Parasomnia

Sleep. Table 1 Examples of various dysomnias and parasomnias... 

Describe the mechanisms of the sleep disorders covered in this chapter, including insomnia, narcolepsy, restless-legs syndrome, obstructive sleep apnea, and parasomnias. 

Non-REM parasomnias have variable prevalence rates depending on patient age and different diagnoses. Sleep talking, brux-ism, sleepwalking, sleep terrors, and enuresis occur more frequently in childhood than in adulthood. Nightmares appear to occur with similar frequency in adults and children. REM behavior disorder (RBD), an REM-sleep parasomnia, has a reported prevalence of 0.5% and frequently is associated with concomitant neurologic conditions.16 Chronic RBD is more common in elderly men and may have a familial disposition. 

The pathogenesis of parasomnias (e.g., sleepwalking, enuresis, sleep talking) is variable and not well described and involves... 

Parasomnias are characterized by undesirable physical or behavioral phenomena that occur during sleep [e.g., sleepwalking, sleep talking, bruxism (grinding of teeth), enuresis, night terrors, and RBD]. RBD patients act out their dreams during sleep, often in a violent manner. 

Non-REM parasomnias usually do not require treatment. If needed, low-dose benzodiazepines such as clonazepam can be prescribed for bothersome episodes. Clonazepam reduces the amount of sleep time spent in stages 3 and 4 of non-REM sleep, where most non-REM parasomnias occur. For treating RBD, clonazepam 0.5 to 2 mg at bedtime is the drug of choice, although melatonin 3 to 12 mg at bedtime also may be effective. Patients with RBD also should have dangerous objects removed from the bedroom and cushions placed on the floor to reduce the chance of injury from breakthrough episodes. 

Parasomnias-abnormal behavioral or physiologic events associated with sleep... 

The sleep disorders fall into four main categories (1) insomnia, (2) hypersomnia, (3) parasomnias, and (4) sleep schedule disorders. Insomnia is the most common sleep problem. It is simply defined as poor sleep and can be manifested by difficulty falling asleep, difficulty staying asleep, waking up too early, or waking up in the morning without feeling refreshed. 

C. The sleep disturbance does not occur exclusively during the course of narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or a parasomnia. 

Laberge, L., Tremblay, R.E., Vitaro, F, and Montplaisir, J. (2000) Development of parasomnias from childhood to early adolescence. Pediatrics 106 67-74. 

The sleep disorders are categorized into primary disorders (i.e., dyssomnias and parasomnias), those related to another mental disorder, those related to a general medical disorder, and those that are substance induced. Like anxiety, disturbances of sleep affect nearly all of us at one time or another. Also like... 

The International Classification of Sleep Disorders lists 88 types, with insomnia the most prominent symptom for many of these (17). Chronic insomnia is the most common sleep problem for which patients consult practitioners (18) and usually reflects psychological/ behavioral disturbances ( 19). Differences in treatment recommendations support the distinction between DSM-IV and the International Classification for Sleep Disorders ( 20). The DSM-IV divides primary disorders into two major groups the dyssomnias (in which the predominant disturbance is the amount, quality, or timing of sleep) and the parasomnias (in which the predominant disturbance is an abnormal event occurring during sleep) (7). 

This group of disorders is characterized by the occurrence of an abnormal event during sleep, specific sleep stages, or the threshold between sleep and wakefulness. These conditions usually involve complaints focused on the abnormal occurrence itself rather than any effect it might have on sleep. Parasomnias include the following ... 

Dyssomnias consist of problems associated with the amount, quality or timing of sleep, whereas parasomnias involve pathological, behavioral, or psychological events that occur with sleep, specific sleep stages, or sleep-wake transitions (see also Chapter 11). The other two categories usually require treatment of the mental or physical condition that has created the sleep disturbance. For all categories, the short-term use of hypnotics may play a role. 

Sleep terrors are a type of sleep disorder known as a parasomnia (abnormal physical behavior during sleep) that... 

Another bizarre parasomnia we mentioned earlier is known as REM behavior disorder (RBD), sometimes called REM... 

Hedman C, Pohjasvaara T, Tolonen U, Salmivaara A, Myllyla VV. Parasomnias decline during pregnancy. Acta Neurol Scand 2002 105 209-214. 

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