About all

Parasomnias treatment: Causes, Symptoms, Types & Management

Содержание

Causes, Symptoms, Types & Management

Overview

What is a parasomnia?

A parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep. A parasomnia can occur before or during sleep or during arousal from sleep. If you have a parasomnia, you might have abnormal movements, talk, express emotions or do unusual things. You are really asleep, although your bed partner might think you’re awake.

Are there different types of parasomnia?

Yes. Parasomnias are grouped by the stage of sleep in which they happen. There are two main stages of sleep – non-rapid eye movement (Non-REM) sleep and rapid eye movement (REM) sleep. There are other parasomnias that fall into an “other” category.

What is non-rapid eye movement (Non-REM) sleep? What parasomnias happen during this sleep stage?

Non-rapid eye movement (Non-REM) sleep are the first three stages of sleep – from first falling asleep to about the first half of the night. Non-REM sleep disorders are also called arousal disorders.

Non-REM parasomnias involve physical and verbal activity. You are not completely awake or aware during these events, are not responsive to others’ attempts to interact with you and you usually don’t remember or only partially remember the event the next day. Non-REM parasomnias usually occur in individuals between five and 25 years of age. Non-REM parasomnias often occur in people who have a family history of similar parasomnias.

Parasomnias that happen during Non-REM sleep include:

  • Sleep terrors: If you experience this sleep disorder, you wake up suddenly in a terrified state. You may scream or cry in fright. Sleep terrors are usually brief (30 seconds), but can last up to a few minutes. Other features of this disorder are a racing heart rate, open eyes with dilated pupils, fast breathing and sweating.
  • Sleepwalking (somnambulism): If you’re a sleepwalker, you get out of bed, move about with your eyes wide open, but you’re actually asleep. You may mumble or talk (sleep talking). You may perform complex activities – such as driving or playing a musical instrument – or do strange things like pee in a closet or move furniture. Sleepwalking can be dangerous and lead to injuries because you’re unaware of your surroundings. You can bump into objects or fall down.
  • Confusional arousals: If you have this sleep disorder, you appear to be partially awake, but you are confused and disoriented to time and space. You remain in bed, may sit up, have your eyes open, and may cry. You speak slowly, have trouble understanding questions that are asked or responding in a sensible way. The episode may last from a few minutes to hours. Confusional arousals are common in childhood and tend to decrease in frequency with increasing age.
  • Sleep-related eating disorder: If you have this sleep disorder, you eat and drink while you’re partially awake. You may eat foods or food combinations you wouldn’t eat if awake (such as uncooked chicken or slabs of butter). Dangers include eating inedible or toxic foods, eating unhealthy or too much food, or injuries from preparing or cooking foods.

What is rapid eye movement (REM) sleep? What parasomnias happen during this sleep stage?

Rapid eye movement (REM) sleep follows the three non-REM stages of the sleep cycle. During REM sleep, your eyes rapidly move under your eyelids and your heart rate, breathing and blood pressure are all increased. This is a time when vivid dreaming occurs. Your body cycles through and repeats non-REM and REM sleep about every 90 to 110 minutes.

Parasomnias happen during the latter part of the night. If awakened during the event, it’s likely you’d be able to recall part or all of the dream.

Parasomnias that happen during REM sleep include:

  • Nightmare disorder: These are vivid dreams that cause feelings of fear, terror and/or anxiety. You may feel a threat to your survival or security. If you are awakened during your nightmare, you’d be able to describe your dream in detail. You often have trouble falling back to sleep. Nightmare disorder is more likely to occur if you’re under stress or experience a traumatic event, illness/fever, extreme tiredness or after alcohol consumption
  • Recurrent isolated sleep paralysis: If you have this sleep disorder, you can’t move your body or limbs during sleep. Scientists think the paralysis might be caused by an extension of REM sleep – a stage in which muscles are already in a relaxed state. This happens either before you fall asleep or as you are waking up. Episodes last seconds to a few minutes and are distressing, usually causing anxiety or fear. Sleep paralysis can be stopped if your bed partner speaks to you or touches you.
  • REM sleep behavior disorder (RSBD): If you have this sleep disorder, you act out, vocalize (e.g., talk, swear, laugh, shout), or make aggressive movements (e.g., punching, kicking, grabbing) as a reaction to a violent dream. This sleep disorder is more common among older adults. Many people with this disorder have neurodegenerative disease, such as Parkinson’s disease, Lewy body dementia, multiple system atrophy or stroke.

Other parasomnias include:

  • Exploding head syndrome: If you have this sleep disorder, you hear a loud noise or explosive crashing sound in your head as you’re falling asleep or waking up. You may also see an imaginary flash of light or have a sudden muscle jerk.
  • Sleep enuresis (bedwetting): This is not the bedwetting that occurs in young children. To be a parasomnia, this bedwetting must happen in children age five and older and must occur at least two times a week for at least three months.
  • Sleep-related hallucinations: If you have this sleep disorder, you experience hallucinations as you’re falling asleep or waking up. You may see things, hear things, feel things or feel movement that doesn’t really exist. You may leave your bed to escape what you’re experiencing.
  • Sleep-related groaning (catathrenia): With this sleep disorder, you have repeat episodes of groaning noises (long groans followed by sighs or grunts) during sleep.
  • Sexsomnia: Persons with this sleep disorder carry out sexual behaviors during their sleep. These may include intercourse, masturbation, sexual assault, fondling your bed partner or sexual vocalizations.

Are certain parasomnias more common to a certain gender?

Nightmares appear to happen more often in females. Sexsomnia is seen more often in males. REM sleep behavior disorder is more commonly reported in males over age 50. Sleep terrors, confusional arousals and sleepwalking occur in a similar number of males and females.

Do parasomnias occur in children?

Yes. Parasomnias are more common in children than in adults. Non-REM sleep disorders are more common in children than REM disorders. The most common parasomnias in children under the age of 15 are:

  • Confusional arousal.
  • Sleepwalking.
  • Sleep terror.
  • Nightmare.

Parasomnias are seen more often in children who have neurologic or psychiatric health issues including epilepsy, attention-deficit hyperactive disorder (ADHD) or developmental issues.

Symptoms and Causes

What are the causes of parasomnias?

Causes of parasomnias can be grouped into those that disrupt sleep and other general health issues.

Issues that disrupt sleep:

  • Incomplete transition from being awake to the stages of sleep.
  • Lack of sleep, irregular sleep-wake schedules (jet lag or shift work).
  • Medications including those that cause sleep (benzodiazepines: zolpidem), treat depression (amitriptyline, bupropion, paroxetine, mirtazapine), treat psychotic disorders (quetiapine, olanzapine), treat high blood pressure (propranolol, metoprolol), treat seizures (topiramate), treat asthma/allergy (montelukast) treat infections (fluoroquinolones).
  • Medical issues that disrupt sleep, such as restless leg syndrome, obstructive sleep apnea, pain, narcolepsy, sleep deprivation, circadian rhythm disorders, or periodic limb movement disorder.
  • Lack of maturity of the sleep-wake cycle (in children with parasomnias).

Other health issues:

  • Fever.
  • Stress.
  • Alcohol or substance abuse.
  • Head injury.
  • Pregnancy or menstruation.
  • Genetics. If there’s a family history of parasomnias, you’re more likely to have them.
  • Inflammatory disease, such as encephalitis.
  • Psychiatric illness, including depression, anxiety and post-traumatic stress disorder.
  • Neurological disease, including Parkinson’s disease, Lewy body dementia, stroke, multiple system atrophy, multiple sclerosis, brain tumors, migraines, and spinocerebellar ataxia type three.

What are the symptoms of parasomnias?

Each type of parasomnia has many unique features and triggers. However, some of the more common symptoms include:

  • Difficulty sleeping through the night.
  • Waking up confused or disoriented.
  • Being tired during the day.
  • Finding cuts and bruises on your body for which you don’t remember the cause.
  • Displaying movements, expressions, vocalizations or activities – as told to you by your bed partner – that you don’t remember.

Diagnosis and Tests

How are parasomnias diagnosed?

Your sleep medicine specialist will ask you and your sleep partner about your sleep symptoms. You will also be asked about your medical history, family history, alcohol use and any substance abuse. You’ll be asked about your current medications. You may be asked to keep a sleep diary and your bed partner may be asked to keep track of your sleep events.

Other sleep disorders tests include:

  • Sleep study (polysomnogram): This is a sleeping laboratory in which you’ll be monitored as you sleep. Your brain waves, heart rate, eye movements and breathing will be recorded as you sleep. Video will record your movements and behavior. While some sleep studies can be done at home, an in-lab study will be recommended if there’s concern for parasomnia.
  • Video electroencephogram (EEG) or sleep EEG: These tests help your healthcare provider see and record your brain activity during a brain event.
  • Neurologic exam, CT or MRI scan to detect degeneration of the brain or other possible neurologic causes of your symptoms.

Management and Treatment

How are parasomnias treated?

Treatment starts with identifying and treating other sleep problems and any other health issues as well as reviewing medications that may trigger the parasomnia.

General management strategies for both Non-REM and REM sleep disorders are to:

  • Follow good sleep hygiene habits (get 7-9 hours of sleep/night; turn off lights, TV and electronic devices; keep room temperature cool; avoid caffeine and strenuous exercise near bedtime).
  • Maintain your regular sleep-wake schedule. Have a consistent bed time and wake up time.
  • Limit, or don’t use, alcohol or recreational drugs.
  • Take all prescribed medications as directed by your healthcare provider.

Other treatments for non-REM sleep disorders:

  • Medication is not usually prescribed for non-REM parasomnias. However, when they are used, benzodiazepines are the medications of choice for parasomnias that are long lasting or potentially harmful. Tricyclic antidepressants are also sometimes tried. Psychological approaches (such as hypnosis, relaxation therapy or cognitive behavioral therapy, psychotherapy) are also considered.

Other treatments for REM sleep disorders:

  • Clonazepam and melatonin are the medications commonly used to manage REM sleep disorders.

Your healthcare provider will discuss the best treatment options – medications and/or psychologic approaches – for your specific type of parasomnia considering your unique health history and medical issues.

Safety precautions

Another discussion you and your healthcare provider will have are suggestions to keep your sleeping environment safe. Tips include:

  • Lock or remove any dangerous or sharp items from the bedroom.
  • Secure tableside lights.
  • Use floor pads to prevent injuries from falls.
  • Pad the edges of bedside furniture.
  • Use plastic bottles and cups if water is needed at the bedside.
  • Install alarms on windows and doors for sleepwalkers.
  • Sleep in separate beds if the person with parasomnia displays aggressive behaviors – like punching or kicking.

How are parasomnias in children treated?

Non-REM parasomnias are most common during childhood and normally end during adolescence. Usually all that’s needed is calming reassurance from the parents that everything is okay. Medications are rarely needed, but if they are, they’re typically only prescribed for three to six weeks. Medications typically tried include benzodiazepines or anti-anxiety drugs.

Prevention

Can parasomnias be prevented?

Although some causes of parasomnias are less likely to be prevented, such as those due to neurological diseases, mental health issues or heredity, others may be prevented by following some of the same management approaches discussed in this article. These include getting seven to nine hours of sleep a night sticking with consistent bedtime and wakeup times, and limiting alcohol and recreational drug use. (See the treatment section for more tips.) Also, ask your healthcare provider to review your current medications. Many can disrupt sleep. If this is the case, perhaps different drugs can be prescribed.

