Parasomnia
Encyclopedia
For the 2008 horror film, see Parasomnia (film)
Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Most parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness and NREM
sleep, or wakefulness and REM sleep.
, motor system
, or cognitive processes during sleep or sleep-wake transitions.
Some NREM parasomnias (sleep-walking, night-terrors, and confusional arousal) are common during childhood but decrease in frequency with increasing age. They can be triggered in certain individuals by alcohol, sleep deprivation
, physical activity, emotional stress, depression
, medications, or a fevered illness. These disorders of arousal can range from confusional arousals, somnambulism, to night terror
s. Other specific disorders include sleepeating, sleep sex
, teeth grinding
, rhythmic movement disorder
, restless legs syndrome
, and somniloquy
.
has a prevalence of 1-17% in childhood, with the most frequent occurrences around the age of eleven-twelve. About 4% of adults experience somnambulism.
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. Unfortunately, all attempts to console the individual are futile and may prolong or intensify the victim’s confused state. Usually the victim experiences amnesia
after the event but it may not be complete amnesia
. Up to 3% of adults suffer from sleep terrors
, and exhibited behavior of this parasomnia can range from mild to extremely violent. They typically occur in stage 3 sleep.
is a common sleep disorder where the sufferer grinds their teeth during sleep. This can cause sleep disruption for the sufferer and bed partner, wear and fracture of teeth, and jaw pain.
-- 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.
Demographically, 90% of RBD patients are males, and most are older than 50 years of age.
Typical clinical features of REM sleep behaviour disorder are:
Acute RBD, occurs mostly as a result of a side-effect in prescribed medication
- usually antidepressants.
Chronic RBD is idiopathic
or associated with neurological disorders. 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.
Patients with narcolepsy
also are more likely to develop RBD.
, a rapid-eye-movement sleep parasomnia consisting of breath holding and expiratory groaning during sleep, is distinct from both somniloquy
and obstructive sleep apnea
. The sound is produced during exhalation as opposed to snoring which occurs during inhalation. It is usually not noticed by the person producing the sound but can be extremely disturbing to sleep partners, although once aware of it, sufferers tend to be woken up by their own groaning as well. Bed partners generally report hearing the person take a deep breath, hold it, then slowly exhale; often with a high-pitched squeak or groaning sound.
Parasomnia (film)
Parasomnia is an independent horror film directed by William Malone and stars Jeffrey Combs, Timothy Bottoms and Dylan Purcell. The filming was funded by Malone himself, and its release was delayed due to difficulties securing distribution.- Plot :...
Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Most parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness and NREM
NREM
Non-rapid eye movement, or NREM is, collectively, sleep stages 1 – 3, previously known as stages 1 – 4. Rapid eye movement sleep is not included. There are distinct electroencephalographic and other characteristics seen in each stage. Unlike REM sleep, there is usually little or no eye movement...
sleep, or wakefulness and REM sleep.
NREM parasomnias
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 systemAutonomic nervous system
The autonomic nervous system is the part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils,...
, motor system
Motor system
The motor system is the part of the central nervous system that is involved with movement. It consists of the pyramidal and extrapyramidal system....
, or cognitive processes during sleep or sleep-wake transitions.
Some NREM parasomnias (sleep-walking, night-terrors, and confusional arousal) are common during childhood but decrease in frequency with increasing age. They can be triggered in certain individuals by alcohol, sleep deprivation
Sleep deprivation
Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain. It adversely affects the brain and cognitive function. Few studies have compared the...
, physical activity, emotional stress, depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
, medications, or a fevered illness. These disorders of arousal can range from confusional arousals, somnambulism, to night terror
Night terror
A night terror, also known as a sleep terror, incubus attack, or pavor nocturnus, is a parasomnia disorder that predominantly affects children, causing feelings of terror or dread, typically occur in the first few hours of sleep during stage 3 or 4 NREM sleep...
s. Other specific disorders include sleepeating, sleep sex
Sleep sex
Sleep sex, or sexsomnia, is a condition in which a person will do sexual acts while still asleep, acts such as masturbation, fondling themselves or others, having sex with another person and in more extreme cases sexual assault and rape....
, teeth grinding
Bruxism
Bruxism is characterized by the grinding of the teeth and typically includes the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
, rhythmic movement disorder
Rhythmic Movement Disorder
Rhythmic Movement Disorder is a neurological disorder characterized by involuntary, repetitive movements of large muscles 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...
, restless legs syndrome
Restless legs syndrome
Restless legs syndrome or Willis-Ekbom disease is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can affect the arms, torso, and even phantom limbs...
, and somniloquy
Somniloquy
Somniloquy or sleep-talking is a parasomnia that refers to talking aloud while sleep. It can be quite loud, ranging from simple sounds to long speeches, and can occur many times during sleep...
.
Confusional arousals
With a prevalence of 4%, confusional arousals are not observed very often in adults; however, they are common in children. Confusional arousals are occasional thrashings or inconsolable crying among children—they are characterized by movements in bed.Sleepwalking (somnambulism)
SleepwalkingSleepwalking
Sleepwalking, also known as somnambulism, is a sleep disorder belonging to the parasomnia family. Sleepwalkers arise from the slow wave sleep stage in a state of low consciousness and perform activities that are usually performed during a state of full consciousness...
has a prevalence of 1-17% in childhood, with the most frequent occurrences around the age of eleven-twelve. About 4% of adults experience somnambulism.
