Clinical neurophysiology of REM parasomnias

Stefani, Ambra; Holzknecht, Evi; Högl, Birgit

doi:10.1016/b978-0-444-64142-7.00062-x

Cited by 20 publications

(10 citation statements)

References 130 publications

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“…4,5 In patients with narcolepsy, the polysomnography showed features intermediate between REM sleep and wakefulness. 7,8 In a single case to date, spectral EEG analysis definitely settled the episode as an intermediate state between wake and REM sleep. 6 Sleep paralysis may sometimes be linked to false awakening, 1 a state characterized by the perception of waking up in a familiar place and starting a normal daytime routine, only to later discover of having been trapped in one's own dream or to realize of having dreamt.…”

Section: Introductionmentioning

confidence: 95%

Are sleep paralysis and false awakenings different from REM sleep and from lucid REM sleep? A spectral EEG analysis

Mainieri

Maranci

Champetier

et al. 2021

Journal of Clinical Sleep Medicine

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Study objectives:To determine the polysomnography characteristics during sleep paralysis, false awakenings and lucid dreaming (which are states intermediate to REM sleep and wake but exceptionally observed in sleep laboratory). Methods:In 5 subjects, we captured 5 episodes of sleep paralysis (2 time-marked with the ocular left-right-left-right code normally used to signal lucid dreaming, 1 time-marked by an external noise and 2 retrospectively reported) and 2 episodes of false awakening. The sleep coding (using three seconds mini-epochs) and spectral EEG analysis were compared during these episodes and normal REM sleep as well as wakefulness in the same four among these five subjects, and vs. lucid REM sleep in four other patients with narcolepsy.Results: During episodes of sleep paralysis, 70.8 % of mini-epochs contained theta EEG rhythm, (vs. 89.7% in REM sleep and 21.2% in wakefulness), 93.8% contained chin muscle atonia (vs. 89.7% in REM sleep and 33.3% in wakefulness) and 6.9% contained rapid eye movements (vs. 11.9% in REM sleep and 8.1% in wakefulness). The EEG spectrum during sleep paralysis was intermediate between wakefulness and REM sleep in the alpha, theta and delta frequencies, whereas the beta frequencies were not different between sleep paralysis and normal REM sleep.The power spectrum during false awakening followed the same profile as in sleep paralysis. Conclusions:The predominant theta EEG rhythm during sleep paralysis and false awakenings (with rare and lower alpha rhythm) suggests that the brain during sleep paralysis is not in an awake but in a dreaming state. 4 BRIEF SUMMARYCurrent Knowledge/Study Rationale: Sleep paralysis is commonly viewed as an awake brain with a complete muscle atonia, but EEG analysis during sleep paralysis is exceptional.Study Impact: Our polysomnography and spectral analysis of time-marked sleep paralyses suggest that the brain during sleep paralysis is not in an awake but in a dreaming state. This may explain why hallucinations are often associated with sleep paralysis.

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Section: Introductionmentioning

confidence: 95%

Are sleep paralysis and false awakenings different from REM sleep and from lucid REM sleep? A spectral EEG analysis

Mainieri

Maranci

Champetier

et al. 2021

Journal of Clinical Sleep Medicine

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“…Sleep paralysis consists in transient, generalized, inability to move and to speak occurring in the transitional period between wakefulness, and sleep (85). It is characterized by the complete inability to move in a subjectively awake person (86).…”

Section: Hallucinations Related To (Recurrent) Isolated Sleep Paralysismentioning

confidence: 99%

“…More rarely and frequently associated with underlying disorders or conditions, such as narcolepsy or altered sleep-wake cycle (92,103), hypnagogic hallucinations can arise from sleep onset REM periods, sharing more similarities with hypnopompic hallucinations, which arise from a mixed state of REM and wake EEG (90). Dream ideation of REM sleep intruding into wakefulness gives hypnopompic hallucinations a greater emotional load, as unpleasant and frightening experiences, especially when associated with sleep paralysis, where the muscular atonia at EMG extends into wakefulness (85,104). During these episodes, the person feels awake but unable to move, perceives ominous sounds (such as approaching footsteps), feels movement in the bed, and then feels (and/or smells) a person, creature or unspecified entity climbing upon the chest, a smothering sensation, and sometimes even a physical or sexual assault (102).…”

Section: Clinical and Polygraphic Featuresmentioning

confidence: 99%

“…Occasional nightmares are frequent, common both in childhood and in adulthood, occurring in an estimated 6.6% of the general population (85,121). Even though nightmares often beginning during childhood could be stable over time, longitudinal studies, especially in adults are scarce (122).…”

Section: Epidemiologymentioning

confidence: 99%

“…Differently from RBD, during nightmares patients may vocalize or move minimally but complex motor behaviors with enacted dreams of defense against aggressions paralleling dream content usually are lacking (131). In addition, patients with nightmare disorder exhibit physiological REM atonia during polysomnography (85). Sleep terrors emerge from stage 3 NREM sleep with shouting and high autonomic changes.…”

Section: Differential Diagnosismentioning

confidence: 99%

See 2 more Smart Citations

Differentiating Oneiric Stupor in Agrypnia Excitata From Dreaming Disorders

Baldelli

Provini

2020

Front. Neurol.

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Oneiric Stupor (OS) in Agrypnia Excitata represents a peculiar condition characterized by the recurrence of stereotyped gestures such as mimicking daily-life activities associated with the reporting of a dream mentation consisting in a single oneiric scene. It arises in the context of a completely disorganized sleep structure lacking any physiological cyclic organization, thus, going beyond the concept of abnormal dream. However, a proper differential diagnosis of OS, in the complex world of the “disorders of dreaming” can become quite challenging. The aim of this review is to provide useful clinical and videopolygraphic data on OS to differentiate it from other dreaming disorders. Each entity will be clinically evaluated among the areas of dream mentation and abnormal sleep behaviors and its polygraphic features will be analyzed and distinguished from OS.

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