Living With

When should I call the doctor about sleep problems?

You should talk to your doctor if you or your family member experiences any abnormal sleep-related behaviors, especially those associated with injuries or sleep disruption.

Parkinson’s Disease Sleep Problems

What is Parkinson’s disease?

Parkinson’s disease is a movement disorder that causes nerve cells in one part of the brain to slowly degrade (get damaged) or die over time. As this nerve damage gets worse, it causes a cascade of symptoms throughout your body.

Parkinson’s disease most notably causes motor symptoms. “Motor symptoms” is a term healthcare providers use to describe any symptom that makes it harder for you to move (or control your movements).

Parkinson’s motor symptoms include:

  • Stiff muscles.
  • Tremors (shaking, typically in your hands or legs, that you can’t control).
  • Problems with balance or coordination.
  • Unusually slow movements (bradykinesia).

Parkinson’s disease can also cause many types of non-motor symptoms. These issues affect your body and mind in different ways. Non-motor symptoms may impact your mood, sense of smell or vision, to name just a few.

What’s the relationship between Parkinson’s and sleep?

Parkinson’s disease and sleep are connected in complex ways that not even scientists completely understand quite yet.

Sometimes, Parkinson’s disease directly causes sleep problems. According to one study, sleep-related symptoms may be one of the earliest signs of Parkinson’s disease. These signs may include things like thrashing while you’re asleep.

Other factors (like Parkinson’s disease treatments and emotional challenges) can also play a role. One thing is clear: For many people with Parkinson’s disease, a restful night’s sleep can be hard to find.

How common are sleep problems for people with Parkinson’s?

Many people with Parkinson’s disease experience sleep problems. Researchers estimate that up to 2 in 3 people with Parkinson’s disease have had trouble sleeping.

How does Parkinson’s disease cause sleep problems?

Researchers have yet to uncover every nuance of the Parkinson’s and sleep connection. So far, medical experts believe several causes may contribute:

  • Chemical changes in the brain: Ongoing research shows that Parkinson’s disease may disrupt sleep-wake cycles. Changes to certain brain chemicals may cause people with Parkinson’s to get less (and less restful) sleep.
  • Medication: Some drugs that treat Parkinson’s disease may make it harder to fall or stay asleep. A medication may also disrupt your sleep patterns by making you drowsy during the day (and wide awake at night).
  • Mental health challenges: People with Parkinson’s commonly deal with mood disorders, such as anxiety or depression. Any mood disorder may keep you up at night or make you sleep less soundly.
  • Parkinson’s symptoms: Pain, waking up at night to pee or other Parkinson’s symptoms can make restful sleep harder to come by. Sleep apnea (common in later stages of Parkinson’s) can also disrupt sleep.

What types of sleep problems do people with Parkinson’s disease have?

Parkinson’s disease affects every person differently. It also impacts sleep in different ways. People with Parkinson’s may have:

  • Insomnia, finding it hard to fall asleep.
  • Fragmented sleep, waking up many times over the night.
  • Excessive daytime sleepiness, finding it hard to stay awake during the day.
  • Very vivid dreams, which may cause hallucinations or confusion after waking up.
  • Emotional dreams or nightmares, which may make you feel emotionally drained after waking up.

What is REM sleep behavior disorder?

Up to half of people with Parkinson’s disease may have this disorder. Your body “acts out” dreams, making strange or possibly dangerous movements while sleeping. Some researchers believe REM sleep behavior disorder could be one of the earliest signs of Parkinson’s.

What other types of sleep disorders do people with Parkinson’s disease have?

Sleep disorders that commonly affect people with Parkinson’s disease include:

When do people with Parkinson’s have sleep problems?

Not everyone with Parkinson’s disease experiences sleep issues. If you do, they can occur at any point before or after a Parkinson’s disease diagnosis.

How are sleep problems diagnosed in people with Parkinson’s disease

?

If you’re having problems sleeping, sit down with your healthcare provider to discuss the issue in detail. Your provider will ask you questions to better understand your symptoms.

Be prepared to explain when sleep disruptions happen and how they affect your life. Keeping a sleep journal for a few weeks can help you remember the details.

If your provider suspects you may have a sleep disorder, they may recommend you have a sleep study. This overnight test uses electrodes attached to your skin to track how your body functions when you’re sleeping.

How are sleep problems treated in people with Parkinson’s disease?

Your provider will recommend treatments that address what’s causing your sleeping challenges. Your provider may:

  • Change your medication: If a medication could be causing your sleep issues, your provider may decide to adjust your treatment plan. Reducing the dose or switching medicines may solve the problem.
  • Prescribe a new medication or therapy: If you have a sleep disorder, your provider will discuss your options. In some cases, your provider may recommend a new medication. If you have sleep apnea, wearing a special oral appliance can help. The device enables you to get a steady flow of oxygen, so your body doesn’t gasp for air.
  • Suggest lifestyle changes: Your daily habits and sleeping environment can help or hurt your sleep efforts. Setting regular sleep and wake times, keeping the room dark and avoiding electronic screens at bedtime may improve how well you sleep. If you have REM sleep disorder, your provider will discuss options for how best to protect you (and those around you) while you sleep.

What else can I do to sleep better with Parkinson’s disease?

Practicing healthy “sleep hygiene” habits may also promote more restful sleep.

Do:

  • Get outside during the day. Bright light tells your body it’s time to be awake.
  • Keep your body moving during the day. Even if all you feel up to is a short walk or two, all physical activity offers benefits.
  • Try at-home remedies, such as massage or a warm bath. Relaxing your mind may help your body fall asleep.

Don’t:

  • Take long naps during the day.
  • Use stimulants, such as caffeine, within six hours of bedtime.
  • Use your bedroom for activities other than sleeping. Go to another room to read, watch TV or work.

Are over-the-counter sleep aids (medications) safe for people with Parkinson’s disease?

Unfortunately, they’re not. Over-the-counter sleeping medicines may feel like an easy and safe bet to try fixing your sleep issues. But they can pose extra risks for people with Parkinson’s disease.

Some over-the-counter and prescription sleep medicines can make sleep problems worse. Certain sleep medications can have serious drug interactions with Parkinson’s medications. Always talk to your provider before taking any new medication, especially a sleep aid.

When should I call my healthcare provider?

Reach out to your provider if trouble sleeping harms your quality of life. Always call your healthcare provider if you experience symptoms that worry you, especially if they could put you or those around you in danger.

Sometimes, a sleep disturbance could be a sign of depression related to Parkinson’s disease. If you’ve lost interest in activities you once loved or feel numb to what’s going on in your life, reach out to a provider you trust. Some people feel better after starting a new medication or talking to someone about what they’re feeling. You don’t have to feel like this.

A note from Cleveland Clinic

Researchers continue to study the sleep-Parkinson’s disease relationship. Understanding more about how Parkinson’s affects sleep (and vice versa) may lead to earlier detection of Parkinson’s disease and more effective treatments. Even now, you have plenty of options to treat sleep problems. Be open with your provider about any sleep issues you’re having. Together, you can find a plan that improves your sleep as well as any other challenges Parkinson’s disease may create in your life.

Parasomnias – Types, Symptoms, & Causes

“Parasomnia” is a catchall term for unusual behaviors that people experience prior to falling asleep, while asleep, or during the arousal period between sleep and wakefulness. These behaviors vary considerably in terms of characteristics, severity, and frequency.

Historically, parasomnias were considered a definitive sign of psychopathology, but some contemporary researchers argue these phenomena occur as the brain transitions in and out of sleep, as well as between rapid eye movement (REM) and non-rapid eye movement (NREM) sleep cycles. Parasomnias are more common in children than adults, but these behaviors have been recorded across different age groups.

Types of Parasomnia

While each parasomnia carries distinct symptoms and diagnostic criteria, these behaviors can be categorized into three general groups: NREM-related, REM-related, and “other.

NREM-Related Parasomnias

Non-rapid eye movement sleep constitutes the first stage of one’s sleep cycle, known as “shallow” sleep, and the second, third, and fourth stages, during which the sleep becomes gradually deeper. Collectively, these stages usually last about 90 minutes.

The most common NREM-related parasomnias are known as disorders of arousal. These parasomnias are characterized by recurrent episodes of incomplete awakening, limited responsiveness to other people attempting to intervene or redirect the sleeper, and limited cognition during the episode. Most people who experience disorders of arousal have little to no memory of their episodes. These disorders include:

  • Confusional arousals: The sleeper exhibits mental confusion or confused behavior in bed. Most people who experience confusional arousals display very little autonomic arousal in the form of mydriasis (dilated pupils), tachycardia (accelerated heartbeat), tachypnea (accelerated breathing), or perspiration. Confusional arousals are also known as Elpenor syndrome.
  • Sleepwalking: Also known as somnambulism, sleepwalking occurs when people get out of bed while still asleep but exhibit limited awareness or responsiveness to their surroundings. They may exhibit other complex behaviors such as sorting clothes. Sleepwalking can also lead to injuries if the individual loses their balance or collides with other objects.
  • Night terrors (or sleep terrors): People who experience night terrors often scream in their sleep, though most are not responsive to outside stimuli and will have no recollection of the source for their terror upon waking. Most night terror episodes last between 30 seconds and three minutes.
  • Sleep-related sexual abnormal behaviors: Known colloquially as “sexsomnia,” this specific parasomnia subtype is characterized by unusual sexual behaviors during sleep, such as aggressive masturbation, initiation of sexual intercourse, and sexual noises.

Studies have shown that males and females are equally susceptible to disorders of arousal, though age appears to play a role. Parasomnias have been reported in roughly 17% of children ages three to 13. For children and adults 15 and older, the prevalence rate falls between 2.9% and 4.2%.

Another common NREM-related parasomnia is sleep related eating disorder, which is characterized by episodes of dysfunctional eating that occur after arousal from sleep. Most people with this condition exhibit limited responsiveness during their eating episodes, and have little to no memory of the events. Hazards associated with sleep related eating disorder include ingestion of toxic substances, injuries from cooking or preparing food, and physiological effects of unhealthy or excessive eating.

REM-Related Parasomnias

Rapid eye movement sleep occurs following the first four NREM stages of the sleep cycle. Following the first complete sleep cycle, NREM and REM stages will repeat in a cyclical fashion every 90 minutes or so for the rest of the night. As the name suggests, a person’s eyes will move rapidly beneath their eyelids during REM sleep. They will also experience faster breathing, and increases in both their heart rate and blood pressure.

Common REM-related parasomnias include:

  • REM sleep behavior disorder: This disorder – RSBD for short – is characterized by unusual vocalizations or movements during REM sleep, often as a reaction to a dream. It is usually attributed to dysfunction in the muscles responsible for skeletal muscle atonia, the extremely relaxed state that occurs in the REM stage. People with RSBD may undergo polysomnography examinations that record brain activity during the REM stage. This condition is most common in people aged 50 or older. Clinical findings of RSBD may be noted in patients taking certain anti-depression medications.
  • Recurrent isolated sleep paralysis: People with this condition feel complete bodily atrophy during sleep onset – the period before they fall asleep – or upon waking. They will not be able to move any part of the body during these episodes, which normally don’t last more than a few minutes. Sleep paralysis can lead to anxiety or distress about falling asleep.
  • Nightmare disorder: Everyone has unpleasant dreams every now and then. Nightmare disorder is limited to those who experience recurrent, vivid dreams defined by threats to survival or security that result in fatigue, distress, reduced cognition, and other daytime impairments. Nightmare disorder is a common component of Post-Traumatic Stress Disorder (PTSD). Motor activity is often limited during nightmare episodes. For children with nightmare disorder, severe psychosocial stressors are often to blame.

