Adult NREM Parasomnia Associated with Lancinating Throat Pain

Abstract

We report the case of a 30-year-old woman presenting with dangerous nocturnal NREM episodes with the clinical feature of lancinating throat pain. We hypothesize that the pain may have represented sensory hallucination analogous to commonly recognized visual images associated with NREM parasomnias. This case is also unusual for probable psychological triggers that could play a role in the pathogenesis of the disease, as evidenced by successful psychotherapy. Keywords: NREM parasomnia, pain, psychotherapy Citation: Bušková J, Šonka K. Adult NREM parasomnia associated with lancinating throat pain. J Clin Sleep Med 2014;10(8):925-926. http://dx.doi.org/10.5664/jcsm.3974 C A S E R E P O R T SN REM parasomnias are arousal disorders emerging during slow wave sleep characterized by greatly variable behavioral and emotional expression.1 These episodes are usually followed by amnesia, but a minority of adult patients recall complex mental activity immediately before and during episodes.2 Thus far, only one case of such an episode associated with pain perception has been described. 3 We report a case of severe NREM parasomnia manifested by the previously unreported feature of lancinating throat pain. REPORT OF CASEThe patient is a 30-year-old, healthy young woman with a high school education, now on maternity leave with her fi rst child. She has suffered from "calm somnambulism" since childhood with no other medical history.Her husband arranged a consultation in our sleep clinic with regard to dangerous behavior exhibited by his wife while asleep. The episodes typically occurred within the fi rst two hours of sleep, and presented with sudden sat up straight in bed and somniloquy that suggestively corresponded to dreamlike visual images. At the beginning of the episode that prompted consultation, the subject began to dream that she was swallowing various indigestible objects (such as scissors, socks, dogs, needles, worms, pet hair), accompanied by terribly unpleasant subjective feelings and lancinating throat pain. She experienced this sensation so dramatically that she spent some time sitting up in bed vigorously trying to remove the object from her throat with her hands until she choked and gagged, injuring her throat, with pain persisting for a week. She was confused for several minutes after the episode and repeatedly asked her husband to remove the object from her throat. There was no identifi ed biopsychosocial trigger for these episodes from the preceding day.The last of these sporadic episodes involved a potential threat to their daughter. Their two-year-old daughter was sleeping with her parents as she had infl uenza. The episode started around midnight. The subject suddenly sat upright in bed, grabbed her daughter and forcibly opened her mouth, trying to insert her fi ngers into her mouth. Her husband acted quickly to protect their daughter. When he succeeded in waking his wife, she said that she had dreamt that her daughter swallowed a coin. She was not sure whether or not it was a dream for an entire day fol...

The spectrum of disorders causing violence during sleep

“…An unusual case of injurious NREM parasomnia associated with lancinating throat pain has been reported in a healthy 30 year-old married woman with childhood-onset, persistent, non-problematic SW (Buskova and Sonka 2014). Within two hours after sleep onset she would sit up in bed dreaming that she was swallowing indigestible objects, such as scissors, needles, worms, etc., which were accompanied by very unpleasant feelings and lancinating throat pain.…”