.7% and 24.2%, while those of workers with and without a history of car accidents were 47.4% and 23.8%, respectively ( < .001). Shift work was associated with higher parasomnia prevalence. Working rotating shifts in particular was an independent risk factor for parasomnia. The parasomnias most frequently associated with shift work were confusional arousal, sleeptalking, and sleep terrors. It should be kept in mind that higher parasomnia rates may increase the risk of occupational and traffic accidents in this population.
Topics: Circadian Rhythm; Humans; Parasomnias; Prevalence; Shift Work Schedule; Sleep Wake Disorders
PubMed: 34107833
DOI: 10.1080/07420528.2021.1932996 -
Clinical EEG and Neuroscience Jan 2015Psychogenic nonepileptic seizures (PNES), a form of functional neurological symptom disorder (FNSD), are very rarely seen in genuine, electroencephalography... (Review)
Review
Psychogenic nonepileptic seizures (PNES), a form of functional neurological symptom disorder (FNSD), are very rarely seen in genuine, electroencephalography (EEG)-confirmed sleep. However, they are more commonly reported as a nocturnal occurrence, likely from a state that is misidentified as sleep (termed by some as "pseudosleep"). Sleep state can be helpful to distinguish FNSD from other neurological disorders. Pseudo-cataplexy, a form of "psychogenic" narcolepsy, "pseudo-parasomnia" and PNES can have a similar presentation. PNES and posttraumatic stress disorder (PTSD) frequently share previously experienced psychological trauma, and therefore the sleep abnormalities found in PTSD may be similarly present in PNES. Future research should use EEG monitoring to evaluate the sleep physiology of patients with FNSD such as PNES, as insights into sleep abnormalities may enable further understanding of the etiology and manifestations of PNES.
Topics: Brain; Conversion Disorder; Electroencephalography; Epilepsy; Humans; Narcolepsy; Parasomnias; Polysomnography; Psychophysiologic Disorders; Sleep Stages; Sleep Wake Disorders
PubMed: 25534169
DOI: 10.1177/1550059414560565 -
Pediatric Annals Sep 2017Parasomnia is a common pediatric sleep disorder that can cause parents or caregivers distress when experienced by their children. Based on the International... (Review)
Review
Parasomnia is a common pediatric sleep disorder that can cause parents or caregivers distress when experienced by their children. Based on the International Classification of Sleep Disorders, parasomnias can be divided into two subgroups: non-rapid eye movement (NREM) parasomnias and rapid eye movement (REM) parasomnias. REM sleep parasomnias include nightmares, REM behavior disorder, and sleep paralysis, whereas NREM sleep parasomnias include disorders of arousal such as confusional arousals, sleepwalking, sleep talking, night terrors, and sleep-related eating disorder. This review focuses on the epidemiology, clinical presentation, diagnosis, and treatment of the most common form of parasomnias-NREM arousal parasomnias. Additionally, this review aims to help clinicians distinguish NREM parasomnias from nocturnal frontal lobe seizures, as this distinction is important to avoid diagnostic delays and inappropriate medication exposure. [Pediatr Ann. 2017;46(9):e327-e331.].
Topics: Adolescent; Arousal; Child; Child, Preschool; Diagnosis, Differential; Humans; Parasomnias; Sleep Stages; United States
PubMed: 28892547
DOI: 10.3928/19382359-20170814-01 -
Annals of the Academy of Medicine,... Apr 2022In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but... (Review)
Review
INTRODUCTION
In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but considerable harm. As such, there is substantial interest on the forensic ramifications of these sleep behaviours.
METHODS
This review examined the diagnostic criteria for parasomnias established in the context of international classification systems; medicolegal case reports; legal frameworks; and court cases in and outside of Singapore, to provide an overview of the implications of NREM parasomnias.
RESULTS
Violent or injurious behaviours that occurred in the context of somnambulism, otherwise known as sleepwalking, have challenged traditional legal theories of criminal culpability. Yet little has changed in the application of sleep science to criminal responsibility. In Singapore, the defence of somnambulism has hitherto not been directly raised. Nonetheless, sleep medicine practitioners may increasingly be requested to render their opinions on legal issues pertaining to violent or injurious behaviours allegedly arising during sleep. Although the understanding of NREM parasomnias has improved, there is still a dearth of evidence to support both medical and legal decisions in this area.
CONCLUSION
NREM parasomnias come with disquieting legal and forensic implications for adjudicating criminal responsibility. There is a need to critically examine legal perspectives on behaviours occurring during sleep. More reliable empirical studies investigating the pathophysiology of NREM parasomnias can offer clearer diagnostic guidelines and address complex behaviours of NREM that often come with medicolegal implications.
Topics: Adult; Humans; Parasomnias; Singapore; Sleep; Somnambulism
PubMed: 35506406
DOI: 10.47102/annals-acadmedsg.2021449 -
Journal of Clinical Sleep Medicine :... Mar 2019Sexsomnia has been reported and is well described in 115 prior cases in the literature. There have been associations with other sleep disorders serving as triggers for...
Sexsomnia has been reported and is well described in 115 prior cases in the literature. There have been associations with other sleep disorders serving as triggers for confusional arousals, thereby worsening sexsomnia episodes. We present a case of an adolescent boy with a history of resected and treated pineoblastoma who later developed sexsomnia marked by multiple episodes of masturbatory events per night. He had additional suspicions of obstructive sleep apnea. Polysomnography confirmed severe obstructive sleep apnea and captured multiple episodes of sexsomnia from both REM and NREM sleep. The patient also had daytime symptoms of severe anxiety and hypersomnia that required pharmacological intervention, cognitive behavioral techniques, and hypnosis. The patient showed improvement with hypnosis along with a multimodal approach to the treatment of sexsomnia.
Topics: Adolescent; Humans; Male; Masturbation; Parasomnias; Polysomnography; Sleep Apnea, Obstructive; Sleep Arousal Disorders; Sleep Stages
PubMed: 30853039
DOI: 10.5664/jcsm.7686