Other Parasomnias

The “other” category for parasomnias is dedicated to behaviors that occur during the transition between sleep or wakefulness, as well as those that can occur during NREM or REM sleep. These parasomnias include:

  • Exploding head syndrome: Also known as sensory sleep starts, people with this condition will hear a loud noise or feel an exploding sensation in their head when they wake up. They may also “see” an imagined flash of light upon waking. This sensation can leave the sleeper with lingering feelings of palpitation, dread, and anxiety, but it is usually painless. Some people may experience multiple episodes per night.
  • Sleep related hallucinations: People with this condition experience hallucinations either during sleep onset (hypnagogic) or when they wake up (hypnopompic). These hallucinations may be visual, auditory, tactile, or kinetic in nature. In extreme cases, sleepers may leave their bed in an attempt to escape what they are experiencing. The hallucinations may persist for up to several minutes after the sleeper awakens.
  • Sleep Enuresis: Known throughout the world as “bedwetting,” sleep enuresis refers to involuntary urination during sleep. Bedwetting is quite common in young children. To be considered a parasomnia, it must occur in people ages five and older and occur at least twice per week for at least three months. Primary sleep enuresis refers to people who never wake up feeling dry, while secondary sleep enuresis occurs in individuals who have not previously experienced bedwetting episodes for at least six months before the first episode occurs.

This list of parasomnias is not exhaustive, but merely reflective of the most common parasomnia types. If you believe you are experiencing a parasomnia, consult with your physician to learn about prevention tips and parasomnia treatment options.

  • Was this article helpful?
  • YesNo

Parasomnia | Michigan Medicine

Parasomnias include disorders with undesirable behaviors or experiences that occur during sleep or during partial arousals from sleep.

Disorders of Arousal

The following three sleep disorders are overlapping types of parasomnia that are often grouped together as “disorders of arousal.” They occur during states of partial arousal out of deep, non-REM sleep, usually in the first third of the night. While experiencing episodes, people are typically disoriented and non-responsive, and they typically don’t remember the episode.

  • Confusional Arousals – Confusional arousals include states of mental confusion or confused behavior during partial arousals from sleep, usually in the first third of the night but sometimes upon awakening in the morning. They are most common in children up to age five. The person may resist direction or even lash out violently if interfered with.
  • Sleepwalking or Somnambulism – Sleepwalking or somnambulism are partial arousals from sleep that include walking around in a state of limited consciousness, which may include diminished awareness of the environment, reduced responsiveness and impaired judgment. Behaviors may be inappropriate, nonsensical or at times dangerous. Sleepwalking is most common in children ages 8 to 12 but can persist into adulthood.
  • Sleep Terrors or Night Terrors – These are sudden partial arousals from sleep with intense fright or terror, often beginning with a scream, frequently with increased heart and respiratory rate, confusion and non-responsiveness, at times with vigorous “fight or flight” behavior that can be dangerous. If mental content is present, it is usually simple and fragmentary (for example, an image of a threatening presence). Often, individuals cannot remember these episodes.

Treatment

Confusional arousals, sleepwalking and sleep terrors may be triggered by other sleep disorders such as obstructive sleep apnea (OSA). Treatment will first address any underlying sleep disorder. Sleep patterns should be consistent and allow for sufficient sleep. Sleep deprivation and alcohol consumption may bring out or increase these disorders. It may be necessary to take safety measures to ensure that people with a disorder of carousel does not harm themselves or others. If dangerous or disruptive behaviors persist, medications may be helpful in controlling the disorder.

Other Parasomnial Sleep Disorders

 

REM Sleep Behavior Disorder (RBD)

This is a disorder in which dreams are acted out due to a loss of the muscle paralysis that usually prevents people from enacting their dreams during REM sleep. The dreams that are acted out may be violent and can lead to injury to the dreamer and/or the bed partner. RBD may occur in conjunction with, or as a predecessor to, certain neurological disorders such as Parkinson’s Disease. Sometimes, it can result from medication usage. RBD can usually be controlled with the use of appropriate medications.

Nightmares

Nightmares are very disturbing dreams that result in repeated awakenings from sleep. Most often they are dreams that are very frightening but also at times may be dreams with anger, sadness, disgust and other unpleasant emotions. The person usually becomes alert quickly when they awaken and has detailed recall of an elaborate dream. Nightmares most often occur out of REM sleep. Repetitive nightmares often occur as a symptom of Post-Traumatic Stress Disorder (PTSD), where they may include a partial replay of a traumatic event. Nightmares typically reflect psychological stress and conflict. If nightmares are persistent and cause significant distress, treatments such as medications, cognitive-behavioral therapy and psychotherapy may be used.

Sleep Paralysis (Recurrent, Isolated Form)

While sleep paralysis may occur as a feature of the sleep disorder called narcolepsy, it also occurs as an isolated symptom. A person experiences an inability to move or speak, either at the onset of sleep or upon awakening from sleep. The episodes may last from seconds to several minutes. Dreamlike experiences may accompany the paralysis. In sleep paralysis, the muscle paralysis that normally occurs during REM sleep spills over into the onset of sleep, or into the immediate period of awakening from sleep. If the person does not understand what is happening, the sleep paralysis may be intensely frightening. Explanations and reassurance may be very helpful.

Sleep-related Eating Disorder

A sleep-related eating disorder includes repeated episodes of eating arising out of sleep, usually in a state of partial awareness and partial sleep, or with nearly full awareness. But sometimes there is virtually no awareness at all, similar to classic sleepwalking. The person may consume odd or even dangerous items. Complications often include weight gain and disrupted sleep with associated daytime fatigue. Medications may be helpful in controlling the symptoms.

Sleep Talking

Sleep talking is not regarded as a sleep disorder. Talking can occur during any stage of sleep and may be more or less understandable. It is often a normal phenomenon, though it may occur as part of the larger picture in parasomnias such as REM Sleep Behavior Disorder, sleepwalking or sleep-related eating.

Rhythmic Movement Disorder

Rhythmic movement disorder is characterized by repetitive, stereotyped, rhythmic movements involving large muscle groups, such as body rocking, head banging and head rolling, that occur around bedtime, at sleep onset or during sleep. These phenomena are common among infants and children and are only considered a disorder if they have serious consequences, such as significant sleep disruption, impairment of daytime functioning or bodily injury to the child. Rhythmic movements typically begin in the first year of life and usually, but not always, spontaneously resolve by age 5.

Diagnoses for Parasomnias

There are almost 100 sleep disorders, and the University of Michigan Sleep Disorders Center has experience in evaluating and treating all of them. Diagnosis of a parasomnia disorder will depend upon the symptoms and may include a sleep study.

Next Steps

Please call 734-936-9068 to schedule a clinic visit.

We will need a referral from your physician before your appointment. We look forward to helping you resolve your sleep issues.

Parasomnia Diagnosis, Symptoms & Treatment

It’s not uncommon to talk in your sleep every once in a while, and you probably know someone who would sleep walk as a child. But sometimes these strange occurrences while we sleep can affect our daily lives. If these nightly disruptions are creeping into your day and impairing your ability to be your best self, our sleep medicine doctors can help.

What is Parasomnia?

Parasomnia is a sleep disorder that causes abnormal behavior during sleep. This abnormal behavior can happen at any stage of sleep. Parasomnias are common but make it difficult for people to get a restful sleep and can also disrupt the sleep of others.

Types of Parasomnia

There are several types of parasomnia, including:

Sleepwalking

Walking while asleep is referred to as sleepwalking or somnambulism. Sleepwalking is a very common parasomnia and can also involve sleep talking or doing normal activities while asleep. Sleepwalking usually happens at night but can also happen during naps.

Sleep Talking

Sleep talking is also a very common type of parasomnia. This parasomnia is characterized by talking when a person is asleep. Talking can range from mumbling to full conversations. Sleep talking can happen during any part of the night but is easier to understand during lighter stages of sleep.

Sleep-Related Groaning

Loud groaning that happens during sleep is referred to as sleep-related groaning (catathrenia). This sound usually happens when a person exhales slowly and deeply. Sleep-related groans can sound like loud humming, roaring or high-pitched cracking sounds. In some cases, sleep-related groaning can be mistaken as snoring, but is not related to breathing issues.

Nightmares

Nightmares are intense or troubling dreams that can cause anger, anxiety or fear. Nightmares can make it difficult to fall back asleep and, in some cases, can happen multiple times a night. Nightmares usually happen during REM sleep, when a person is more likely to dream.

Night Terrors

Night terrors, or sleep terrors, cause a person to suddenly wake up in a terrified state. Night terrors can last anywhere from 30 seconds to 5 minutes. Night terrors can also cause:

  • Crying
  • Screaming
  • Skin flushing
  • Sweating
  • Fast heart rate

Night terrors are different from nightmares because they usually involve little to no dream activity and happen during non-REM sleep.

Bedwetting

Bedwetting (nocturnal enuresis) is involuntary urination during sleep. It is most common in children (usually younger than 6 years old). Bedwetting usually occurs when the bladder has more urine than it can hold. Some cases of bedwetting don’t have an underlying cause, while others are due to other conditions, like urinary tract infections.

Confusional Arousal

Confusional arousal is the experience of waking up feeling very confused. You may have trouble understanding what you’re doing or where you are. If you have confusional arousal, you may also experience other behaviors, like slow speech, crying, poor memory or slow reaction time.

Teeth Grinding

Teeth grinding (sleep bruxism) causes a person to clench or grind their teeth while sleeping. This condition can cause soreness in the jaw, face or neck, tooth pain or sensitivity as well as earache-like pains.

Sleep-Related Eating Disorders

A sleep-related eating disorder happens when a person binge eats and drinks during non-REM sleep. A person can be partly or fully conscious during this type of binge eating. These episodes happen frequently and are often accompanied with specific behaviors, such as:

  • Eating and drinking quickly
  • Eating unusual foods, like a stick of butter or unusual food combinations
  • Consuming toxic food, like uncooked meat

REM Sleep Behavior Disorder

People with REM sleep behavior disorder (RBD) have vivid dreams and act them out during REM sleep. People with REM sleep behavior disorder often exhibit certain behaviors, including grabbing, kicking, shouting, punching and jumping. This type of sleep disorder is different from nightmares because the person  usually does not wake up or remember the episodes.

More unusual types of sleep parasomnias include:

  • Sleep texting, where a person sends text messages during sleep
  • Exploding head syndrome, where a person imagines a loud or sudden noise right as they’re about to fall asleep
  • Sexsomnia, where a person acts out sexual behaviors while asleep
  • Sleep driving, a rare form of sleepwalking that causes a person to drive while sleeping
  • Sleep-related scratching, where a person scratches during sleep and often wakes up with scratching, bleeding or cuts
  • Sleep-related hallucinations, which are hallucinations that one sees, feels or hears either while waking up or falling asleep

Factors and Symptoms of Parasomnia

Depending on the type of parasomnia, symptoms can vary. Aside from unusual behavior, parasomnia can cause other behaviors, like:

  • Waking up wondering where you are
  • Waking up confused or disoriented
  • Not remembering doing certain activities
  • Finding unfamiliar cuts on the body
  • Daytime sleepiness or fatigue
  • Having difficulty sleeping through the night

In many cases, parasomnia can be associated with other triggers, such as:

Diagnosis and Testing for Parasomnia

In order to diagnose parasomnia, your primary care doctor can help make an initial diagnosis but will likely refer you to a sleep specialist to further examine your sleep behavior. Diagnosis usually includes a review of your medical history, sleep history or a sleep study.

