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  3. The Parasomnias and Other Sleep-Related Movement Disorders
  • Cited by 9
Publisher:
Cambridge University Press
Online publication date:
November 2010
Print publication year:
2010
Online ISBN:
9780511711947
DOI:
https://doi.org/10.1017/CBO9780511711947
Subjects:
Psychiatry and Clinical Psychology, Neurology and Clinical Neuroscience, Medicine, Psychiatry
Information

Book description

The first authoritative review on the parasomnias - disorders that cause abnormal behavior during sleep - this book contains many topics never before covered in detail. The behaviors associated with parasomnias may lead to injury of the patient or bed-partner, and may have forensic implications. These phenomena are common but often unrecognized, misdiagnosed, or ignored in clinical practice. With increasing awareness of abnormal behaviors in sleep, the book fulfils the need for in-depth descriptions of clinical and research aspects of these disorders, including differential diagnosis, pathophysiology, morbidity, and functional consequences of each condition, where known. Appropriate behavioral and pharmacological treatments are addressed in detail. There are authoritative sections on disorders of arousal, parasomnias usually associated with REM sleep, sleep-related movement disorders and other variants, and therapy of parasomnias. Sleep specialists, neurologists, psychiatrists, psychologists and other healthcare professionals with an interest in sleep disorders will find this book essential reading.

Reviews

"This is a good reference for practicing sleep clinicians and will likely serve as a helpful reference for sleep researchers."
--Doody's Review Service

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Contents

Page 2 of 2

Contents
  • Chapter 20 - Sleep-related hallucinationsand exploding head syndrome
    pp 194-201
  • View abstract

    Summary

    The essential features of confusional arousals are mental confusion or confusional behavior during or following arousals from sleep, typically from deep non-rapid eye movement (NREM) or slow-wave sleep (SWS) in the first part of the night, but also upon attempted awakening from sleep in the morning. The notion of confusional arousals in children has received less attention overall compared with that concerning adults. The impression gained in adults is that, especially in response to forced awakenings, the behavioral disturbance in adult episodes is more forceful, vigorous and resistive, sometimes leading to violent behavior. Childhood confusional arousals do not usually require treatment, only advice to parents that they can be considered to be a passing phase. The same cannot necessarily be said of confusional arousals in adult life when they have more of a tendency to persist, depending on their etiology and relationship to other sleep disorders.
  • Chapter 21 - Sleep-related eating disorder
    pp 202-210
  • View abstract

    Summary

    This chapter focuses on sleepwalking, also known as somnambulism. The symptoms and manifestations that characterize sleepwalking show great variations both within and across predisposed patients. Sleepwalking is more common in childhood than in adulthood, as most children will experience, at least temporarily, one or more of the NREM sleep parasomnias during childhood or early adolescence. Sleep laboratory investigations have yielded considerable information on the polysomnographic characteristics of sleepwalkers. There is a strong genetic component to somnambulism. About 80% of somnambulistic patients have at least one family member affected by this parasomnia, and the prevalence of somnambulism is higher in children of parents with a history of sleepwalking. In addition to the atypical sleep parameters and genetic component reviewed, other factors have been proposed, including psychopathology and deregulation of serotonergic systems. Hypnosis (including self-hypnosis) has been found to be effective in both children and adults presenting with chronic sleepwalking.
  • Chapter 22 - Restless legs syndrome (RLS) and periodic leg movements (PLM)
    pp 213-228
  • View abstract

    Summary

    During Rhazes' time, research shows that mater puerorum have been used to describe both epileptic attacks and night terrors. In a case report published in 1953, Sullivan described night terrors as an indication of an emotional problem arising out of certain stages in a child's development. Classically, night terrors arise during the first sleep cycle, usually within 1-3 hours of sleep. Parents identified the following as precipitants: overtiredness, fever, separation, loss, moving, divorce, change of school, death in the family, return to school from vacation, or change of school. The prevalence of sleepwalking and night terrors in first-degree relatives was estimated as being ten times greater than in the general population. Treatment of night terrors can be divided into two categories: behavioral and medical strategies. Night terrors are fascinating entities that share many of the same characteristics of the other parasomnias occurring as arousals from non-rapid eye movement (NREM) sleep.
  • Chapter 24 - Fragmentary myoclonus
    pp 237-243
  • View abstract

