Parasomnia

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Parasomnia
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Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, NREM sleep, and REM sleep, and their combinations.

Contents

Classification

The newest version of the International Classification of Sleep Disorders (ICSD, 3rd. Ed.) uses State Dissociation as the paradigm for parasomnias. [1] [2] Unlike before, where wakefulness, non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep were considered exclusive states, research has shown that combinations of these states are possible and thus, may result in unusual unstable states that could eventually manifest as parasomnias or as altered levels of awareness. [1] [3] [4] [5] [6] [7]

Although the previous definition is technically correct, it contains flaws. The consideration of the State Dissociation paradigm facilitates the understanding of the sleep disorder and provides a classification of 10 core categories. [1] [2]

NREM parasomnias are arousal disorders that occur during stage 3 (or 4 by the R&K standardization) of NREM sleep—also known as slow wave sleep (SWS). They are caused by a physiological activation in which the patient's brain exits from SWS and is caught in between a sleeping and waking state. In particular, these disorders involve activation of the autonomic nervous system, motor system, or cognitive processes during sleep or sleep-wake transitions. [8]

Diagnosis

Differential diagnosis for NREM-related parasomnias: [2]

Confusional arousals

Confusional arousal is a condition when an individual awakens from sleep and remains in a confused state. It is characterized by the individual's partial awakening and sitting up to look around. They usually remain in bed and then return to sleep. These episodes last anywhere from seconds to minutes and may not be reactive to stimuli. [9] Confusional arousal is more common in children than in adults. It has a lifetime prevalence of 18.5% in children and a lifetime prevalence of 2.9–4.2% in adults. [10] [11] [12] [13] Infants and toddlers usually experience confusional arousals beginning with large amounts of movement and moaning, which can later progress to occasional thrashings or inconsolable crying. In rare cases, confusional arousals can cause injuries and drowsy driving accidents, thus it can also be considered dangerous. [14] Another sleeping disorder may be present triggering these incomplete arousals. [15]

Sleep-related abnormal sexual behavior, Sleep sex, or sexsomnia, is a form of confusional arousal that may overlap with somnambulism. [1] Thereby, a person will engage in sexual acts while still asleep. It can include such acts as masturbation, inappropriate fondling themselves or others, having sex with another person; and in more extreme cases, sexual assault. [16] These behaviors are unconscious, occur frequently without dreaming, and bring along clinical, social, and legal implications. [17] It has a lifetime prevalence of 7.1% and an annual prevalence of 2.7%. [11]

Sleepwalking (somnambulism)

Sleepwalking has a prevalence of 1–17% in childhood, with the most frequent occurrences around the age of eleven to twelve. About 4% of adults experience somnambulism. [18]

Normal sleep cycles include states varying from drowsiness all the way to deep sleep. Every time an individual sleeps, he or she goes through various sequences of non-REM and REM sleep. Anxiety and fatigue are often connected with sleepwalking. For adults, alcohol, sedatives, medications, medical conditions and mental disorders are all associated with sleepwalking. Sleep walking may involve sitting up and looking awake when the individual is actually asleep, and getting up and walking around, moving items or undressing themselves. They will also be confused when waking up or opening their eyes during sleep. Sleep walking can be associated with sleeptalking. [19]

Sleep terrors (night terrors/pavor nocturnus)

Sleep terror is the most disruptive arousal disorder since it may involve loud screams and panic; in extreme cases, it may result in bodily harm or property damage by running about or hitting walls. All attempts to console the individual are futile and may prolong or intensify their confused state. Usually they experience amnesia after the event but it may not be complete amnesia. Up to 3% of adults have sleep terrors and exhibited behavior of this parasomnia can range from mild to extremely violent. This is very prevalent in those who have violent post-traumatic stress disorder (PTSD). [10] They typically occur in stage 3 sleep. [20]