Treatment for Parasomnia

Parasomnia treatment depends on the type and severity of the parasomnia. In the cases of frequent or recurring parasomnia, medication can help manage it. Some medications prescribed to help treat parasomnia include:

  • Antidepressants
  • Melatonin
  • Topriamate
  • Levodopa
  • Benzodiazepines

However, if your parasomnia is caused by medication, your doctor may recommend a different medication or dose.

People with parasomnia may also benefit from cognitive behavioral therapy. This type of therapy often helps with mental health concerns, like stress and anxiety. Other methods that can be used alongside cognitive behavioral therapy include psychotherapy, relaxation therapy and hypnosis.

There are also some treatment options people can try at home, such as:

  • Scheduling awakenings, where a parent wakes a child about 15 to 30 minutes before they spontaneously wake up. This can help minimize behaviors that follow a certain pattern, such as sleepwalking and night terrors
  • Creating a safer sleep environment, such as sleeping alone, removing dangerous items from the home, locking doors and windows, placing the mattress on the floor and sleeping with extra padding

Parasomnia episodes can vary from person to person, which is why it’s important to talk to your doctor to receive an individualized treatment plan. Our sleep medicine experts are here to help you get a safe and comfortable night’s sleep.

Parasomnias: Definition and Types

What Is Parasomnia?

Parasomnias are types of disturbing disorders that can happen just before you fall asleep, while you’re sleeping, or as you’re waking up.

Parasomnias include:

Nightmares

Nightmares are vivid dreams that can cause fear, terror, and anxiety. They might make you wake suddenly and have a hard time getting back to sleep. You’ll probably remember the episode in detail. Many things can cause nightmares, including illness, anxiety, the loss of a loved one, or reactions to a medication. Talk to your doctor if you have nightmares more than once a week or if they keep you from getting a good night’s sleep for a long time.

Night Terrors

Night terrors, also called sleep terrors, are similar to nightmares but usually happen during deep sleep. They cause you to wake suddenly, feeling terrified and confused. You can’t talk and won’t respond to voices. You might not seem fully awake.

Episodes of this parasomnia last about 15 minutes, and then you’ll probably fall back asleep. You usually won’t remember it the next morning.

People who have night terrors can be a danger to themselves or other people because of body movements that they can’t control. This parasomnia is fairly common in children, mostly between ages 3 and 8.

Adults can also have night terrors, and they may run in families. Strong emotional stress and alcohol use can make adults more likely to have them.

Sleepwalking

Sleepwalking is when you’re moving around and look awake but are actually asleep. You won’t remember it the next day. Sleepwalking is most common during a stage called deep non-rapid eye movement (non-REM) sleep early in the night. It can also happen during REM sleep in the early morning. This parasomnia mostly happens in children between ages 5 and 12. It tends to stop as children enter the teen years.

Sleepwalking tends to run in families. It’s not dangerous to wake a sleepwalker, but they might be confused when they wake up. Sleepwalking itself can be risky because the person isn’t aware of where they are and can fall or bump into things.

Confusional Arousals

Confusional arousals usually happen when you wake from a deep sleep during the first part of the night. This parasomnia, which is also known as excessive sleep inertia or sleep drunkenness, makes you very slow when you wake up. You react slowly to commands and may have trouble understanding when someone asks you a question. You probably won’t remember the event the next day.

Rhythmic Movement Disorder

Rhythmic movement disorder happens mostly in children under age 1, often just before they fall asleep. A child may lie flat, lift their head or upper body, and then forcefully hit their head on the pillow. This parasomnia, which doctors also call headbanging, can also involve movements such as rocking on hands and knees.

Sleep Talking

Sleep talking is a sleep-wake transition disorder. This parasomnia usually isn’t dangerous but can disturb bed partners or family members. Sleep talking can involve simple brief sounds or long speeches. The talker probably won’t remember doing it. Things like fever, emotional stress, or other sleep disorders can cause sleep talking.

Nocturnal Leg Cramps

Nocturnal leg cramps are sudden, uncontrolled muscle contractions during rest. They usually happen in your calves. The cramping feeling may last from a few seconds to 10 minutes, but the pain may linger.

Nocturnal leg camps often happen in middle-aged or older people, but anyone can have them. They’re different from restless legs syndrome, which usually doesn’t involve cramping or pain.

Sometimes, there’s no clear trigger for these cramps. Other times, they’re linked to sitting for a long time, dehydration, overworked muscles, or physical problems like flat feet.

Sleep Paralysis

When you have sleep paralysis, you can’t move while falling asleep or while waking up. The paralysis can be partial or total. Sleep paralysis can run in families, but experts aren’t sure what causes it.

This parasomnia isn’t dangerous. It can be scary if you don’t know what’s happening. A sound or touch might end the episode, making you able to move again within minutes. Some people have it only once, but others have it again and again.

Impaired Sleep-Related Erections

Men usually have erections as a part of REM sleep. This parasomnia happens in men who, while they sleep, can’t keep an erect penis that would be rigid enough for sex. Impaired sleep-related erections may mean you have erectile dysfunction.

Sleep-Related Painful Erections

Rarely, a man’s erections are painful enough that they wake up.

Irregular Heart Rhythms

Cardiac arrhythmia is the medical term for an uneven heartbeat. People who have coronary artery disease and who have lower blood oxygen because of sleep-related breathing problems may be more likely to have arrhythmias, which happen during REM sleep. Continuous positive airway pressure (CPAP) treatment may lower this risk.

REM Sleep Behavior Disorder (RBD)

REM sleep usually involves sleep paralysis, but people with this parasomnia act out dramatic or violent dreams during that sleep stage. RBD usually happens in men 50 and older. It’s different from sleepwalking and sleep terrors because a person who has RBD can be woken easily and can recall vivid details of their dream.

Sleep Bruxism (Teeth Grinding)

Bruxism is when you grind or clench your teeth severely while you sleep. It may happen along with other sleep disorders. This parasomnia can cause dental problems including unusual wear on your teeth or discomfort in your jaw muscles. Your dentist can probably give you a night guard to wear over your teeth while you sleep so they don’t grind against each other.

Sleep Enuresis (Bedwetting)

People who have this parasomnia can’t control their bladder while they sleep. It usually happens in children. There are two kinds of enuresis. In the primary form, the child has never had control of their bladder at night. It runs in families. In secondary enuresis, the person loses bladder control after previously having it. Medical conditions (for example, diabetes, urinary tract infections, and sleep apnea) or psychiatric disorders can cause enuresis.

Exploding Head Syndrome

People who have this parasomnia think they hear a loud noise, like a bang or an explosion, just before they fall asleep or wake up. Some may think they’re having a stroke. Getting more sleep can help prevent it.

Nocturnal Paroxysmal Dystonia (NPD)

This parasomnia might be a form of epilepsy. It can cause seizure-like episodes during non-REM sleep, sometimes several times a night.

Sleep-related eating disorder (SRED)

People who have this parasomnia eat while they’re asleep, often unusual foods like raw meat or cake mix. When they wake up, they remember only fragments or nothing at all. It happens because of a mixture of wakefulness and non-REM sleep.

The Treatment of Parasomnias with Hypnosis: a 5-Year Follow-Up Study

INTRODUCTION

Parasomnias are undesirable events or experiences that occur either during sleep or within close proximity to sleep.1 Many parasomnias clearly have organic etiologies. Among them are the neurodegenerative disorders associated with rapid eye movement (REM) sleep behavior disorder.2,3 Also, other organic sleep disorders such as nocturnal epilepsies and obstructive sleep apneas may mimic parasomnias.4,5 However, the pathogenesis of other parasomnias is more complex and includes contributing psychogenie factors.6

We speculated that it might be inappropriate to treat with hypnosis those parasomnias that were of primarily organic etiology, such as REM sleep behavior disorder. Similarly, we did not want to treat with hypnosis parasomnias that were caused directly by an acute trauma, such as a recent accident or rape, because, in those cases, psychotherapy would seem to be more appropriate. Rather, this study focuses on parasomnias that had become “functionally autonomous”7; that is, parasomnias that behaved like “bad habits” without there being any currently active organic or psychological cause.

Of interest, there is almost no empirical evidence for using traditional psychotherapy in parasomnias; e.g., for attempts to resolve the presumptive psychological conflicts that might underlie some of them. Rather, cognitive-behavioral therapies are usually advocated.8 Such cognitive-behavioral techniques include relaxation and desensitization,9,10 rescripting and rehearsing alternate contents for nightmares,11,12 eye movement desensitization,13,14 and training in lucid dreaming.15 However, with the exception of the study by Marquis,13 most studies documenting the cognitive-behavioral treatment of parasomnias involve either individual cases or small case series with very short follow-ups, and there are almost no replicated findings.

Hypnosis seems to be the technique that is best documented for the psychological treatment of certain parasomnias. Although case studies and small case series again provide the bulk of support for this treatment,16–18 some larger case series exist (Reid,19 12 cases; Hurwitz et al,20 27 cases), and there has been one attempt at a single-blind crossover design,21 all suggesting that hypnosis might have its place in the treatment of parasomnias.

The research reported here was carried out to replicate and extend the above-mentioned study by Hurwitz et al,20 on the use of hypnosis in sleepwalking and sleep terrors. In that study, 27 adults received 1 to 6 sessions of hypnotherapy and were then recontacted by telephone 6 to 63 months later. As many as 74% of the patients who were contacted reported much or very much improvement in their parasomnias.

METHODS

Subjects

The initial subject pool for this study was all 42 patients who had been referred for hypnotherapy between 1994 and 2000. These referrals had all been made by sleep specialists at the Mayo Sleep Disorders Center who had evaluated the patients prior to referral. Eighteen had been referred after 1 or 2 clinical interviews, 24 had undergone a polysomnogram (PSG) prior to their referral for hypnotherapy, often with an extended parasomnia montage. A preliminary report of this work was published in 2004.22 The study was approved by the Mayo Clinic Institutional Review Board on June 10, 1997.

To be included in the study, the patients’ parasomnias had to be judged treatable through hypnotherapy by the referring sleep clinician and had to have lasted for at least 1 year, with a minimum of at least 2 episodes per month. All patients included here were offered hypnotherapy by the sleep specialist; none had directly asked for this treatment.

Patients were excluded from the study if they showed:

  1. A high likelihood that the parasomnia was predominantly associated either with organic factors such as REM sleep behavior disorder or was due to other sleep disorders such as nocturnal epilepsy or obstructive sleep apnea. If such likelihood existed, the patient first underwent an extended PSG to rule out these considerations prior to referral for hypnotherapy. Of the 42 patients in the initial subject pool, 24 had undergone such a PSG. In 8 of them, in addition to the usual PSG, 16 additional electroencephalographic derivations were recorded all night and read by a neurologist to rule out a possible nocturnal seizure disorder. In 7 patients, an additional arm electromyographic derivation was added to the routine montage to rule out REM sleep behavior disorder. Nine patients had undergone a PSG specifically to rule out either obstructive sleep apnea or periodic limb movements of sleep. The PSGs in each of the 24 patients from this study were within normal limits in respect to electroencephalography, movements during REM sleep, respiration, or periodic limb movements of sleep. However, 1 patient was later excluded by this criterion when, about 2 years after admission to this study, he developed a partial complex seizure disorder, even though his nocturnal electroencephalogram had been normal at intake.

