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At least 19 recordsLinked to original sources
PubMed1996

REM sleep parasomnias.

This article focuses primarily on REM sleep behavior disorder, a recently identified syndrome with a corresponding animal model. Diagnostic methods and criteria, treatment, and the world literature are reviewed, and the experience of the authors' institution--The Minnesota Regional Sleep Disorders Center (Minneapolis, MN)--is summarized. Other REM parasomnias, including nightmares, REM sleep-related sinus arrest, and sleep-related painful erections, are discussed briefly.

Animals↗
PubMed2002

The misinterpretation of a non-REM sleep parasomnia as suicidal behavior in an adolescent.

We report a case of misinterpretation of a non-REM sleep parasomnia as suicidal behavior in an early adolescent. A 12-year-old female with a history of sleepwalking but no prior psychiatric diagnosis awoke in the middle of the night with a deep laceration to her neck and complete amnesia for the event. During the initial 2-week pediatric hospitalization, it was believed that the wound was intentionally self-inflicted despite patient claims and evidence to the contrary. The patient was placed on a psychiatric hold and transferred to an appropriate facility. We review rule-out diagnoses and evidence supporting this case as an example of a violent non-REM parasomnia resulting in self-injurious behavior. Diagnostic and treatment implications are discussed.

Adolescent↗
PubMed1994

[REM sleep parasomnia].

The parasomnias consist of a heterogenous group of sleep behaviour disorders with different etiologies and various symptomatologies. By employing polysomnography and the simultaneous video recording of behaviour during sleep, it is possible to associate behavioral disturbances during sleep with specific sleep stages. In the present case study, a patient with a REM (rapid eye movement) sleep behaviour disorder is discussed. This rare form of parasomnia is characterized by motor enactment of vivid and striking dreams. Underlying disease in the present case involved bilateral lacunar ischemic infarcts in the brain stem. Under the combined psychotropic medication of carbamazepine and amitriptyline, the behaviour disorder during REM sleep remitted markedly.

Amitriptyline↗
PubMedDate not supplied

Atypical sexual behavior during sleep.

OBJECTIVE: This article reports a case series of atypical sexual behavior during sleep, which is often harmful to patients or bed partners. METHODS: Eleven subjects underwent clinical evaluation of complaints of sleep-related atypical sexual behavior. Complaints included violent masturbation, sexual assaults, and continuous (and loud) sexual vocalizations during sleep. One case was a medical-legal case. Sleep logs, clinical evaluations, sleep questionnaires, structured psychiatric interviews, polysomnography, actigraphy, home electroencephalographic monitoring during sleep, and clinical electroencephalographic monitoring while awake and asleep were used to determine clinical diagnoses. RESULTS: Atypical sexual behaviors during sleep were associated with feelings of guilt, shame, and depression. Because of these feelings, patients and bed partners often tolerated the abnormal behavior for long periods of time without seeking medical attention. The following pathologic sleep disorders were demonstrated on polysomnography: partial complex seizures, sleep-disordered breathing, stage 3 to 4 non-rapid eye movement (REM) sleep parasomnias, and REM sleep behavior disorder. These findings were concurrent with morning amnesia. CONCLUSIONS: The atypical behaviors were related to different syndromes despite the similarity of complaints from bed partners. In most cases the disturbing and often harmful symptoms were controlled when counseling was instituted and sleep disorders were treated. In some cases treatment of seizures or psychiatric disorders was also needed. Clonazepam with simultaneous psychotherapy was the most common successful treatment combination. The addition of antidepressant or antiepileptic medications was required in specific cases.

Adolescent↗
PubMed2002

Parasomnias. Things that go thump in the night.