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) classifies sleep-related eating disorder (SRED) under sleepwalking, while ICSD classifies it as NREM-related parasomnia. [1] [21] It is conceptualized as a mixture of binge-eating behavior and arousal disorder. [1] [21] Thereby, preferentially high-caloric food is consumed in an uncontrolled manner. [22] However, SRED should not be confused with nocturnal eating syndrome, which is characterized by an excessive consumption of food before or during sleep in full consciousness. [22] [23] Since sleep-related eating disorders are associated with other sleep disorders, successful treatment of the latter can reduce symptoms of this parasomnia. [22]

REM sleep behavior disorder

Unlike other parasomnias, rapid eye movement sleep behavior disorder (RBD) in which muscle atonia is absent is most common in older adults. [24] This allows the individual to act out their dreams and may result in repeated injury—bruises, lacerations, and fractures—to themselves or others. Patients may take self-protection measures by tethering themselves to bed, using pillow barricades, or sleeping in an empty room on a mattress. [10] Besides ensuring the sleep environment is a safe place, pharmacologic therapy using melatonin and clonazepam is also common as a treatment for RBD, even though they might not eliminate all abnormal behaviours. [25] Before starting a treatment with clonazepam, a screening for obstructive sleep apnea should performed. [22] However, clonazepam needs to be manipulated carefully because of its significant side effects, i.e., morning confusion or memory impairment, [22] mainly in patients with neurodegenerative disorders such as dementia. [26]

Demographically, 90% of RBD patients are males, and most are older than 50 years of age. [10] However, this prevalence in males could be biased due to the fact that women tend to have a less violent type of RBD, which leads to lower reports at sleep centres and different clinical characteristics. [27] [28] While men might have more aggressive behaviour during dreaming, women have presented more disturbance in their sleep. [27] [28] RBD may be also influenced by a genetic compound, since primary relatives seem to have significantly more chance to develop RBD compared with non-relatives control group. [25] [29]

Typical clinical features of REM sleep behavior disorder are: [30]

Acute RBD occurs mostly as a result of a side-effect in prescribed medication—usually antidepressants. Furthermore, substance abuse or withdrawal can result in RBD. [22]

Chronic RBD is idiopathic, meaning of unknown origin, or associated with neurological disorders. [22] There is a growing association of chronic RBD with neurodegenerative disorders—Parkinson's disease, multiple system atrophy (MSA), or dementia—as an early indicator of these conditions by as much as 10 years. RBD associated with neurological disorders is frequently related to abnormal accumulation of alpha-synuclein, and more than 80% of patients with idiopathic RBD might develop Lewy body disease (LBD). [25]

The diagnosis is based on clinical history, including partner's account and needs to be confirmed by polysomnography (PSG), mainly for its accuracy in differentiating RBD from other sleep disorders, since there is a loss of REM atonia with excessive muscle tone. [22] However, screening questionnaires, such as RBDSQ, are also very useful for diagnosing RBD. [25] [27] [28]

Hypnogely

A similar phenomenon to somniloquy named hypnogely has been observed, characterised by the sleeper spontaneously laughing. This phenomenon appears to be fairly common. [31] In a majority of cases, hypnogely is a genuine behavioural response and benign physiological phenomenon that occurs while the sleeper is dreaming in REM sleep. The laughter exhibited by subjects experiencing hypnogely isn't always connected with the subject of the dream; 'Typically, these dreams are odd, bizarre or even unfunny for a person when awake'. [32] In a minority of cases, hypnogely may be associated with neurological disorders of the central nervous system. [32]

Recurrent isolated sleep paralysis

Recurrent isolated sleep paralysis is an inability to perform voluntary movements at sleep onset, or upon waking from sleep. [22] Although the affected individual is conscious and recall is present, the person is not able to speak or move. However, respiration remains unimpaired. [22] The episodes last seconds to minutes and diminish spontaneously. [22] The lifetime prevalence is 7%. [33] Sleep paralysis is associated with sleep-related hallucinations. [22] Predisposing factors for the development of recurrent isolated sleep paralysis are sleep deprivation, an irregular sleep-wake cycle, e.g. caused by shift work, or stress. [22] A possible cause could be the prolongation of REM sleep muscle atonia upon awakening. [34]

