Parasomnias

Abstract

Parasomnias are defined as unpleasant or undesirable behavioral or experiential phenomena that occur predominately or exclusively during the sleep period. Initially thought to represent a unitary phenomenon, often attributed to psychiatric disease, it is now clear that parasomnias are not a unitary phenomenon but rather are the manifestation of a wide variety of completely different conditions, most of which are diagnosable and treatable. The parasomnias may be conveniently categorized as "primary sleep parasomnias" (disorders of the sleep states per se) and "secondary sleep parasomnias" (disorders of other organ systems, which manifest themselves during sleep). The primary sleep parasomnias can be classified according to the sleep state of origin: rapid eye movement (REM) sleep, non-REM (NREM) sleep, or miscellaneous (i.e., those not respecting sleep state). The secondary sleep parasomnias can be further classified by the organ system involved. The underlying pathophysiology of many parasomnias is state dissociation-the brain is partially awake and partially asleep. The result of this mixed state of being is that the brain is awake enough to perform very complex and often protracted motor and/or verbal behaviors but asleep enough not to have conscious awareness of, or responsibility for, these behaviors.

Lifetime prevalence and incidence of parasomnias in a population of young adult Nigerians

“…Parasomnias are unpleasant or undesirable behavioural or experiential phenomena which occur predominantly or exclusively during sleep [1]. They occur during REM sleep, any of the four stages of non-REM sleep, and during transitions between sleep and wakefulness [2,3].…”

Parasomnias in children

“…Benzodiazepine is often an effective treatment for arousal disorders: low-dose clonazepam, starting with 0.25 mg an hour before bedtime, increasing slowly with attention to daytime sedation. Generally 3-6 weeks of treatment may be curative for a long time [31]. However, in children the use of psychotropic drugs is generally not recommended because: a) they are thought to mask the symptoms rather than to treat the causes of partial arousals; b) the drug-induced decrease in slow-wave sleep might have detrimental effects; c) tolerance and rebound effects occur frequently and cause severe increase in partial arousals.…”

“…Parasomnias occur mainly in childhood because of the different sleep structure with an increase of SWS pressure in earlier ages [31]. For the same reason, sleep deprivation followed by a SWS rebound can precipitate episodes.…”

“…The stressful events, such as family conflicts, work-or school-related problems and change in sleep environment can trigger parasomnias; on the contrary, childhood psychopathology is not frequently associated with parasomnias [31].…”

“…The events may be either calm or agitated with varying degrees of complexity and duration [31]. They often begin with sitting up in the bed and looking around in a confused manner before walking, but sometimes can immediately leave the room, walking or running around or out of the house, talking (often nonsensically), dressing, eating and drinking [3].…”