    Summary

    Rapid eye movement (REM) sleep behavior disorder (RBD) was first formally identified in 1986 by Schenck and Mahowald in five elderly subjects presenting similar motor behavioral patterns during REM sleep consisting of violent dream-enacting behaviors. The clinical manifestations of RBD are typically dream-related motor-behavioral manifestations that appear to be the enactment of a fight. Subclinical or preclinical RBD, status dissociatus and parasomnia overlap syndrome are the clinical-pathophysiological subtypes of RBD, according to ICSD-2. The literature contains anecdotal reports of co-existing RBD and narcolepsy in both adults and children, in some cases with the RBD episodes as the presenting symptoms. The parasomnia and non-parasomnia disorders are taken into account in the differential diagnosis of RBD. In humans, RBD has been associated with several etiologies and abnormalities. Anecdotal reports and uncontrolled, retrospective studies of small patient series suggest that levodopa and pramipexole (D3 agonist) reduce RBD manifestations.
  • Chapter 25 - Sleep-related leg cramps
    pp 244-251
  • View abstract

    Summary

    Sleep paralysis is classified as a parasomnia associated with rapid-eye-movement periods (REMPs). The paralysis is consistent with atonia observed during normal REMPs produced by hyperpolarization of the spinal motoneurons originating in cholinoceptive neurons in dorsolateral regions of the pontine reticular formation. Estimates of RISP prevalence vary dramatically, yielding estimates between 6% and 40%. Sleep paralysis is often considered as a sleep-onset problem under the assumption that episodes occur at the beginning of the sleep period during Sleep Onset REM Period (SOREMP). Multiphase sleep-wake schedule (MPS) regimes likely produce high level of cognitive arousal precipitating episodes by increasing potential for waking during immediate post-interruption REMPs. Vestibular-motor (V-M) hallucinations likely arise via interactions between subcortical and cortical vestibular centers. RISP associated with a variety of affective disorders including depression, panic disorder, PTSD, and social anxiety. RISP has typically been thought to reflect anomalies of the functioning of monoaminergic and/or cholinergic neural systems.
  • Chapter 26 - Sleep-related bruxism
    pp 252-260
  • View abstract

    Summary

    This chapter presents the history, clinical findings, prevalence, etiology, and management of nightmares in children and adult. Nightmares are REM sleep phenomena and often occur in the second half of the night. Upon awakening, the person is oriented about her/his surroundings and can give a detailed description of the dream action. Several researchers conceptualize nightmare as a primary sleep disorder, because empirical evidence clearly demonstrates low subjective sleep quality in nightmare sufferers, presumably due to direct effects and indirect effects. Nightmare frequency is higher in girls and women, and decreases based on age. The prevalence of children experiencing nightmares once a week or more often is estimated to be about 5%. The etiology of nightmares is best described by a disposition-stress model. The chapter presents case reports of a child and an adult suffering from nigntmare disorders.
  • Chapter 28 - Sleep-related rhythmic movement disorder
    pp 270-277
  • View abstract

    Summary

    Sleep-related dissociative disorders, a variant of dissociative disorders, are parasomnias that can emerge at any point during sleep period, either at transition from wakefulness to sleep or within several minutes after awakening from stages 1 or 2 non-rapid eye movement (NREM) sleep or REM sleep. Patient's clinical features may support a specific dissociative disorder subtype diagnosis associated with sleep-related episodes, specifically dissociative identity disorder, dissociative fugue, or dissociative disorder NOS. With any form of sleep-related dissociative disorder, onset can be gradual and sporadic in nature. Females are reported to be affected predominantly, and onset can range from childhood to midlife. Sexualized and frankly sexual behaviors can emerge with sleep-related dissociative disorders. There are several potential considerations for differential diagnosis of sleep-related dissociative disorders, including an NREM arousal disorder parasomnia, parasomnia associated with REM sleep, or nocturnal seizures.
  • Chapter 29 - Sleep panic arousals
    pp 278-288
  • View abstract