BACKGROUND: General practitioners are well versed with patients presenting to the surgery with sleep symptoms, however, the approach to evaluating these symptoms is often haphazard. Insomnia is the commonest presenting complaint. Sleep apnoea, although readily treatable, carries with it significant morbidity and mortality. OBJECTIVE: This article aims to highlight those disorders that occur infrequently during the night but which interrupt sleep--the parasomnias. DISCUSSION: Knowledge of the spectrum of parasomnias and their symptoms usually allows a reasonably accurate clinical diagnosis and the assistance of a sleep physician or sleep laboratory is not often required. Parasomnias may be classified by the sleep phase during which they occur. Nonrapid eye movement (NREM) parasomnias are most likely to occur during the first episode of stages 3 and 4 of NREM sleep (slow wave sleep) which is approximately one hour after sleep onset. Rapid eye movement (REM) sleep density is usually greatest in the last few hours of sleep, therefore REM sleep parasomnias are most likely to occur during this time.

Dreams↗
PubMed2005

Interobserver reliability of ICSD-R minimal diagnostic criteria for the parasomnias.

OBJECTIVE: To estimate the interobserver reliability (IR) of the minimal diagnostic criteria for the parasomnias provided in the International Classification of Sleep Disorders Revised (ICSD-R). METHODS: Fifty consecutive subjects underwent a structured interview by three doctors based on the ICSD-R minimal criteria for the diagnosis of 13 parasomnias at any time in life. IR was calculated by Kappa statistics and interpreted according to conventional categories. RESULTS: In the group of Arousal Disorders, IR was "substantial" (kappa 0.74) for confusional arousals, "slight" (kappa 0.36) for sleepwalking, "fair" (kappa -0.02) for sleep terrors. In the group of Wake-Sleep Transition Disorders, IR was "substantial" to "almost perfect", but "moderate" for sleep starts (kappa 0.41). In the group of Parasomnias usually associated with REM Sleep, IR was "substantial" (kappa 0.69) for sleep paralysis, "moderate" (kappa 0.46) for RBD, "fair" (kappa 0.25) for nightmares. In the group of Other Parasomnias, IR was "substantial" to "almost perfect" (kappa between 0.73 and 0.93). CONCLUSIONS: When the clinical diagnosis of parasomnias is based on the ICSD-R: 1) the majority of Arousal Disorders and REM sleep parasomnias showed only a "fair" to "moderate" IR; 2) all of the other parasomnias showed a "substantial" to "almost perfect" IR. Nosological entities with unsatisfactory IR share complex motor phenomenology associated with a mental state difficult for the patient to define. The source of disagreement probably lies in the difficulty in interpreting patients' reports. For these parasomnias IR must be verified and possibly improved with training.

Adolescent↗
PubMedDate not supplied

[Parasomnia].

The parasomnias comprises a group of disorders that intrude into the sleep process and are not primarily disorders of sleep and wake states per se. These disorders are manifestations of central nervous system activation usually transmitted through skeletal muscle or autonomic nervous system channels (ICSD 1990). The parasomnias are divided into four groups: Arousal disorders (sleepwalking, night terrors, and confusionnal arousal), sleep-wake transition disorders (rhythmic movement disorder, sleep starts), REM sleep parasomnias (nightmares, sleep paralysis, hallucinations, and REM sleep behavior disorders), and other parasomnias (sleeptalking, nocturnal enuresis, and nocturnal bruxism.

Adult↗
PubMed1987

A case of parasomnia at REM sleep onset.

A case is reported of dyssomnia at the onset of REM sleep with thrashing, shouting, and urinary incontinence throughout the night. The attacks did not respond to, and may have been worsened by, antiepileptic drugs and diazepam, and the patient had microsleeps and brief apneas during a night of severely fragmented sleep. The case underscores the value of differentiating REM and NREM disorders in patients with atypical nocturnal attacks.

Adult↗
PubMed2001

Vocalization during episodes of prolonged expiration: a parasomnia related to REM sleep.