Nightmare disorder

Nightmares are like dreams primarily associated with REM sleep. Nightmare disorder is defined as recurrent nightmares associated with awakening dysphoria that impairs sleep or daytime functioning. [1] [2] It is rare in children, however persists until adulthood. [11] [35] About 2/3 of the adult population report experiencing nightmares at least once in their life. [11]

Catathrenia

Before the ICSD-3, catathrenia was classified as a rapid-eye-movement sleep parasomnia, but is now classified as sleep-related breathing disorder. [1] [36]

The painful penile erections will appear only during sleep. [37] This condition is present during REM sleep. [37] Sexual activity does not produce any pain. [37] There is no lesion or physical damage, but hypertonia of the pelvic floor could be one cause. [38] It affects men of all ages, but especially from middle-age onward. [38] Several pharmacologic treatments such as propranolol, clozapine, clonazepam, baclofen and various antidepressants are considered effective. [37]

Other parasomnias

Exploding head syndrome

Sleep-related hallucinations are brief episodes of dream-like imagery that can be of any sensory modality, i.e., auditory, visual, or tactile. [2] They are differentiated between hypnagogic hallucination, that occur at sleep onset, and hypnapompic hallucinations, which occur at the transition of sleep to awakening. [2] Although normal individuals have reported nocturnal hallucinations, they are more frequent in comorbidity with other sleep disorders, e.g. narcolepsy. [1] [2] [39]

Sleep enuresis

Parasomnia, unspecific

Isolated symptom/normal variant

Sleep talking (somniloquy)

According to ICSD-3 it is not defined a disorder in particular. It is rather an isolated symptom or normal variant and ranges from isolated speech to full conversations without recall. [1] [2] [22] With a lifetime prevalence of 69% it is considered fairly common. [11] Sleep talking is associated with REM-related parasomnias as well as with disorders or arousal. [1] [2] It occurs in all sleep states. As yet, there is no specific treatment for sleeptalking available. [22]

Diagnosis

Parasomnias are most commonly diagnosed by means of questionnaires. These questionnaires include a detailed analyses of the clinical history and contain questions to: [22]

  1. Rule out sleep deprivation
  2. Rule out effects of intoxication or withdrawal
  3. Rule out sleep disorders causing sleep instability
  4. Rule out medical disorders or treatments associated with sleep instability
  5. Confirm presence of NREM parasomnias in other family members and during the patient's childhood
  6. Determine the timing of the events
  7. Determine the morphology of the events.

Furthermore, a sleep diary is helpful to exclude that sleep deprivation could be a precipitating factor. [22] An additional tool could be the partner's log of the events. [22] The following questions should therefore be considered: [41]

  1. Do you or your bed partner believe that you move your arms, legs, or body too much, or have unusual behaviors during sleep?
  2. Do you move while dreaming, as if you are simultaneously attempting to carry out the dream? Have you ever hurt yourself or your bed partner during sleep?
  3. Do you sleepwalk or have sleep terrors with loud screaming?
  4. Do your legs feel restless or begin to twitch a lot or jump around when you are drowsy or sleepy, either at bedtime or during the day?
  5. Do you eat food or drink fluids without full awareness during the night? Do you wake up in the morning feeling bloated and with no desire to eat breakfast?

In potentially harmful or disturbing cases a specialist in sleep disorders should be approached. [22] Video polysomnographic documentation is necessary only in REM sleep behavior disorder (RBD), since it is an essential diagnostic criteria in the ICSD to demonstrate the absence of muscle atonia and to exclude comorbid sleep disorders. [1] [2] [22] For most of the other parasomnias, polysomnographic monitoring is a costly, but still supportive tool in the clinical diagnosis. [2] [22]

The use of actigraphy can be promising in the diagnostical assessment of NREM-related parasomnias, for example to rule out sleep deprivation or other sleep disorders, like circadian sleep-wake rhythm disorder which often develops among shift workers. [22] However, there is currently no generally accepted standardized technique available of identifying and quantifying periodic limb movements in sleep (PLMS) that distinguishes movements resulting from parasomnias, nocturnal seizures, and other dyskinesias. [42] Eventually, using actigraphy for parasomnias in general is disputed. [43]

