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Chapter 028. Sleep Disorders (Part 12)

Parasomnias The term parasomnia refers to abnormal behaviors or experiences that arise from or occur during sleep. A continuum of parasomnias arise from NREM sleep, from brief confusional arousals to sleepwalking and night terrors. The presenting complaint is usually related to the behavior itself, but the parasomnias can disturb sleep continuity or lead to mild impairments in daytime alertness. Two main parasomnias occur in REM sleep: REM sleep behavior disorder (RBD), which will be described below, and nightmare disorder. Sleepwalking (Somnambulism) Patients affected by this disorder carry out automatic motor activities that range from simple to complex. . | Chapter 028. Sleep Disorders Part 12 Parasomnias The term parasomnia refers to abnormal behaviors or experiences that arise from or occur during sleep. A continuum of parasomnias arise from NREM sleep from brief confusional arousals to sleepwalking and night terrors. The presenting complaint is usually related to the behavior itself but the parasomnias can disturb sleep continuity or lead to mild impairments in daytime alertness. Two main parasomnias occur in REM sleep REM sleep behavior disorder RBD which will be described below and nightmare disorder. Sleepwalking Somnambulism Patients affected by this disorder carry out automatic motor activities that range from simple to complex. Individuals may walk urinate inappropriately eat or exit from the house while remaining only partially aware. Full arousal may be difficult and individuals may rarely respond to attempted awakening with agitation or even violence. Sleepwalking arises from stage 3 or 4 NREM sleep usually in the first 2 hours of the night and is most common in children and adolescents when these sleep stages are most robust. Episodes are usually isolated but may be recurrent in 1-6 of patients. The cause is unknown though it has a familial basis in roughly one-third of cases. Sleep Terrors This disorder also called pavor nocturnus occurs primarily in young children during the first several hours after sleep onset in stages 3 and 4 of NREM sleep. The child suddenly screams exhibiting autonomic arousal with sweating tachycardia and hyperventilation. The individual may be difficult to arouse and rarely recalls the episode on awakening in the morning. Parents are usually reassured to learn that the condition is self-limited and benign and that no specific therapy is indicated. Both sleep terrors and sleepwalking represent abnormalities of arousal. In contrast nightmares occur during REM sleep and cause full arousal with intact memory for the unpleasant episode. Sleep Bruxism Bruxism is an involuntary .