  2. Patients were also excluded if they showed evidence of a still ongoing psychopathologic process related to their parasomnia. For example, a patient with nightmares would be excluded if the nightmares had started after a rape, the psychological sequelae of which had not yet been adequately addressed, whereas a patient would be accepted if the nightmares had started after a rape for which the patient has received adequate counseling. Two patients were excluded by this criterion.

  3. To avoid complications stemming from the hypnotic treatment, patients were also excluded if they had psychological characteristics that would make them poor candidates for hypnosis, such as borderline personalities, dependent personalities, or psychotic disorders. Three patients were excluded by this criterion.

The final patient sample consisted of 36 patients (17 females) with a mean age of 32.7 years (range 6 to 71 years). Four of the patients were children aged 6, 8, 12, and 16. In 20 patients, the parasomnias had started before the age of 10. Mean duration of the parasomnia prior to hypnosis was 18.7 years, with a range from 1 year (the 6-year-old patient) to 68 years. The mean number of parasomnia episodes reported for the month prior to evaluation was 15.7; none had reported fewer than 4 episodes during that month.

The sample’s parasomnia diagnoses (made by the referring sleep consultant previous to referral for hypnosis) were: 11 sleep-walking, 10 nightmares, 6 sleep terrors, 4 epic dreaming, 2 sleep-related eating disorder, and 1 each with sleep-related groaning, sleep-related hallucinations, and severe sleep talking. Epic dreaming was defined as a patient’s perception of excessive dreaming all night long, often with continuous repetitive activation, usually associated with daytime fatigue.23

Following their treatment with hypnotherapy (see procedures), patients then received 3 one-page questionnaires concerning their parasomnias. These questionnaires were sent to them after 1 month, 18 months, and 5 years following the hypnosis treatment. However, some patients had moved without a forwarding address, and 1 refused further follow-up after the first one. Therefore, the questionnaires were sent to 36 patients for the 1-month follow-up, to 33 for the 18-month follow-up, and to 29 for the 5-year follow-up.

Procedures

The goal was to carry out the entire hypnotic treatment within 1 session lasting about 50 minutes. However, in 9 of the 36 study patients, a second hypnosis session was needed, either because the technical quality of the recorded tape was poor, or because the session was interrupted (e.g., by a fire alarm), or because the patient requested some different wording on the tape, or because patients felt that a second session would help with deepening their hypnotic state. Four patients requested and were granted a “refresher” session 6 to 12 months after the initial hypnosis session.

All hypnosis was performed by 1 of the authors (PJH) who is a clinical psychologist trained in hypnosis and a board-certified sleep specialist. At the beginning of the session, the patient’s folder was reviewed, questions concerning exclusion criteria were addressed, and the patient’s understanding of hypnosis was clarified. For purposes of this study, hypnosis was defined as a state of deep physical relaxation but with retention of an active and focused mind, so that possible new thoughts could be evaluated and incorporated into the hypnotized person’s thinking. The person was assured that everything that would happen during the hypnotic session would be remembered and that a tape would be made of the proceedings, to be given to the patient. To deal with fears of possibly not being hypnotizable, patients were asked to simply “go along” and “fake it” if they felt nothing was happening. Safety issues were addressed: 14 female patients asked that another person (usually a friend or spouse; on rare occasions, a sleep lab nurse) be present in the room during hypnosis. Finally, for purposes of the hypnotic induction, patients were asked during the interview to describe an outdoor place where they could imagine themselves lying down and relaxing while watching clouds in the sky.

Following these preliminaries (done in PJH’s office), we moved to a sleep center bedroom and the audio tape to record the proceedings was started. The patient was asked to lie comfortably on a bed, relax, and concentrate on a spot in the ceiling. Following eye closure by this classic induction procedure, patients were asked to imagine themselves walking slowly down a staircase, with continuing suggestions that each step would bring increased relaxation and comfort. Finally, patients were asked to imagine themselves in the previously described outdoor spot, watching the clouds go by. In a series of guided images, they then imagined a cloud coming down from the sky, enveloping them, and the patient then gradually dissolving into the cloud and floating through the sky as part of the cloud.

Treatment then consisted of patients imagining seeing themselves in a movie, depicting how they were experiencing a good, parasomnia-free night of sleep at home. That is, they would see themselves going to bed, close their eyes, enter first a light, then a deeper stage of sleep, then REM, etc., throughout the night. This was laced with suggestions that they were safe now and that the previously necessary parasomnias simply were no longer needed and could be abandoned. They were also told that if they ever found themselves starting their parasomnias during sleep, they could simply tell themselves “that it is no longer necessary.”

At the end of the session, patients were asked to fold their hands and were then told that these hands were now glued together so that they could not be separated. In an attempt to gauge the depth of their hypnosis, they were then challenged, first mildly, then more forcefully, to pull their hands apart. Eight of the 36 patients (22%) could easily separate their hands, i.e., clearly had not been hypnotized.

Patients were then aroused from their relaxation, debriefed, and asked to listen to the tape that had been recorded during their session. They were to do this at home, once per day for at least 2 weeks, at a time when they were unlikely to be disturbed. They were told to expect a gradual diminution, then a cessation, of their parasomnia. They were asked to call if they had questions, but only 2 patients ever did. A follow-up 30-minute session was scheduled 2 weeks after hypnotherapy to deal with possible questions, but patients were told they could cancel this follow-up if they did not feel the need for it. Of the 36 patients in this study, fully 21 patients canceled. Patients were also told that 1 month, 18 months, and 5 years after the hypnotherapy session they would be sent a 1-page questionnaire dealing with their progress and that their answers to this questionnaire were important for us to decide if we should continue offering this treatment.

Statistical Issues

No comparative statistics were used in this study because it did not employ a control group. The study simply aimed to describe what happened to the parasomnias over time after 1 or 2 hypnotic sessions.

There is some discussion among statisticians about what basis to use when evaluating questionnaire data. When using as a base only the number of questionnaires that were returned, the rate of improvement is likely to be overestimated because successful patients might be more willing to respond, but when basing the success rate on the number of all questionnaires sent out, the rate of improvement is likely to be underestimated because even some successful patients might not have returned the questionnaire. Therefore, Table 1 computes both of these improvement rates and then averages them for a best estimate of the “true” improvement rate.

Table 1 Analysis of the Questionnaire Responses

Response Rates 1Month 18Months 5Years
Questionnaires sent, no. 36 33 29
Responses received, no. 27 24 18
Patients responding, % 75.0% 72.7% 62.1%
Satisfaction with Study
Would you recommend this treatment to a friend with a similar problem? % yes 82.5 63.2 77.8
Improvement Rates
Spell-free for the last month, no. 9 5 6
Not spell-free but much improved, no. 5 7 3
Spell free or improved (based on the number of questionnaires sent out), % 38.9 36.4 31.0
Spell free or improved (based on the number of questionnaires returned), % 51.9 50.0 50.0
“Best statistical estimate” of improvement rate (see text), % 45.4 43.2 40.5
Improvement if hypnotized patients only are included (see text), % 55.5 54.0 44.7

RESULTS

Table 1 indicates that the questionnaire response rate in this study was 75% for the 1-month follow-up, 72.7% for the follow-up at 18 months, and still 62.2% for the follow-up 5 years later. These relatively high response rates may be due to the fact that, during their treatment hour, patients had been informed to expect these follow-ups and were told how important their responses would be for our decision whether or not to continue offering this treatment.

One way to measure patients’ satisfaction with their treatment is to ask if they would recommend this treatment to a friend who had a similar problem (Table 1). Although satisfaction dropped somewhat after 18 months (but recovered at the 5-year follow-up), it was always higher than the improvement rate that is reported later in Table 1. Some patients attached spontaneous responses to the questionnaire about this issue, stating that, although this treatment had not worked for them, they still felt it might be useful for others.

As Table 1 indicates, the initial treatment response to hypnosis (at the 1-month follow-up) showed that 9 patients were totally spell-free during that first month and that the overall beneficial response rate (at least “much improved”) was 45.4%. This beneficial response rate declined very little over the next 5 years. However, whereas the 1-month response rate is likely to be caused by hypnotherapy alone because there was little time for anything else to affect their parasomnias in these very chronic patients, the later response rates (18 months and 5 years) cannot necessarily be attributed to hypnotherapy alone. Over the course of those times, some might have recovered spontaneously, whereas others might have sought alternative treatments (e.g., drugs or other behavioral therapy), or their stress-inducing environments might have changed.

To shed some light on this latter issue, the time course of the 18 patients who had completed all 3 follow-ups were analyzed in Table 2. It appears that, of the 9 patients who initially responded successfully to hypnosis, 5 continued this response over the next 5 years, whereas 4 others showed an initially successful response but later relapsed. Of the 9 patients who showed no or minimal change in their parasomnia after 1 month following hypnotherapy, 3 patients later improved, but 6 never showed any improvements. Thus, the improvement at 5 years may be associated with the hypnotherapy in 5 of 18 (28%) of the patients.

Table 2 Tracking Individual Changes Over Time

Patients, no. (%) Changes over Time
5 (28) “No spells” or “much improved” throughout the study
4 (22) Initially “no spells” or “much improved” but little or no improvement on later follow-ups
3 (17) No improvement initially but improved on later follow-ups
6(33) Little or no improvement on any of the 3 follow-ups

In this study, all appropriate referrals were accepted for hypnotherapy regardless of whether they were hypnotizable. Eight patients (22% of the sample) turned out not to be hypnotized when tested at the end of the treatment. Success rates improved somewhat when eliminating these 8 patients from the analysis of the improvement rates and after going through the same statistical process as described earlier for the analysis of all patients (Table 1).

The numbers in this study are too small to answer decisively whether hypnotherapy is more appropriate for one or another form of a “functionally autonomous” parasomnia. Nevertheless, because no data at all exist on that point, a preliminary analysis of this issue is reported in Table 3. Because the numbers were so small, the 2 patients with sleep-related eating and the 3 patients with unique diagnoses were combined into the category of “Other” for Table 3. It would appear that, in the long run, nightmares responded best to hypnotherapy, whereas sleep terrors were treated less successfully in this way.

Table 3 Success Rates Within Parasomnia Subcategories

Category No.a Spell Free or Much Improvedb


Little or No Improvementc


After 18 months After 5 years After 18 months After 5 years
Sleepwalking 11 3/6 (50%) 2/3 (67%) 3/6 (50%) 1/3 (33%)
Nightmares 10 5/7 (71%) 4/6 (67%) 2/7 (29%) 2/6 (33%)
Sleep Terrors 6 1/5 (20%) 1/4 (25%) 4/5 (80%) 3/4 (75%)
Epic Dreaming 4 2/3 (67%) 1/3 (33%) 1/3 (33%) 2/3 (67%)
Others 5 1/3 (33%) 1/2 (50%) 2/3 (67%) 1/2 (50%)

DISCUSSION

The results indicate that 1 month after hypnotherapy, close to half of the study patients showed either no parasomnia events or at least rated themselves as much improved. It seems likely that this short-term effect is a direct consequence of the hypnotherapy, given the patients’ chronicity (mean duration of their parasomnia was 18.7 years), and given that 9 of the patients (one third of those who returned the questionnaire) were totally spell free. It seems unlikely that spontaneous recovery or changed life situations played a significant role during this short 1-month time period.