Treatment

Parasomnias can be considered as potentially harmful to oneself as well as to bed partners, and are associated with other disorders. [22] Children with parasomnias do not undergo medical intervention, because they tend to recover the NREM-related disorder with the process of growth. [34] In those cases, the parents receive education on sleep hygiene to reduce and eventually eliminate precipitating factors. [34]

In adults psychoeducation about a proper sleep hygiene can reduce the risk to develop parasomnia. [22] Case studies have shown that pharmacological interventions can improve symptoms of parasomnia, however mostly they are accompanied by side-effects. [22] [44] Behavioral treatments, i.e., relaxation therapy, biofeedback, hypnosis, and stress reduction, may also be helpful, but are not considered as universally effective. [44]

Prognosis

NREM-related parasomnias which are common in childhood show a good prognosis, since severity decreases with age, the symptoms tend to resolve during puberty. [34] [35] Adults with NREM-related parasomnias, however, are faced with a stronger persistence of the symptoms, therefore, full remission is quite unlikely and is also associated with violent complications, including homicide. [1] [35] The variant sleep-related eating disorders is chronic, without remission, but treatable. [35]

REM sleep behavior disorder (RBD) can mostly be handled well with the use of melatonin or clonazepam. [25] [35] However, there is high comorbidity with neurodegenerative disorders, that is in up to 93% of cases. [35] The underlying psychopathology of nightmare disorder complicates a clear prognosis. [35]

The prognosis for other parasomnias seems promising. While exploding head syndrome usually resolves spontaneously, the symptoms for sleep-related hallucinations tend to diminish over time. [35]

