Non–Rapid Eye Movement Sleep Parasomnias

Parasomnias are abnormal behaviors emanating from or associated with sleep. Sleepwalking and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, or promote sleep inertia lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after an arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications; in particular, the widely prescribed benzodiazepine receptor agonists. Recently, compelling evidence suggests that nocturnal eating may in some cases be a nonmotor manifestation of Restless Legs Syndrome (RLS). rapid eye movement (REM) Sleep Behavior Disorder (RBD) is characterized by a loss of REM paralysis leading to potentially injurious dream enactment. The loss of atonia in RBD often predates the development of Parkinson's disease and other disorders of synuclein pathology. Parasomnia behaviors are related to an activation (in NREM parasomnias) or a disinhibition (in RBD) of central pattern generators (CPGs). Initial management should focus on decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders. Clonazepam and melatonin appear to be effective therapies in RBD, whereas paroxetine has been reported effective in some cases of sleep terrors. At this point, pharmacotherapy for other parasomnias is less certain, and further investigations are necessary.Keywords Parasomnia . Sleepwalking . Sleep terrors . REM sleep behavior disorder . Restless legs syndrome Classification of ParasomniasParasomnias are typically classified by the sleep state from which they arise: non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM) (see Table 1 NREM parasomnias include: confusional arousals, sleepwalking disorder, and sleep terrors. These behaviors arise when the cortex incompletely arouses from deep NREM sleep, often due to comorbid conditions that provoke repeated arousal or promote sleep inertia. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking and related disorders [3].Sleep-related eating disorder (SRED) is currently classified in the International Classification of Sleep Disorders, 2nd edition (ICSD-2) under "Other Parasomnia" [1]. However the vast majority of SRED cases emanate from NREM [4], and the complex amnestic behaviors with ambulation are striking similar to sleepwalking [5]. Furthermore, both SRED and sleepwalking are frequently triggered by sedating agents in the setting of underlying motor restlessness [6]. Thus, considering these similarities, SRED will be reviewed immediately after NREM parasomnias.REM sleep behavior disorder is the most clinically relevant REM parasomnia. The loss of atoni...

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“…The sleep fragmentation of OSA during REM or NREM sleep can lead to DEB or CoA/ SW, respectively [55,198] (see Table 7). …”

Section: Polysomnographymentioning

confidence: 99%

Parasomnias: An Updated Review

2012

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“…[3][4][5][6][7] These give clinical features, epidemiological information, genetics and the relationship of somnambulism to other sleep abnormalities. They also suggest medical treatments for the condition but usually without showing the evidence base for each treatment option.…”

Section: Background and Aim For Reviewmentioning

confidence: 99%

Treatments for somnambulism in adults: Assessing the evidence

Harris

Grunstein

2009

Sleep Medicine Reviews

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Somnambulism, or sleep walking, is a parasomnia of non-rapid eye movement (NREM) sleep where movement behaviours usually confined to wakefulness are displayed during sleep. Generally, if sleep walking is causing distress or danger in spite of safety measures, medical or psychological treatment is indicated. Clinicians will need to assess the evidence for treatment options. Medline, Embase, Psychinfo and the Ovid EBM multifile databases were searched. No properly powered rigorous controlled trials were found for treatment of sleepwalking in adults. Seven reports described small trials with some kind of control arm, or retrospective case series which included 30 or more somnambulism patients. With no high quality evidence to underpin recommendations for treatments of somnambulism, full discussion with patients is advised. Adequately powered, well designed clinical trials are now needed, and multicentre collaborations may be required to obtain the sample sizes required.

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“…6 Parasomnias may be categorized as primary (disorders of sleep states per se) or secondary (disorders of other organ systems that manifest themselves during sleep). 7 Sleep related scratching is repetitive scratching of the body surface during the sleep period, and this behavior may represent a primary or secondary parasomnia, depending on whether it is not, or is (respectively) triggered by a dermatological or systemic disorder. The three cases presented herein suggest that sleep related scratching can occur as a primary parasomnia, without known dermatologic or systemic precipitant, and without itching or scratching outside the sleep period.…”

Section: Conclusi Onmentioning

confidence: 99%

Sleep Related Scratching: A Distinct Parasomnia?

Nigam

Riaz

Hershner

et al. 2016

Journal of Clinical Sleep Medicine

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Pruritus (itching) during the sleep period can present as a symptom of dermatological or systemic disease, or as a parasomnia. Sleep related scratching as a primary parasomnia, exclusively confined to sleep in the absence of coexisting dermatological disorders, has not been well described. This case series describes three such patients, and discusses potentially relevant pathophysiology that can underlie itching or pain. Such cases of sleep related scratching may merit nosologic classification apart from previously defined parasomnias.

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Non–Rapid Eye Movement Sleep Parasomnias

Cited by 53 publications

References 263 publications

Parasomnias: An Updated Review

Parasomnias: An Updated Review

Treatments for somnambulism in adults: Assessing the evidence

Sleep Related Scratching: A Distinct Parasomnia?

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