Parasomnias are abnormal behaviors and/or experiences emanating from or associated with sleep typically manifesting as motor movements of varying semiology. We discuss mainly nonrapid eye movement sleep and related
parasomnias in this article.
Sleepwalking (SW),
sleep terrors (ST),
confusional arousals, and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, and/or promote sleep inertia, lead to NREM
parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a
biomarker of arousal instability in NREM sleep, are noted in
sleepwalking disorders. Sleep-related
eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after arousal from sleep. SRED is often associated with the use of
sedative-
hypnotic medications, in particular the widely prescribed
benzodiazepine receptor agonists. Compelling evidence suggests that nocturnal eating may in some cases be another nonmotor manifestation of
Restless Legs Syndrome (RLS). Initial management should focus upon decreasing the potential for sleep-related injury followed by treating comorbid
sleep disorders and eliminating incriminating drugs. Sexsomnia is a subtype of disorders of arousal, where sexual behavior emerges from partial arousal from nonREM sleep. Overlap
parasomnia disorders consist of abnormal sleep-related behavior both in nonREM and REM sleep. Status dissociatus is referred to as a breakdown of the sleep architecture where an admixture of various sleep state markers is seen without any specific demarcation.
Benzodiazepine therapy can be effective in controlling SW, ST, and sexsomnia, but not SRED.
Paroxetine has been reported to provide benefit in some cases of ST.
Topiramate,
pramipexole, and
sertraline can be effective in SRED.
Pharmacotherapy for other
parasomnias continues to be less certain, necessitating further investigation. NREM
parasomnias may resolve spontaneously but require a review of priming and predisposing factors.