Improvement rates remained high after 18 months (42.2%) and after 5 years (40.5%). However, these improvement rates cannot be that easily ascribed to hypnotherapy alone because spontaneous recoveries and other treatments sought elsewhere now might have had some time to work. Only a randomized controlled study could assess how much of the later follow-up results can still be ascribed to the 1 or 2 sessions of hypnotherapy. Nevertheless, it does seem impressive that 5 (28%) of the 18 previously chronic patients in Table 2 still rated themselves as spell free or at least much improved at the 5-year follow-up.

Eight of the 36 patients in this study turned out not to be hypnotized when tested at the end of the hypnotherapy session. Improvement rates were higher when these patients were not included in the analysis (Table 2). However, it would not seem feasible for a referring sleep clinician to first have to test the hypnotizability of potential patients before referring them, especially because assessing hypnotizability would take at least 30 minutes, whereas the entire treatment took only about 1 hour. Rather, the clinician’s question when referring a patient concerns the likelihood that a patient who is selected by the criteria mentioned in the methods section improves with hypnotherapy.

Data are very preliminary, but our follow-up data would seem to indicate that nightmares were most successfully treated by hypnotherapy, whereas sleep terrors were somewhat less successfully managed. Because parasomnias of primarily organic etiology were excluded a priori, this study has nothing to say about whether hypnosis might also be a useful technique to treat the more organic parasomnias.

It is left for further research to evaluate whether manipulating some of the parameters in this study might have improved the efficacy of hypnotherapy. Specifically, one might consider adding more initial hypnotherapy sessions or adding some follow-up sessions later on, among other possibilities.

No case-series data with a 5-year follow-up are available for any of the other cognitive-behavioral treatments that might have been used instead of hypnotherapy in these cases. Therefore, no claims can be made that, in the long run, hypnotherapy is either more or less effective than the other approaches. However, it is a very short, time-efficient treatment, whereas many of the other cognitive-behavioral therapies require considerably more than 1 or 2 sessions.

In summary, given the brevity of the hypnotic treatment and its documented success in this and other studies, hypnotherapy would seem to be a treatment of first choice for patients with “functionally autonomous” (apparently self-perpetuating) parasomnias.

Disclosure Statement

This was not an industry supported study. Drs. Hauri, Silber, and Boeve have indicated no financial conflicts of interest.

REFERENCES

  • 1 ICSD-2 International Classification of Sleep Disorders: Diagnostic and coding manual20052nd ed.Westchester, IllAmerican Academy of Sleep Medicine

  • 2 Boeve B, Silber M, Parisi J, et al.Synucleinopathy pathology and REM sleep behavior disorder plus dementia or parkinsonismNeurology200361405, 12847154

  • 3 Schenck C, Mahowald MREM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEPSleep20022512038, 11902423

  • 4 Zucconi M, Ferrini-Stambi LNREM parasomnias: arousal disorders and differentiation from nocturnal frontal lobe epilepsyClin Neurophysiol2000111S12935, 10996566

  • 5 Mahowald MW, Schenck CH, Rowan AJ, Gates JRParasomnia purgatory: the epileptic/non-epileptic interfaceNon-epileptic Seizures1993BostonButterworth-Heinemann12339

  • 6 Lavie PSleep disturbances in the wake of traumatic eventsN Engl J Med2001345182532, 11752360

  • 7 Halliday GDirect psychological therapies for nightmares: a reviewClin Psych Review1987750123

  • 8 Coalson BNightmare help: treatment of trauma survivors with PTSDPsychotherapy1995323818

  • 9 Miller WR, DiPilato MTreatment of nightmares via relaxation and desensitization: a controlled evaluationJ Consult Clin Psychol1983518707, 6140275

  • 10 Cavior N, Deutsch AMSystematic desensitization to reduce dream-induced anxietyJ Nerv Ment Dis19751614335, 468

  • 11 Germain A, Nielson TAImpact of imagery rehearsal treatment on distressing dreams, psychological distress, and sleep parameters in nightmare patientsBehav Sleep Med2003114054, 15600218

  • 12 Krakow B, Sandoval D, Schrader R, et al.Treatment of chronic nightmares in adjudicated adolescent girls in a residential facilityJ Adolesc Health20012994100, 11472867

  • 13 Marquis JA report of seventy-eight cases treated by eye movement desensitizationJ Behav Ther Exp Psychiatry199122187192, 1687145

  • 14 Pellicier XEye movement desensitization treatment of a child’s nightmares: a case reportJ Behav Ther Exp Psychiatry1993247375

  • 15 Zadra AL, Pihl ROLucid dreaming as a treatment for recurrent nightmaresPsychother Psychosom1997665055

  • 16 Kingsbury SJBrief hypnotic treatment of repetitive nightmaresAm J Clin Hypn1993351619, 8434562

  • 17 Schenck CH, Mahowald MWTwo cases of pre-menstrual sleep terrors and injurious sleep-walkingJ Psychosom Obstet Gynaecol1995167984, 7640726

  • 18 Howsam DGHypnosis in the treatment of insomnia, nightmares, and night terrorsAustr Soc Hypnosis199927329

  • 19 Reid WHTreatment of somnambulism in military traineesAm J Psychother1975291016, 1147086

  • 20 Hurwitz TD, Mahowald MW, Schenck CH, Schluter JL, Bundlie SRA retrospective outcome study and review of hypnosis as treatment of adults with sleepwalking and sleep terrorJ Nerv Ment Dis199117922833, 2007894

  • 21 Reid WH, Ahmed I, Levie CATreatment of Sleepwalking: a controlled studyAm J Psychother1981352737, 7020438

  • 22 Hauri PJ, Silber MH, Boeve BFTreating parasomnias with hypnosisSleep200427A286

  • 23 Schenck CH, Mahowald MWA disorder of epic dreaming with daytime fatigue, usually without polysomnographic abnormalities, that predominantly affects womenSleep Res199524137

90,000 causes, symptoms, diagnosis and treatment

Parasomnias – heterogeneous paroxysmal states that occur during falling asleep, sleep, or shortly after awakening. These include nightmares and fears, nocturnal enuresis, drowsiness, somnambulism, sleep paralysis, sleep-related dissociative disorders and eating disorders, night groans, bruxism, and much more. The diagnosis of parasomnia is established by polysomnography with video monitoring.Additionally, a neuropsychological examination, an EEG with provocative tests, an MRI of the brain, and a psychiatrist’s consultation are carried out. In the treatment of parasomnia, psychotherapy, pharmacotherapy, psychological counseling, reflexology, “programmed awakening” are used.

General information

Previously, parasomnias were considered directly related to the content of dreams and attributed to the field of psychiatry. Recently, in connection with the isolation of sleep phases and certain advances in the study of their neurochemistry, the idea that such sleep disorders are the result of functional disorders of cerebral sleep regulation has become fundamental.Distinguish between the phase of rapid (FBS) and the phase of slow sleep (FMS) sleep. It is believed that parasomnia is based on the introduction of components from one phase of sleep into another. Sleep phase dependence is the basis for the classification of parasomnia, which has been used in clinical neurology since 2005. According to her, arousal disorders, parasomnias associated with FBS, and other parasomnias are distinguished.

In some cases, parasomnias do not disturb the patient’s social adaptation and do not require therapy. However, they often lead to the occurrence of insomnia or hypersomnia, and may be accompanied by dangerous behavior in relation to others and to oneself.In addition, parasomnias can be secondary in nature and are a symptom of various psychiatric, neurological and general somatic diseases.

Parasomnias

Arousal disorders

Night fears

Night fears are episodes of night screaming, accompanied by behavioral manifestations corresponding to strong fear. The peak incidence occurs in children at the age from 4 to 12 years, in adults – in the third decade of life. In children with epilepsy, it is observed 2 times more often than the average in the population.During a paroxysm, the person suddenly sits up in bed and screams. His eyes are open, but he is non-contact. Mydriasis, tachycardia, hyperhidrosis, tachypnea, muscle hypertonicity are noted.

The attack ends with a transition to sleep or waking up with some disorientation. His complete amnesia is characteristic. In some cases, an episode of nighttime fear is accompanied by aggressive behavior. Polysomnography shows the onset of paroxysms during delta sleep, EEG does not reveal epi-discharges. For people with this type of parasomnia, the presence of nonspecific slow bilaterally synchronous activity during the waking phase is typical.

Sleepwalking

Sleepwalking (sleepwalking, sleepwalking) is a parasomnia characterized by unconscious complex motor activity occurring in a dream. More often found at 4-12 years old, which is associated with immaturity of cerebral sleep regulation; in adults – episodically after strong shocks or positive global life events. During an attack of sleepwalking, patients can perform simple actions (feel their own clothes, rub their eyes) while sitting in bed, or get up, walk, paint, play the piano, go outside.At the same time, they have an “absent” appearance, are non-contact, are not aware of the danger and can harm others or themselves.

It is not always possible to wake up a person during sleepwalking, if it succeeds, then such awakening can provoke an attack of fear in him. Episodes of somnambulism occur during slow wave sleep. They can have a variable EEG pattern: bursts of delta activity, monotonous alpha rhythm, low-amplitude bilaterally synchronous theta rhythm.

Sleepy intoxication

Sleepy intoxication (awakening with confusion).This type of parasomnia is often associated with night fears, sleepwalking, and nocturnal enuresis; more common in children who sleep long and deeply. An increase in the sleep-wake transition time is typical. Confusion of consciousness upon awakening is manifested by lethargy, some temporal and spatial disorientation. An episode of such parasomnia proceeds with reduced motor activity, but may be accompanied by automatisms, aggressive and / or inappropriate behavior.

Duration of sleepy intoxication varies from 1-2 minutes to an hour.After some time, amnesia occurs for the events that occurred during the episode of parasomnia. Polysomnography determines the onset of paroxysms in the phase of slow sleep, EEG – a weakly expressed diffuse alpha rhythm or periodic delta activity.

Parasomnias associated with FBS

Sleep paralysis

Sleep paralysis is an episode of inability to perform voluntary movements lasting several minutes, while maintaining a normal respiratory excursion of the chest and oculomotor function.It occurs during the period of falling asleep or when waking up. Accompanied by feelings of anxiety or fear. Periodic attacks of this type of parasomnia were observed in about 5-6% of people, several family cases have been described. When conducting polysomnography, there are no specific changes. Parasomnias associated with FBS must be differentiated from narcolepsy, catalepsy, psychogenic paralysis, atonic seizures, hypokalemic paralysis, morning local paralysis due to compression of the peripheral nerve during sleep.

Nightmares

Nightmares are complex and long-lasting fabulous dreams of a threatening nature. Predominantly in children. May occur with alcoholism, barbituromania, methylphenidate or amphetamine abuse; when taking psychostimulants for medical purposes. The scary component of nightmares grows over time. As a rule, the emotional-affective reaction of fear is combined with some vegetative symptoms (hyperhidrosis, palpitations, feeling short of breath, etc.)).