See also

Notes

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 International Classification of Sleep Disorders. Darien, IL: American Academy of Sleep Medicine. 2014.
  2. 1 2 3 4 5 6 7 8 9 10 11 Kazaglis, Louis; Bornemann, Michel A. Cramer (2016). "Classification of Parasomnias". Current Sleep Medicine Reports. 2 (2): 45–52. doi: 10.1007/s40675-016-0039-y . ISSN   2198-6401.
  3. ↑ Mahowald MW, Schenk CH. Dissociated states of wakefulness and sleep. In: Lydic R, Baghdoyan HA, editors. Handbook of behavioral state control: cellular and molecular mechanisms. Boca Raton: CRC Press; 1999. p. 143-58.
  4. ↑ Mahowald MW, Schenk CH. dissociated states of wakefulness and sleep. Neurology. 1992; 42(7 Suppl 6):44-51.
  5. ↑ Nobili, Lino; De Gennaro, Luigi; Proserpio, Paola; Moroni, Fabio; Sarasso, Simone; Pigorini, Andrea; De Carli, Fabrizio; Ferrara, Michele (2012), "Local aspects of sleep", The Neurobiology of Circadian Timing, Progress in Brain Research, vol. 199, Elsevier, pp. 219–232, doi:10.1016/b978-0-444-59427-3.00013-7, ISBN   9780444594273, PMID   22877668
  6. ↑ Nobili, Lino; Ferrara, Michele; Moroni, Fabio; De Gennaro, Luigi; Russo, Giorgio Lo; Campus, Claudio; Cardinale, Francesco; De Carli, Fabrizio (2011). "Dissociated wake-like and sleep-like electro-cortical activity during sleep". NeuroImage. 58 (2): 612–619. doi:10.1016/j.neuroimage.2011.06.032. PMID   21718789. S2CID   357553.
  7. ↑ Peter-Derex, Laure; Magnin, Michel; Bastuji, Hélène (2015). "Heterogeneity of arousals in human sleep: A stereo-electroencephalographic study". NeuroImage. 123: 229–244. doi:10.1016/j.neuroimage.2015.07.057. PMID   26220744. S2CID   207194956.
  8. ↑ Bassetti, Claudio; Vella, Silvano; Donati, Filippo; Wielepp, Peter; Weder, Bruno (August 2000). "SPECT during sleepwalking". The Lancet. 356 (9228): 484–485. doi:10.1016/S0140-6736(00)02561-7. PMID   10981896. S2CID   35001207.
  9. ↑ Peters, Brandon R. (2014-12-01). "Irregular Bedtimes and Awakenings". Sleep Medicine Clinics. 9 (4): 481–489. doi:10.1016/j.jsmc.2014.08.001. ISSN   1556-407X.
  10. 1 2 3 4 Mahowald, Mark W.; Schenck, Carlos H. (October 2005). "Insights from studying human sleep disorders". Nature. 437 (7063): 1279–1285. Bibcode:2005Natur.437.1279M. doi:10.1038/nature04287. ISSN   0028-0836. PMID   16251953. S2CID   205210740.
  11. 1 2 3 4 5 Bjorvatn, Bjørn; Grønli, Janne; Pallesen, Ståle (2010). "Prevalence of different parasomnias in the general population". Sleep Medicine. 11 (10): 1031–1034. doi:10.1016/j.sleep.2010.07.011. PMID   21093361.
  12. ↑ Ohayon MM, Priest RG, Zulley J, Smirne S. The place of confusional arousals in sleep and mental disorders: findings in a general population sample of 13,057 subjects. J Nerv Ment Dis. 2000;188(6):340-8.
  13. ↑ Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry. 1999;60(4):268-76.
  14. ↑ "Sleep education".
  15. ↑ Durmer, Jeffrey S.; Chervin, Ronald D. (June 2007). "Pediatric Sleep Medicine". CONTINUUM: Lifelong Learning in Neurology. 13: 153–200. doi:10.1212/01.CON.0000275610.56077.ee. ISSN   1080-2371. S2CID   75736368.
  16. ↑ "R. v. Luedecke, 2008 ONCA 716". CanLII.org. October 17, 2008.
  17. ↑ Ingravallo, Francesca; Poli, Francesca; Gilmore, Emma V.; Pizza, Fabio; Vignatelli, Luca; Schenck, Carlos H.; Plazzi, Giuseppe (2014-08-15). "Sleep-Related Violence and Sexual Behavior in Sleep: A Systematic Review of Medical-Legal Case Reports". Journal of Clinical Sleep Medicine . 10 (8): 927–935. doi:10.5664/jcsm.3976. ISSN   1550-9389. PMC   4106950 . PMID   25126042.
  18. ↑ Mahowald & Schenck. 1283.
  19. ↑ "Sleepwalking". ADAM Medical Encyclopedia. ADAM Inc. 2012. Archived from the original on 28 August 2012.
  20. ↑ Katugampola, M. (2005) Health & Human Development, Pearson Education.
  21. 1 2 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Publishing. ISBN   9780890425558. OCLC   1031488488.
  22. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Fleetham, J. A.; Fleming, J. A. E. (2014-05-13). "Parasomnias". Canadian Medical Association Journal. 186 (8): E273–E280. doi:10.1503/cmaj.120808. ISSN   0820-3946. PMC   4016090 . PMID   24799552.
  23. ↑ O'Reardon, John P.; Peshek, Andrew; Allison, Kelly C. (2005). "Night eating syndrome". CNS Drugs. 19 (12): 997–1008. doi:10.2165/00023210-200519120-00003. ISSN   1172-7047. PMID   16332142. S2CID   25478218.
  24. ↑ Das, John; Johal, Arminder; Stahl, Stephanie (20 April 2024). "Importance of Arm Electromyography for REM Without Atonia Detection". SLEEP . 47 (1): A513–A514. doi:10.1093/sleep/zsae067.01204.