Sleep terrors (night terrors)
Sleep terrorNight terror
A night terror, also known as a sleep terror, incubus attack, or pavor nocturnus, is a parasomnia disorder that predominantly affects children, causing feelings of terror or dread, typically occur in the first few hours of sleep during stage 3 or 4 NREM sleep...
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
Property damage
Property damage is damage to or the destruction of public or private property, caused either by a person who is not its owner or by natural phenomena. Property damage caused by persons is generally categorized by its cause: neglect , and intentional damage...
by running about or hitting walls. Unfortunately, all attempts to console the individual are futile and may prolong or intensify the victim’s confused state. Usually the victim experiences amnesia
Amnesia
Amnesia is a condition in which one's memory is lost. The causes of amnesia have traditionally been divided into categories. Memory appears to be stored in several parts of the limbic system of the brain, and any condition that interferes with the function of this system can cause amnesia...
after the event but it may not be complete amnesia
Amnesia
Amnesia is a condition in which one's memory is lost. The causes of amnesia have traditionally been divided into categories. Memory appears to be stored in several parts of the limbic system of the brain, and any condition that interferes with the function of this system can cause amnesia...
. Up to 3% of adults suffer from sleep terrors
Night terror
A night terror, also known as a sleep terror, incubus attack, or pavor nocturnus, is a parasomnia disorder that predominantly affects children, causing feelings of terror or dread, typically occur in the first few hours of sleep during stage 3 or 4 NREM sleep...
, and exhibited behavior of this parasomnia can range from mild to extremely violent. They typically occur in stage 3 sleep.
Bruxism (teeth grinding)
BruxismBruxism
Bruxism is characterized by the grinding of the teeth and typically includes the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
is a common sleep disorder where the sufferer grinds their teeth during sleep. This can cause sleep disruption for the sufferer and bed partner, wear and fracture of teeth, and jaw pain.
Restless legs syndrome & Periodic Limb Movements
Both of these conditions (RLS and PLM) are classified as dyssomnias according to the DSM-IV. They are considered parasomnias.REM sleep behavior disorder
REM Sleep Behavior Disorder is the most common REM sleep parasomnia in which muscle atonia is absent. This allows the individual to act out their dreams and may result in repeated injuryInjury
-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...
-- 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.
Demographically, 90% of RBD patients are males, and most are older than 50 years of age.
Typical clinical features of REM sleep behaviour disorder are:
- Male gender predilection
- Mean age of onset 50–65 years (range 20–80 years)
- Vocalisation, screaming, swearing that may be associated with dreams
- Motor activity, simple or complex, that may result in injury to patient or bed-partner
- Occurrence usually in latter half of sleep period (REM sleep)
- May be associated with neurodegenerative disease
Acute RBD, occurs mostly as a result of a side-effect in prescribed medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
- usually antidepressants.
Chronic RBD is idiopathic
Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...
or associated with neurological disorders. There is a growing association of chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
RBD with neurodegenerative disorders—Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
, multiple system atrophy
Multiple system atrophy
Multiple system atrophy is a degenerative neurological disorder. MSA is associated with the degeneration of nerve cells in specific areas of the brain. This cell degeneration causes problems with movement, balance and other autonomic functions of the body such as bladder control or blood pressure...
(MSA) or dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
—as an early indicator of these conditions by as much as 10 years.
Patients with narcolepsy
Narcolepsy
Narcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive sleepiness and sleep attacks at inappropriate times, such as while at work. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which often is confused with insomnia...
also are more likely to develop RBD.
Catathrenia
CatathreniaCatathrenia
Catathrenia is a rapid eye movement sleep parasomnia consisting of end-inspiratory apnea and expiratory groaning during sleep. Catathrenia is distinct from both somniloquy and obstructive sleep apnea. The sound is produced during exhalation as opposed to snoring which occurs during inhalation...
, a rapid-eye-movement sleep parasomnia consisting of breath holding and expiratory groaning during sleep, is distinct from both somniloquy
Somniloquy
Somniloquy or sleep-talking is a parasomnia that refers to talking aloud while sleep. It can be quite loud, ranging from simple sounds to long speeches, and can occur many times during sleep...
and obstructive sleep apnea
Obstructive sleep apnea
Obstructive sleep apnea or obstructive sleep apnea syndrome is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in...
. The sound is produced during exhalation as opposed to snoring which occurs during inhalation. It is usually not noticed by the person producing the sound but can be extremely disturbing to sleep partners, although once aware of it, sufferers tend to be woken up by their own groaning as well. Bed partners generally report hearing the person take a deep breath, hold it, then slowly exhale; often with a high-pitched squeak or groaning sound.
See also
- DyssomniaDyssomniaDyssomnias are a broad classification of sleeping disorders that make it difficult to get to sleep, or to remain sleeping.Dyssomnias are primary disorders of initiating or maintaining sleep or of excessive sleepiness and are characterized by a disturbance in the amount, quality, or timing of...
- InsomniaInsomniaInsomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
- Jactatio capitis nocturna
- Sleep medicineSleep medicineSleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many questions about sleep-wake functioning. The rapidly evolving field has...
- Sleep paralysisSleep paralysisSleep paralysis is paralysis associated with sleep that may occur in healthy persons or may be associated with narcolepsy, cataplexy, and hypnagogic hallucinations. The pathophysiology of this condition is closely related to the normal hypotonia that occurs during REM sleep. When considered to be a...