Distinctive features of this type of parasomnia are: rapid restoration of complete clarity of consciousness upon awakening and distinct memories of the content of the nightmare. Polysomnography shows the onset of an attack during REM sleep, which makes it possible to differentiate nightmares from parasomnias in the form of night fears that occur during REM sleep.

Other disorders

Behavioral disorders associated with FBS are complex physical activity that occurs during REM sleep and is closely related to dreaming.More common in men. Motor phenomena range from simple (for example, moving with only one hand) to very complex motor acts, accompanied by dreaming or screaming; in some cases, they resemble sleepwalking. Approximately 60% of this type of parasomnia are idiopathic cases, which are observed mainly in people over 60 years of age.

Symptomatic (secondary) episodes of behavioral disturbances during FBS occur in dementia, chronic cerebral ischemia, subarachnoid hemorrhage, intracerebral tumors, olivoponto-cerebellar degeneration.

Other parasomnias

Sleepy enuresis

Sleepy enuresis – involuntary urination occurring during sleep. Parasomnia can be characterized by sporadic episodes of nocturnal enuresis in a week or by nightly involuntary urination. It occurs mainly in childhood, and with increasing age, the frequency of occurrence decreases. So, among 4-year-old children, bedwetting is observed in 30 children out of 100, and at the age of 12 – only in 3. This is associated with the gradual maturation of the regulatory mechanisms of both sleep and nocturnal urination.It was noted that the latter has other regulatory mechanisms than daytime urination, and is closely related to the regulation of sleep.

Polysomnography reveals the occurrence of sleepy enuresis during the transition from FMS to FBS, which is preceded by a high-amplitude delta wave discharge, accompanied by increased respiration and pulse rate, as well as motor activity during sleep. Secondary nocturnal enuresis usually develops several years after similar episodes of parasomnia in early childhood. It is a symptom of some urological diseases (cystitis, urethritis), sickle cell anemia, diabetes mellitus.

Eating Disorders

Sleep-Related Eating Disorders are repeated unconscious episodes of drinking water and eating that occur on awakening at night. 65-80% of cases are women. As a rule, parasomnias with eating disorders occur on the background of prolonged depression; are possible with encephalitis, hepatitis, during the period of smoking cessation, cessation of drug or alcohol use in the presence of addiction.

Usually episodes of parasomnia proceed in a state of incomplete awakening, partially or completely amnesic.During paroxysm, strange combinations of foods and even poisonous substances (for example, household chemicals) can be eaten, the patient can be injured with a knife and get burned. Such parasomnias can lead to anorexia, increased blood cholesterol, obesity, allergies and problems with the digestive tract (gastritis, peptic ulcer, acute pancreatitis).

Dissociative disorders

Dissociative disorders associated with sleep are emotional-behavioral psychogenic reactions that occur before going to sleep or immediately after the transition to wakefulness.They are recorded in victims of violence and represent a reconstruction of a case of violence. Accompanied by automatisms and confusion. Lasts from minutes to 1 hour. Usually they are completely amnesiac.

Night moans

Night moans are serial loud enough sounds made by the patient during sleep. The causes of this parasomnia have not yet been determined. The duration of a series can vary from 1 minute to an hour; there can be several such series per night. The peculiarity is the preservation of a calm expression on the face of the moaning person, the end of a series of moans with a “hum” or a sigh, and the absence of complaints of sleep disturbances.

Exploding Head Syndrome

Exploding Head Syndrome is a sensation of a loud, harsh noise, as described by patients, resembling an “explosion” or “loud bang” that “comes straight from the head”. Episodes of parasomnia occur before falling asleep or during nighttime awakenings. The reasons have not been established. It is known that similar paroxysms were observed in healthy people after severe stress or overwork.

Parasomnias also include bruxism, nocturnal cramps, sleep-related hallucinations, nocturnal paroxysmal dystonia, restless legs syndrome, paroxysmal nocturnal hemoglobinuria, etc.

Diagnosis of parasomnia

Diagnostic search for parasomnia is carried out jointly by a neurologist and a somnologist. It is aimed at both establishing a diagnosis and identifying the secondary nature of parasomnia and the underlying disease behind it. The latter is of paramount importance in adult patients, since it is in them in the vast majority of cases that parasomnia is secondary.

The main diagnostic method is polysomnography with video monitoring.Polysomnography allows you to identify the phases of sleep, analyze their course, identify a failure in the phase change. During the examination, data on the bioelectrical activity of the brain, the state of the cardiovascular and respiratory systems are recorded; night pulse oximetry and capnography are performed. Video surveillance allows you to track emotional-affective reactions and motor phenomena. In terms of the differential diagnosis of parasomnia with epilepsy, daytime EEG monitoring and EEG with provocative tests can be additionally carried out, according to the results of which an epileptologist’s consultation is appointed.

When diagnosing parasomnia in adults, to exclude cerebral organic pathology, CT or MRI of the brain, USDG of extracranial vessels and transcranial USDG are recommended. Assessment of the patient’s psycho-emotional characteristics is carried out through psychological testing, research of the personality structure, neuropsychological examination. If there is a suspicion of the occurrence of parasomnia against the background of a mental disorder, a psychiatrist consultation is prescribed.

Treatment of parasomnia

In cases where parasomnia does not negatively affect the patient’s daily life, it does not require treatment.In other cases, depending on the root cause and characteristics of parasomnia, the presence of an underlying disease, its therapy is carried out by a neurologist, psychologist, psychiatrist or their collegial efforts.

Creation of the correct “ritual” of falling asleep and observance of sleep hygiene is of no small importance. Children practice the so-called. “Programmed awakening” – 15-20 minutes before the time when an episode of parasomnia usually occurs, the child is woken up and then put back to bed. During nocturnal enuresis, patients are specifically awakened to go to the toilet.If the episodes of parasomnia are associated with active motor acts, then measures are taken to protect the patient during sleep. For example, they remove sharp and breakable objects from the room, close the windows.

Among the non-drug methods of treatment, the main ones are psychological counseling, cognitive-behavioral psychotherapy, psychoanalysis, psychoanalytic psychotherapy. Reflexotherapy, electrosleep, medicinal phyto baths with sedative preparations are used. In the pharmacotherapy of parasomnia, the leading place is given to drugs with a GABA-ergic effect, i.e.That is, potentiating the inhibitory effect of GABA in the central nervous system. These include benzodiazepines: clonazepam, lorazepam, diazepam, gidazepam, etc. According to indications, it is possible to use sedatives (valerian root, motherwort, peony tincture and combined phytopreparations), antidepressants (imipramine) and anxiolytics (meprobamate, benzoinactizine). In the complex therapy of parasomnia in children, nootropic drugs are used to accelerate the maturation of sleep regulation mechanisms.

90,000 causes, symptoms, diagnosis and treatment

Parasomnias – heterogeneous paroxysmal states that occur during falling asleep, sleep, or shortly after awakening.These include nightmares and fears, nocturnal enuresis, drowsiness, somnambulism, sleep paralysis, sleep-related dissociative disorders and eating disorders, night groans, bruxism, and much more. The diagnosis of parasomnia is established by polysomnography with video monitoring. Additionally, a neuropsychological examination, an EEG with provocative tests, an MRI of the brain, and a psychiatrist’s consultation are carried out. In the treatment of parasomnia, psychotherapy, pharmacotherapy, psychological counseling, reflexology, “programmed awakening” are used.

General information

Previously, parasomnias were considered directly related to the content of dreams and attributed to the field of psychiatry. Recently, in connection with the isolation of sleep phases and certain advances in the study of their neurochemistry, the idea that such sleep disorders are the result of functional disorders of cerebral sleep regulation has become fundamental. Distinguish between the phase of rapid (FBS) and the phase of slow sleep (FMS) sleep. It is believed that parasomnia is based on the introduction of components from one phase of sleep into another.Sleep phase dependence is the basis for the classification of parasomnia, which has been used in clinical neurology since 2005. According to her, arousal disorders, parasomnias associated with FBS, and other parasomnias are distinguished.

In some cases, parasomnias do not disturb the patient’s social adaptation and do not require therapy. However, they often lead to the occurrence of insomnia or hypersomnia, and may be accompanied by dangerous behavior in relation to others and to oneself. In addition, parasomnias can be secondary in nature and are a symptom of various psychiatric, neurological and general somatic diseases.

Parasomnias

Arousal disorders

Night fears

Night fears are episodes of night screaming, accompanied by behavioral manifestations corresponding to strong fear. The peak incidence occurs in children at the age from 4 to 12 years, in adults – in the third decade of life. In children with epilepsy, it is observed 2 times more often than the average in the population. During a paroxysm, the person suddenly sits up in bed and screams. His eyes are open, but he is non-contact.Mydriasis, tachycardia, hyperhidrosis, tachypnea, muscle hypertonicity are noted.

The attack ends with a transition to sleep or waking up with some disorientation. His complete amnesia is characteristic. In some cases, an episode of nighttime fear is accompanied by aggressive behavior. Polysomnography shows the onset of paroxysms during delta sleep, EEG does not reveal epi-discharges. For people with this type of parasomnia, the presence of nonspecific slow bilaterally synchronous activity during the waking phase is typical.

Sleepwalking

Sleepwalking (sleepwalking, sleepwalking) is a parasomnia characterized by unconscious complex motor activity occurring in a dream. More often found at 4-12 years old, which is associated with immaturity of cerebral sleep regulation; in adults – episodically after strong shocks or positive global life events. During an attack of sleepwalking, patients can perform simple actions (feel their own clothes, rub their eyes) while sitting in bed, or get up, walk, paint, play the piano, go outside.At the same time, they have an “absent” appearance, are non-contact, are not aware of the danger and can harm others or themselves.

It is not always possible to wake up a person during sleepwalking, if it succeeds, then such awakening can provoke an attack of fear in him. Episodes of somnambulism occur during slow wave sleep. They can have a variable EEG pattern: bursts of delta activity, monotonous alpha rhythm, low-amplitude bilaterally synchronous theta rhythm.

Sleepy intoxication

Sleepy intoxication (awakening with confusion).This type of parasomnia is often associated with night fears, sleepwalking, and nocturnal enuresis; more common in children who sleep long and deeply. An increase in the sleep-wake transition time is typical. Confusion of consciousness upon awakening is manifested by lethargy, some temporal and spatial disorientation. An episode of such parasomnia proceeds with reduced motor activity, but may be accompanied by automatisms, aggressive and / or inappropriate behavior.

Duration of sleepy intoxication varies from 1-2 minutes to an hour.After some time, amnesia occurs for the events that occurred during the episode of parasomnia. Polysomnography determines the onset of paroxysms in the phase of slow sleep, EEG – a weakly expressed diffuse alpha rhythm or periodic delta activity.

Parasomnias associated with FBS

Sleep paralysis

Sleep paralysis is an episode of inability to perform voluntary movements lasting several minutes, while maintaining a normal respiratory excursion of the chest and oculomotor function.It occurs during the period of falling asleep or when waking up. Accompanied by feelings of anxiety or fear. Periodic attacks of this type of parasomnia were observed in about 5-6% of people, several family cases have been described. When conducting polysomnography, there are no specific changes. Parasomnias associated with FBS must be differentiated from narcolepsy, catalepsy, psychogenic paralysis, atonic seizures, hypokalemic paralysis, morning local paralysis due to compression of the peripheral nerve during sleep.