Objective: We report on a sleep-related respiratory dysrhythmia that is characterized by episodes of bradypnea associated with vocalization.Background: To date, many parasomnias with affinity for NREM sleep, REM sleep or both sleep states have been identified. While the reported clinical syndrome may resemble these known parasomnias, different clinical features are pointed out.Methods: Ten patients (seven males and three females) aged between 20 and 49 years, were included. All patients underwent standard clinical examinations and full polysomnography.Results: The principal complaint was unusual sound-making during sleep. Polysomnography demonstrated the presence of clustered bradypneic events associated with prolonged expiration and expiratory sound production. Replay of the sound signal revealed monotonous vocalization, consistent with groaning. These episodes occurred predominantly during REM sleep. Repeated sleep studies showed a remarkably constant night-to-night consistency of these vocalization episodes. Medical and neurological examinations disclosed no particular abnormalities, except in one patient, in whom a frontal meningioma was detected. Different empirical treatments, including pharmacotherapy and nasal continuous positive airway pressure therapy, provided insufficient symptomatic control.Conclusions: The syndrome described above clearly has distinct features with respect to well-defined sleep disorders, such as central sleep apnea syndrome and somniloquy. Therefore, it is proposed as a separate nosological entity.

Journal Article↗
PubMed2003

Parkinson's disease and sleep.

Sleep disorders are common in Parkinson's disease (PD), as almost two thirds of PD patients report them. From a clinical point of view, they can be classified into disorders of initiation and maintenance of sleep (DIMS), parasomnias, and excessive daytime sleepiness (EDS). Among the causes of DIMS are degenerative changes in the CNS affecting centers for sleep regulation, persistence into the night of daytime PD-related symptoms, concomitant medical or psychiatric disease, disruption of circadian rhythms, and effects of dopaminergic (and other) medication on sleep regulation. Parasomnias might further contribute to sleep disturbance, as they can be accompanied by motor desinhibition during REM sleep. Parasomnias can precede by several years the presence of daytime PD symptoms. EDS has been over the last years the focus of attention for both sleep and movement disorders specialists, due to the fact that it might predispose to traffic accidents. However, the so-called "sleep attacks" never occur without preexisting somnolence. Thus, a careful sleep history can be helpful to determine which patients are exposed to suffer them. Although EDS was initially attributed to the effects of dopaminergic medication, it seems likely that several disease-related factors might also play an important role. An adequate education of the PD patients in sleep hygiene measures and a skilled use of the medication seem necessary to prevent sleep disturbance.

Cholinergic Antagonists↗
PubMed1997

[Acoustic hallucinations as a symptom of a REM sleep-associated parasomnia].

This 52-year-old man suffered from auditory hallucinations that occurred during brief episodes of sleep paralysis at the end of REM sleep periods. During these episodes the patient experienced a dissociated state of consciousness with REM sleep intrusions into wakefulness. The occurrence of this mixed state, and of excessive sleep-onset REM periods during daytime polysomnography (MSLT = Multiple Sleep Latency Test), point to a disorder of REM sleep generation. The existence of narcolepsy could be ruled out. The observation of REM sleep-associated hallucinations has been reported earlier. In the presented polysomnographic sleep studies the existence of a REM sleep associated parasomnia characterised by hallucinations and sleep paralysis could be confirmed.

Acoustic Stimulation↗
PubMed2000

Parasomnias. Managing bizarre sleep-related behavior disorders.

Sleep can be a troubling experience for persons plagued by nocturnal disorders known as parasomnias. While they are "asleep," such persons may be walking, screaming in terror, rearranging furniture, eating odd food concoctions, or wielding weapons. Or they may be unable to fall asleep because of the unpleasant sensations of restless legs syndrome. Although these disorders are indeed bizarre, effective treatments are available. In this article, Drs Schenck and Mahowald discuss the evaluation and treatment of parasomnias and provide illustrative patient vignettes from their extensive experience at a sleep disorders center.

Aged↗
PubMed2004

Abnormal heart rate variability in a subject with second degree atrioventricular blocks during sleep.