  25. 1 2 3 4 5 McCarter, S., & Howell, J. (2017). REM Sleep Behavior Disorder and Other Sleep Disturbances in Non-Alzheimer Dementias. Current Sleep Medicine Reports, 3(3), 193-203.
  26. ↑ Aurora, R., Zak, R., Maganti, R., Auerbach, S., Casey, K., Chowdhuri, S., . . . Morgenthaler, T. (2010). Best practice guide for the treatment of REM sleep behavior disorder (RBD). Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 6(1), 85-95.
  27. 1 2 3 Bjørnarå, Dietrichs, & Toft. (2013). REM sleep behavior disorder in Parkinson's disease – Is there a gender difference? Parkinsonism and Related Disorders, 19(1), 120-122.
  28. 1 2 3 Bjørnarå, K., Dietrichs, E., & Toft, M. (2015). Longitudinal assessment of probable rapid eye movement sleep behaviour disorder in Parkinson's disease. European Journal of Neurology, 22(8), 1242-1244.
  29. ↑ Dauvilliers, B., Yves, Postuma, Livia, Ronald, Ferini-Strambi, Livia, Luigi, Arnulf, Livia, Isabelle, Högl, Livia, Birgit, Manni, Livia, Raffaele, . . . Montplaisir, Livia, Jacques. (2013). Family history of idiopathic REM behavior disorder: A multicenter case-control study. Neurology, 80(24), 2233-2235.
  30. ↑ Boeve, B. F.; Silber, M. H.; Saper, C. B.; Ferman, T. J.; Dickson, D. W.; Parisi, J. E.; Benarroch, E. E.; Ahlskog, J. E.; Smith, G. E. (2007-04-05). "Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease". Brain. 130 (11): 2770–2788. doi: 10.1093/brain/awm056 . ISSN   0006-8950. PMID   17412731.
  31. ↑ Eichelberger, Hillary; Lindo, Ryan O.; Rodriguez, Alcibiades J. (2023-10-01). "Differential diagnosis of sleep laughter: A case report and literature review". Sleep Medicine. 110: 231–234. doi:10.1016/j.sleep.2023.08.018. ISSN   1389-9457.
  32. 1 2 Trajanovic, Nikola N.; Shapiro, Colin M.; Milovanovic, Srdjan (July 2013). "Sleep-laughing--hypnogely". The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques. 40 (4): 536–539. doi:10.1017/s0317167100014621. ISSN   0317-1671. PMID   23786736.
  33. ↑ Sharpless, Brian A.; Barber, Jacques P. (2011). "Lifetime prevalence rates of sleep paralysis: A systematic review". Sleep Medicine Reviews . 15 (5): 311–315. doi:10.1016/j.smrv.2011.01.007. PMC   3156892 . PMID   21571556.
  34. 1 2 3 4 Singh, Shantanu; Kaur, Harleen; Singh, Shivank; Khawaja, Imran (2018-12-31). "Parasomnias: A Comprehensive Review". Cureus . 10 (12): e3807. doi: 10.7759/cureus.3807 . ISSN   2168-8184. PMC   6402728 . PMID   30868021.
  35. 1 2 3 4 5 6 7 8 "Parasomnias in adults Prognosis - Epocrates Online". online.epocrates.com. Retrieved 2019-06-29.
  36. ↑ "Alaska Sleep Clinic". Archived from the original on 2019-06-23. Retrieved 2019-06-23.
  37. 1 2 3 4 Silber, M. H., St. Louis, E. K., & Boeve, B. F. (2017). Rapid Eye Movement Sleep Parasomnias. In Principles and Practice of Sleep Medicine (p. 993-1001.e6). https://doi.org/10.1016/B978-0-323-24288-2.00103-3
  38. 1 2 Vreugdenhil, S., Weidenaar, A. C., de Jong, I. J., & van Driel, M. F. (2018). Sleep-Related Painful Erections: A Meta-Analysis on the Pathophysiology and Risks and Benefits of Medical Treatments. The Journal of Sexual Medicine, 15(1), 5‑19. https://doi.org/10.1016/j.jsxm.2017.11.006
  39. ↑ Ivanenko, Anna; Relia, Sachin (2013), Kothare, Sanjeev V.; Ivanenko, Anna (eds.), "Sleep-Related Hallucinations", Parasomnias, Springer New York, pp. 207–220, doi:10.1007/978-1-4614-7627-6_14, ISBN   9781461476269
  40. ↑ Hilditch, Cassie J.; McHill, Andrew W. (2019-08-22). "Sleep inertia: current insights". Nature and Science of Sleep. 11: 155–165. doi: 10.2147/nss.s188911 . PMC   6710480 . PMID   31692489.
  41. ↑ Mahowald, Mark W.; Schenck, Carlos H. (2000-01-01). "Diagnosis and management of parasomnias". Clinical Cornerstone. 2 (5): 48–54. doi:10.1016/S1098-3597(00)90040-1. ISSN   1098-3597. PMID   10875046.
  42. ↑ Chokroverty, Sudhansu; Thomas, Robert J. (2014), "Specialized Techniques", Atlas of Sleep Medicine, Elsevier, pp. 255–299, doi:10.1016/b978-1-4557-1267-0.00014-x, ISBN   9781455712670
  43. ↑ Louter, Maartje; Arends, Johan BAM; Bloem, Bastiaan R; Overeem, Sebastiaan (2014). "Actigraphy as a diagnostic aid for REM sleep behavior disorder in Parkinson's disease". BMC Neurology . 14 (1): 76. doi: 10.1186/1471-2377-14-76 . ISSN   1471-2377. PMC   3986453 . PMID   24708629.
  44. 1 2 "Disorders That Disrupt Sleep: Parasomnia Causes & Types". eMedicineHealth. Retrieved 2019-06-23.