    Summary

    Sleep enuresis (SE) is characterized by recurrent involuntary voiding of urine during sleep that occurs at least twice a week, for at least 3 consecutive months, in a child of 5 years age. The assessment of SE is based on history (familial predisposition and emotional standpoint), sleep habits, and also on physical examination. There is a strong genetic influence in SE; when both parents suffer from SE, almost 75% of their children are expected to be also enuretic, while the prevalence of SE in the offspring of two parents who were not enuretic during childhood is only 15%. Several polysomnographic studies reported that children with SE have normal sleep architecture, in terms of proportion and distribution of sleep stages during night. The management of primary enuresis starts from the education of the patient and family including: supportive approach, evening fluid restriction, and sleep hygiene rules.
  • Chapter 30 - Sleep-related epilepsy
    pp 289-298
  • View abstract

    Summary

    Four patients had a positive personal history for parasomnias and two- a positive family history. Personal history was positive for parasomnias in two patients. Family history was positive for parasomnias in two patients, for nocturnal groaning in one patient, and for sudden infant death syndrome in one patient. Eight patients were reporting a family history positive for parasomnias and three for nocturnal groaning. Catathrenia is associated with a positive personal or familial history for other parasomnias. There is no drug medication available for catathrenia. Empirical pharmacological treatments with dosulepine, trazodone, clonazepam, paroxetine, carbamazepine, gabapentin, and pramipexole have been unsuccessful or refused. The efficacy of the nCPAP ventilation is still debated. In particular, nCPAP treatment seems effective only when noisy breathing during sleep, diagnosed as catathrenia, is related to the co-existence of expiratory and inspiratory flow limitation with obstructive apneas or hypopneas and consequent intermittent hypoxia.
  • Chapter 31 - Pharmacotherapy and parasomnias
    pp 301-311
  • View abstract

    Summary

    Hallucinations occur when sensations are perceived in the absence of environmental stimuli. They are generated by the brain under normal or abnormal situations, including drowsiness, sensory deprivation, use of or withdrawal from drugs or toxins, structural or metabolic brain disease, seizures or migraine, and psychiatric disorders such as schizophrenia. Hypnagogic and hypnopompic hallucinations (HH) are typically visual, but can be auditory, tactile or kinetic. Complex nocturnal visual hallucinations (CNVH) have somewhat different phenomenology and putative pathophysiology from HHs and can be seen in a variety of pathologic conditions. CNVH have similar phenomenology and represent a final common pathway for a variety of etiologies. The exploding head syndrome (EHS) is thought to be a benign condition characterized by an imagined very loud sound or explosion in the head at sleep onset or on waking during night.
  • Chapter 32 - Behavioral and psychiatric treatment of parasomnias
    pp 312-322
  • View abstract

    Summary

    This chapter reviews clinical disorders in which the daily pattern of food intake is dysregulated such that eating occurs at night during sleep period. It presents the characteristics, diagnosis, demographics, consequences, physiology and treatment of sleep-related eating disorders. The chapter also provides brief reference to differential diagnosis with night-eating syndrome (NES). It also describes the associations of SRED with other disorders, including sleep disorders, mood disorders and eating disorders. Polysomnographic (PSG) studies of patients with SRED demonstrate high prevalence of concurrent sleep disorders. Treatments that are employed to manage daytime eating disorders may be beneficial in controlling night-time eating episodes. Pharmacologic treatments for SRED (and NES) are either derived from effective therapeutics in related disorders (e.g. bulimia nervosa or somnambulism) or those useful in disorders which are commonly comorbid with nocturnal eating disorders (e.g. restless legs syndrome (RLS)).

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