OBJECTIVE: We compare the profiles of heart rate variability (HRV) during sleep stages in 9 healthy controls and one subject with second degree atrioventricular blocks (AVB), investigating the role of sympathovagal balance in such pathology. METHOD: Sleep and cardiac records were taken for one night in 9 male subjects from 21:00 to 07:00 h and for two nights in a male subject with AVB. Time and frequency domain indexes of HRV were calculated over 5 min-periods. RESULTS: In one subject without any daytime heart disease, 253 and 318 AVB of type 2 (Mobitz 2) were observed during the two experimental nights, predominantly during rapid eye movement (REM) sleep and the surrounding sleep stage 2 in the second half of the night. In the 9 control subjects, absolute HRV indexes and low frequency (LF)/(LF+high frequency, HF) (where LF and HF are low frequency and high frequency power) were low during slow wave sleep, and significantly increased during REM sleep and the preceding sleep stage 2. In the subject with AVB, these HRV indexes were abnormally low during all sleep stages, with a predominant increase in parasympathetic activity as inferred from low LF/(LF+HF). During wake, however, LF/(LF+HF) normally increased, and the tachycardia observed with the arousal that terminates SWS was preserved in the subject with AVB. CONCLUSION: These results suggest that in the subject with second degree atrioventricular blocks, sleep processes, particularly during REM sleep, create a specific neurological background that prevents an increase in sympathetic tone and triggers cardiac pauses.

Adult↗
PubMed2003

Hypnic headache syndrome: association of the attacks with REM sleep.

We describe the polysomnographic data of two patients with nocturnal headache attacks fulfilling the clinical criteria for hypnic headache syndrome. Two overnight polysomnographic studies were performed in each patient. Four nocturnal headache attacks were captured, all emerging from the REM phase of sleep. Our findings suggest a close relationship between the REM phase of sleep and the appearance of hypnic headache attacks.

Female↗
PubMed2006

Parasomnias.

Parasomnias are undesirable behaviors that arise from sleep but are not fully under voluntary control. Parasomnias are grouped broadly according to whether they arise from non-rapid eye movement (NREM) or rapid eye movement (REM) sleep. NREM parasomnias are disorders of arousal that occur along a continuum of behavioral, affective, and autonomic activation. REM-related parasomnias include REM sleep behavior disorder, sleep paralysis, and nightmare disorder. Parasomnias can often be managed successfully using behavioral and pharmacologic therapies.

Arousal↗
PubMedDate not supplied

Sleep disorders in childhood: a review.

Several studies in the last ten years have been directed towards a better understanding of sleep disorders in childhood. Defining sleep disorders in this age is difficult in dependence of relevant differences in sleep patterns at subsequent developmental stages. In new-borns total sleep time is fairly equal during night and day. Normally, day-time sleep gradually decreases over the first three years of life, such that night-time sleep progressively increases till the age of four, and similar to adult sleep-time by adolescence. The most frequent sleep disorders observed in childhood are parasomnias, that, thought to be a CNS sign of immaturity, tend to be quite predictable, recurring in the same families and not even influenced by environmental stimuli. These disorders included: a) arousal disorders, that generally emerge from delta sleep or relate to arousals occurring during NREM sleep, very common in childhood and fairly common in adulthood either; b) somnambulism and somniloquy, that have many common characteristics: first of all, they have the potential to generate a great sense of discomfort and fear in parents watching a child who suddenly sits up in bed eyes-opened but 'unseeing'; c) nocturnal enuresis, that is substantially not a problem of depth of sleep, despite many parents believe. Although narcolepsy is more common in adolescence, many studies have demonstrated that narcoleptic symptoms may begin in childhood. Narcoleptic symptoms in children are similar in their appearance to those predominant in adults, but their expression may be different because of CNS maturational factors. Historical descriptions of the OSAS evidenced since the beginning the importance of neurobehavioral complications associated with the cessation of airflow at the nose and mouth accompanied by respiratory effort, deriving from upper airway obstruction which occurs during sleep.

Adolescent↗