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Periodic limb movement disorder (PLMD) is a sleep disorder where the patient moves limbs involuntarily and periodically during sleep, and has symptoms or problems related to the movement. PLMD should not be confused with restless legs syndrome (RLS), which is characterized by a voluntary response to an urge to move legs due to discomfort. PLMD on the other hand is involuntary, and the patient is often unaware of these movements altogether. Periodic limb movements (PLMs) occurring during daytime period can be found but are considered as a symptom of RLS; only PLMs during sleep can suggest a diagnosis of PLMD.

Somniloquy, commonly referred to as sleep-talking, is a parasomnia in which one speaks aloud while asleep. It can range from simple mumbling sounds to loud shouts or long, frequently inarticulate, speeches. It can occur many times during a sleep cycle and during both NREM and REM sleep stages, though, as with sleepwalking and night terrors, it most commonly occurs during delta-wave NREM sleep or temporary arousals therefrom.

Rhythmic movement disorder (RMD) is a neurological disorder characterized by repetitive movements of large muscle groups immediately before and during sleep often involving the head and neck. It was independently described first in 1905 by Zappert as jactatio capitis nocturna and by Cruchet as rhythmie du sommeil. The majority of RMD episodes occur during NREM sleep, although REM movements have been reported. RMD is often associated with other psychiatric conditions or mental disabilities. The disorder often leads to bodily injury from unwanted movements. Because of these incessant muscle contractions, patients' sleep patterns are often disrupted. It differs from restless legs syndrome in that RMD involves involuntary muscle contractions before and during sleep while restless legs syndrome is the urge to move before sleep. RMD occurs in both males and females, often during early childhood with symptoms diminishing with age. Many affected individuals also have other sleep related disorders, like sleep apnea. The disorder can be differentially diagnosed into small subcategories, including sleep related bruxism, thumb sucking, hypnagogic foot tremor, and rhythmic sucking, to name a few. In order to be considered pathological, the ICSD-II requires that in the sleep-related rhythmic movements should “markedly interfere with normal sleep, cause significant impairment in daytime function, or result in self-inflicted bodily injury that requires medical treatment ”.

The International Classification of Sleep Disorders (ICSD) is "a primary diagnostic, epidemiological and coding resource for clinicians and researchers in the field of sleep and sleep medicine". The ICSD was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979. A second edition, called ICSD-2, was published by the AASM in 2005. The third edition, ICSD-3, was released by the AASM in 2014. A text revision of the third edition (ICSD-3-TR) was published in 2023 by the AASM.

