Abstract:Violent behavior during sleep is a common problem, affecting > 2% of the population > 15 years old as found in two large epidemiologic studies. The differential diagnosis of sleep related injury and violence includes: REM sleep behavior disorder (RBD); NREM sleep parasomnias (sleepwalking, sleep terrors); parasomnia overlap disorder (RBD + NREM sleep parasomnias); obstructive sleep apnea; sexsomnia (sleep related abnormal sexual behaviors); sleep related dissociative disorder; trauma-associated sleep disorder/… Show more
“…293 The disorders that may cause sleep-related violence and injury include a wide range of parasomnias, other sleep disorders and malingering. 294,295 The most common final diagnoses are sleep terrors or sleepwalking, RBD, obstructive sleep apnea, dissociative disorder, and sleep epilepsy. 294 Although this may be a behavior seen in the majority of patients with parasomnias attending sleep clinics.…”
Section: Sleep-related Violence and Dream Enactment Behaviormentioning
Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motorsuppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.
“…293 The disorders that may cause sleep-related violence and injury include a wide range of parasomnias, other sleep disorders and malingering. 294,295 The most common final diagnoses are sleep terrors or sleepwalking, RBD, obstructive sleep apnea, dissociative disorder, and sleep epilepsy. 294 Although this may be a behavior seen in the majority of patients with parasomnias attending sleep clinics.…”
Section: Sleep-related Violence and Dream Enactment Behaviormentioning
Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motorsuppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.
“…Violent behaviours during sleep are beyond the scope of this review; for this matter, we suggest the studies of Siclari et al (2010) and Schenck (2019).…”
The World Health Organization (WHO) defines violence as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation" (Krug et al., 2002). The Global Health Observatory of the WHO reported homicide as the third prime cause of death for males aged between 15 and 44 years old; 25% of adults reported a background of physical abuse (Global Health Observatory, 2012).Low socio-economic environments have a higher prevalence of violence and crime and sleep complaints, sleep disorders and less hours of mean sleep duration (
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