Parasomnias Flashcards
When NREM Sleep Arousal Disorder is accompanied by another sleep disorder, like sleep-disordered breathing or restless leg syndrome, . . .
. . . correction of the accompanying sleep disorder often results in resolution of the NREM Sleep Arousal Disorder (night terrors or somnamlbulism)
Dyssomnias
Sleep difficulties associated with the duration and type of sleep
Characterized by excessive sleepiness or difficulty initiating or maintaining sleep
Sleep disordered breathing
Describes a group of disorders characterized by abnormal respiratory pattern during sleep or quantity of ventilation during sleep.
OSA is the most common.
Sleep cycle
A typical cycle lasts ~90 minutes
Sleep stages on EEG
What is a “parasomnia”?
Parasomnia is a broad term used to describe sleep disorders charaterized by physiologic and behavioral phenomena triggered by sleep.
Parasomnias manifest when the basic sleep-wake phases (wakefulness, NREM, REM) overlap with one another.
They include: sleep terrors, somnambulism, somniloquy, rhythmic movement disorder, nightmares, sleep paralysis, bruxism, and enuresis
Factors that may increase the frequency of NREM sleep arousal disorder episodes
Fever, sleep deprivation, CNS depressants
Two forms of NREM sleep arousal disorder
Somnambulism and sleep terror
Why do patients never remember night terrors – not even a little?
Because it occurs in NREM when memory is totally shut down
In REM, some memories can be formed, but they fade quickly unless reinforced.
Diagnostic criteria for NREM Sleep Arousal Disorder
- Presence of either sleepwalking or sleep terrors
- No or little dream imagery is recalled and there is amnesia of the episodes.
- Episodes cause clinically significant distress or impairment
- Disturbance is not attributable to the physiological effects of substances or due to another mental or medical disorder.
Subtype specifiers of somnambulism
Sleep-related eating
Sleep-related sexual behavior
Unspecified
Peak age for sleepwalking
4-12 years of age
Treatment of NREM sleep arousal disorder
- The first step is always to reassure parents that the child will outgrow these events with time, even without intervention
- Then, education about safety measures: Keep sharp objects and weapons out of reach, lock house doors and windows, consider installing safety alarm devices
- In patients with an accompanying sleep disorder (such as disordered breathing or restless leg syndrome), treating that disorder is the most effective method for resolving NREM-SAD.
- Sleep hygiene
- Scheduled awakening has shown some efficacy
- Pharmacologic agents (reserved for severe cases):
- Benzodiazepines (clonazepam, lorazepam, diazepam)
___ is a common precipitant of NREM sleep arousal disorder
Change in sleep schedule is a common precipitant of NREM sleep arousal disorder
Main DDx for sleep terrors
- Nightmares: However, there will be preserved memory. May or may not be in the context of PTSD or ASD.
- Panic disorder with nocturnal panic attacks: In contrast to sleep terrors, these episodes will produce rapid, complete awakening without confusion or amnesia, or the motor phenomena typical of NREM sleep arousal disorder.