<span class="mw-page-title-main">Catathrenia</span> Sleep-related breathing disorder

Catathrenia or nocturnal groaning is a sleep-related breathing disorder, consisting of end-inspiratory apnea and expiratory groaning during sleep. It describes a rare condition characterized by monotonous, irregular groans while sleeping. Catathrenia begins with a deep inspiration. The person with catathrenia holds his or her breath against a closed glottis, similar to the Valsalva maneuver. Expiration can be slow and accompanied by sound caused by vibration of the vocal cords or a simple rapid exhalation. Despite a slower breathing rate, no oxygen desaturation usually occurs. The moaning sound is usually not noticed by the person producing the sound, but it can be extremely disturbing to sleep partners. It appears more often during expiration REM sleep than in NREM sleep.

<span class="mw-page-title-main">Narcolepsy</span> Human sleep disorder

Narcolepsy is a chronic neurological disorder that impairs the ability to regulate sleep–wake cycles, and specifically impacts REM sleep. The pentad symptoms of narcolepsy include excessive daytime sleepiness (EDS), sleep-related hallucinations, sleep paralysis, disturbed nocturnal sleep (DNS), and cataplexy. People with narcolepsy tend to sleep about the same number of hours per day as people without it, but the quality of sleep is typically compromised.

Nocturnal sleep-related eating disorder (NSRED) is a combination of a parasomnia and an eating disorder. It is a non-rapid eye movement sleep (NREM) parasomnia. It is described as being in a specific category within somnambulism or a state of sleepwalking that includes behaviors connected to a person's conscious wishes or wants. Thus many times NSRED is a person's fulfilling of their conscious wants that they suppress; however, this disorder is difficult to distinguish from other similar types of disorders.

<span class="mw-page-title-main">Synucleinopathy</span> Medical condition

Synucleinopathies are neurodegenerative diseases characterised by the abnormal accumulation of aggregates of alpha-synuclein protein in neurons, nerve fibres or glial cells. There are three main types of synucleinopathy: Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). Other rare disorders, such as various neuroaxonal dystrophies, also have α-synuclein pathologies. Additionally, autopsy studies have shown that around 6% of sporadic Alzheimer's Disease exhibit α-synuclein positive Lewy pathology, and are sub-classed as Alzheimer's Disease with Amygdalar Restricted Lewy Bodies (AD/ALB).

The REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) is a specific questionnaire for rapid eye movement behavior disorder (RBD) developed by Stiasny-Kolster and team, to assess the most prominent clinical features of RBD. It is a 10-item, patient self-rating instrument with short questions to be answered by either 'yes' or 'no'. The validity of the questionnaire was studied by researchers and they have observed it to perform with high sensitivity and reasonable specificity in the diagnosis of RBD.

Classification of sleep disorders comprises systems for classifying medical disorders associated with sleep. Systems have changed, increasingly using technological discoveries to advance the understanding of sleep and recognition of sleep disorders.

The REM Sleep Behavior Disorder Single-Question Screen (RBD1Q) is a one-question screening tool for dream enactment behaviors associated with the parasomnia REM sleep behavior disorder (RBD). It screens for RBD with a simple yes/no response.

A confusional arousal is medical condition where a person awakened from sleep shows mental confusion for at least several minutes. Complete or partial amnesia of the episodes may be present.

Rapid eye movement sleep behaviour disorder and Parkinson's disease is rapid eye movement sleep behavior disorder (RBD) that is associated with Parkinson's disease. RBC is linked genetically and neuropathologically to α- synuclein, a presynaptic neuronal protein that exerts deleterious effects on neighbouring proteins, leading to neuronal death. This pathology is linked to numerous other neurodegenerative disorders, such as Lewy body dementias, and collectively these disorders are known as synucleinopathies. Numerous reports over the past few years have stated the frequent association of synucleinopathies with REM sleep behaviour disorder (RBD). In particular, the frequent association of RBD with Parkinson's. In the general population the incidence of RBD is around 0.5%, compared to the prevalence of RBD in PD patients, which has been reported to be between 38% and 60%. The diagnosis and symptom onset of RBD typically precedes the onset of motor or cognitive symptoms of PD by a number of years, typically ranging anywhere from 2 to 15 years prior. Hence, this link could provide an important window of opportunity in the implementation of therapies and treatments, that could prevent or slow the onset of PD.

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