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The Parasomnias/Disorders of NREM Sleep/REM Sleep (REM Sleep Behaviour…
The Parasomnias/Disorders of NREM Sleep/REM Sleep
Parasomnias
Parasomnias can be associated with any stage of sleep: (1) disorders from arousal/NREM > sleepwalking, night terrors (2) disorders of REM > REM sleep behaviour disorder, nightmare disorder, sleep paralysis (3) other > enuresis, sleep-related eating, head banging, restless legs
Disorders of NREM
Sleep Arousal Disorders: (a) recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the sleep episode, accompanied by: sleep walking or sleep terror (b) no/little imagery recalled (c) amnesia for episodes (d) significant distress (e) not attributable to a substance (f) coexisting medical and/or mental health disorders to do explain the episodes
Sleep Terrors in NREM: DSM criteria - abrupt awakening from sleep, intense fear and autonomic response, unresponsive during, no recall [distinct from nightmares which are during REM]
Sleep terrors prevalence 1-6% children, <1% adults, age onset typically children 4-12, adults 20-30
Treatment for sleep terrors: basically just avoid waking during a sleep terror, quietly shush child, cold bedroom
Sleep walking criteria: complex motor movement during slow wave sleep, reduced alertness and responsiveness, limited recall of events if awaken, regain full cognition after episode
Prevalence: 1-5% (10-30% children sleep walk), prevalence peaks at 8-12 years old
Nightmare Disorder
Treatment: CBT (overcoming fears that are in dreams
Criteria (a) repeated occurance of extended, extremely dysphoric and well remembered dreams that occur in second half of night (b) awake and alert when awakening (c) significant distress (d) not due to other illness
REM Sleep Behaviour Disorder
Criteria (a) repeated episodes of arousal during sleep associated with vocalisation and/or complex motor behaviours (b) behaviours arise in REM sleep and occur more than 90 minutes after sleep onset, later in the sleep episode and uncommon during naps (c) individuals is awake and alert (d) either i. REM sleep without atonia ii. history suggestive of REM sleep BD and/or established disorder
Course: injury 79% injure themselves or bed partner, recall of dreams (up to 93% of cases), multiple events per night, once/2 months
Treatment: benzodiazipines
Sleep Paralysis
Discrete period of time during which voluntary muscle movement is inhibited (other movements are intact), occurs at sleep onset/offset, sleep on back, varied supernatural explanations, linked with hypertension; narcolepsy; seizure; anxiety; sleep disturbances; insufficient sleep; jetlag; shift work
~ 8% prevalence
Other disorders
Headbanging, bruxism (grinding teeth), enuresis (bed wetting), periodic leg movements, sexsomnia, confusional arousals
Warning Signs
Excessive daytime sleepiness, morning headaches, problems initiating/maintaining sleep, snoring, overweight, bizarre imagery during sleep onset, not being able to move upon awakening, partner complaints
Sleep in Psychiatric Disorders
Current thinking is that this is attributable to common shared pathways
Disorders associated with sleep disturbances: MDD, BPD, schizo, anxiety, OCD, PTSD, Alzheimer's, Parkinson's