Nightmares

Nightmares are complex and long-lasting fabulous dreams of a threatening nature. Predominantly in children. May occur with alcoholism, barbituromania, methylphenidate or amphetamine abuse; when taking psychostimulants for medical purposes. The scary component of nightmares grows over time. As a rule, the emotional-affective reaction of fear is combined with some vegetative symptoms (hyperhidrosis, palpitations, feeling short of breath, etc.)).

Distinctive features of this type of parasomnia are: rapid restoration of complete clarity of consciousness upon awakening and distinct memories of the content of the nightmare. Polysomnography shows the onset of an attack during REM sleep, which makes it possible to differentiate nightmares from parasomnias in the form of night fears that occur during REM sleep.

Other disorders

Behavioral disorders associated with FBS are complex physical activity that occurs during REM sleep and is closely related to dreaming.More common in men. Motor phenomena range from simple (for example, moving with only one hand) to very complex motor acts, accompanied by dreaming or screaming; in some cases, they resemble sleepwalking. Approximately 60% of this type of parasomnia are idiopathic cases, which are observed mainly in people over 60 years of age.

Symptomatic (secondary) episodes of behavioral disturbances during FBS occur in dementia, chronic cerebral ischemia, subarachnoid hemorrhage, intracerebral tumors, olivoponto-cerebellar degeneration.

Other parasomnias

Sleepy enuresis

Sleepy enuresis – involuntary urination occurring during sleep. Parasomnia can be characterized by sporadic episodes of nocturnal enuresis in a week or by nightly involuntary urination. It occurs mainly in childhood, and with increasing age, the frequency of occurrence decreases. So, among 4-year-old children, bedwetting is observed in 30 children out of 100, and at the age of 12 – only in 3. This is associated with the gradual maturation of the regulatory mechanisms of both sleep and nocturnal urination.It was noted that the latter has other regulatory mechanisms than daytime urination, and is closely related to the regulation of sleep.

Polysomnography reveals the occurrence of sleepy enuresis during the transition from FMS to FBS, which is preceded by a high-amplitude delta wave discharge, accompanied by increased respiration and pulse rate, as well as motor activity during sleep. Secondary nocturnal enuresis usually develops several years after similar episodes of parasomnia in early childhood. It is a symptom of some urological diseases (cystitis, urethritis), sickle cell anemia, diabetes mellitus.

Eating Disorders

Sleep-Related Eating Disorders are repeated unconscious episodes of drinking water and eating that occur on awakening at night. 65-80% of cases are women. As a rule, parasomnias with eating disorders occur on the background of prolonged depression; are possible with encephalitis, hepatitis, during the period of smoking cessation, cessation of drug or alcohol use in the presence of addiction.

Usually episodes of parasomnia proceed in a state of incomplete awakening, partially or completely amnesic.During paroxysm, strange combinations of foods and even poisonous substances (for example, household chemicals) can be eaten, the patient can be injured with a knife and get burned. Such parasomnias can lead to anorexia, increased blood cholesterol, obesity, allergies and problems with the digestive tract (gastritis, peptic ulcer, acute pancreatitis).

Dissociative disorders

Dissociative disorders associated with sleep are emotional-behavioral psychogenic reactions that occur before going to sleep or immediately after the transition to wakefulness.They are recorded in victims of violence and represent a reconstruction of a case of violence. Accompanied by automatisms and confusion. Lasts from minutes to 1 hour. Usually they are completely amnesiac.

Night moans

Night moans are serial loud enough sounds made by the patient during sleep. The causes of this parasomnia have not yet been determined. The duration of a series can vary from 1 minute to an hour; there can be several such series per night. The peculiarity is the preservation of a calm expression on the face of the moaning person, the end of a series of moans with a “hum” or a sigh, and the absence of complaints of sleep disturbances.

Exploding Head Syndrome

Exploding Head Syndrome is a sensation of a loud, harsh noise, as described by patients, resembling an “explosion” or “loud bang” that “comes straight from the head”. Episodes of parasomnia occur before falling asleep or during nighttime awakenings. The reasons have not been established. It is known that similar paroxysms were observed in healthy people after severe stress or overwork.

Parasomnias also include bruxism, nocturnal cramps, sleep-related hallucinations, nocturnal paroxysmal dystonia, restless legs syndrome, paroxysmal nocturnal hemoglobinuria, etc.

Diagnosis of parasomnia

Diagnostic search for parasomnia is carried out jointly by a neurologist and a somnologist. It is aimed at both establishing a diagnosis and identifying the secondary nature of parasomnia and the underlying disease behind it. The latter is of paramount importance in adult patients, since it is in them in the vast majority of cases that parasomnia is secondary.

The main diagnostic method is polysomnography with video monitoring.Polysomnography allows you to identify the phases of sleep, analyze their course, identify a failure in the phase change. During the examination, data on the bioelectrical activity of the brain, the state of the cardiovascular and respiratory systems are recorded; night pulse oximetry and capnography are performed. Video surveillance allows you to track emotional-affective reactions and motor phenomena. In terms of the differential diagnosis of parasomnia with epilepsy, daytime EEG monitoring and EEG with provocative tests can be additionally carried out, according to the results of which an epileptologist’s consultation is appointed.

When diagnosing parasomnia in adults, to exclude cerebral organic pathology, CT or MRI of the brain, USDG of extracranial vessels and transcranial USDG are recommended. Assessment of the patient’s psycho-emotional characteristics is carried out through psychological testing, research of the personality structure, neuropsychological examination. If there is a suspicion of the occurrence of parasomnia against the background of a mental disorder, a psychiatrist consultation is prescribed.

Treatment of parasomnia

In cases where parasomnia does not negatively affect the patient’s daily life, it does not require treatment.In other cases, depending on the root cause and characteristics of parasomnia, the presence of an underlying disease, its therapy is carried out by a neurologist, psychologist, psychiatrist or their collegial efforts.

Creation of the correct “ritual” of falling asleep and observance of sleep hygiene is of no small importance. Children practice the so-called. “Programmed awakening” – 15-20 minutes before the time when an episode of parasomnia usually occurs, the child is woken up and then put back to bed. During nocturnal enuresis, patients are specifically awakened to go to the toilet.If the episodes of parasomnia are associated with active motor acts, then measures are taken to protect the patient during sleep. For example, they remove sharp and breakable objects from the room, close the windows.

Among the non-drug methods of treatment, the main ones are psychological counseling, cognitive-behavioral psychotherapy, psychoanalysis, psychoanalytic psychotherapy. Reflexotherapy, electrosleep, medicinal phyto baths with sedative preparations are used. In the pharmacotherapy of parasomnia, the leading place is given to drugs with a GABA-ergic effect, i.e.That is, potentiating the inhibitory effect of GABA in the central nervous system. These include benzodiazepines: clonazepam, lorazepam, diazepam, gidazepam, etc. According to indications, it is possible to use sedatives (valerian root, motherwort, peony tincture and combined phytopreparations), antidepressants (imipramine) and anxiolytics (meprobamate, benzoinactizine). In the complex therapy of parasomnia in children, nootropic drugs are used to accelerate the maturation of sleep regulation mechanisms.

90,000 causes, symptoms, diagnosis and treatment

Parasomnias – heterogeneous paroxysmal states that occur during falling asleep, sleep, or shortly after awakening.These include nightmares and fears, nocturnal enuresis, drowsiness, somnambulism, sleep paralysis, sleep-related dissociative disorders and eating disorders, night groans, bruxism, and much more. The diagnosis of parasomnia is established by polysomnography with video monitoring. Additionally, a neuropsychological examination, an EEG with provocative tests, an MRI of the brain, and a psychiatrist’s consultation are carried out. In the treatment of parasomnia, psychotherapy, pharmacotherapy, psychological counseling, reflexology, “programmed awakening” are used.

General information

Previously, parasomnias were considered directly related to the content of dreams and attributed to the field of psychiatry. Recently, in connection with the isolation of sleep phases and certain advances in the study of their neurochemistry, the idea that such sleep disorders are the result of functional disorders of cerebral sleep regulation has become fundamental. Distinguish between the phase of rapid (FBS) and the phase of slow sleep (FMS) sleep. It is believed that parasomnia is based on the introduction of components from one phase of sleep into another.Sleep phase dependence is the basis for the classification of parasomnia, which has been used in clinical neurology since 2005. According to her, arousal disorders, parasomnias associated with FBS, and other parasomnias are distinguished.

In some cases, parasomnias do not disturb the patient’s social adaptation and do not require therapy. However, they often lead to the occurrence of insomnia or hypersomnia, and may be accompanied by dangerous behavior in relation to others and to oneself. In addition, parasomnias can be secondary in nature and are a symptom of various psychiatric, neurological and general somatic diseases.

Parasomnias

Arousal disorders

Night fears

Night fears are episodes of night screaming, accompanied by behavioral manifestations corresponding to strong fear. The peak incidence occurs in children at the age from 4 to 12 years, in adults – in the third decade of life. In children with epilepsy, it is observed 2 times more often than the average in the population. During a paroxysm, the person suddenly sits up in bed and screams. His eyes are open, but he is non-contact.Mydriasis, tachycardia, hyperhidrosis, tachypnea, muscle hypertonicity are noted.

The attack ends with a transition to sleep or waking up with some disorientation. His complete amnesia is characteristic. In some cases, an episode of nighttime fear is accompanied by aggressive behavior. Polysomnography shows the onset of paroxysms during delta sleep, EEG does not reveal epi-discharges. For people with this type of parasomnia, the presence of nonspecific slow bilaterally synchronous activity during the waking phase is typical.

Sleepwalking

Sleepwalking (sleepwalking, sleepwalking) is a parasomnia characterized by unconscious complex motor activity occurring in a dream. More often found at 4-12 years old, which is associated with immaturity of cerebral sleep regulation; in adults – episodically after strong shocks or positive global life events. During an attack of sleepwalking, patients can perform simple actions (feel their own clothes, rub their eyes) while sitting in bed, or get up, walk, paint, play the piano, go outside.At the same time, they have an “absent” appearance, are non-contact, are not aware of the danger and can harm others or themselves.

It is not always possible to wake up a person during sleepwalking, if it succeeds, then such awakening can provoke an attack of fear in him. Episodes of somnambulism occur during slow wave sleep. They can have a variable EEG pattern: bursts of delta activity, monotonous alpha rhythm, low-amplitude bilaterally synchronous theta rhythm.

Sleepy intoxication

Sleepy intoxication (awakening with confusion).This type of parasomnia is often associated with night fears, sleepwalking, and nocturnal enuresis; more common in children who sleep long and deeply. An increase in the sleep-wake transition time is typical. Confusion of consciousness upon awakening is manifested by lethargy, some temporal and spatial disorientation. An episode of such parasomnia proceeds with reduced motor activity, but may be accompanied by automatisms, aggressive and / or inappropriate behavior.

Duration of sleepy intoxication varies from 1-2 minutes to an hour.After some time, amnesia occurs for the events that occurred during the episode of parasomnia. Polysomnography determines the onset of paroxysms in the phase of slow sleep, EEG – a weakly expressed diffuse alpha rhythm or periodic delta activity.

Parasomnias associated with FBS

Sleep paralysis

Sleep paralysis is an episode of inability to perform voluntary movements lasting several minutes, while maintaining a normal respiratory excursion of the chest and oculomotor function.It occurs during the period of falling asleep or when waking up. Accompanied by feelings of anxiety or fear. Periodic attacks of this type of parasomnia were observed in about 5-6% of people, several family cases have been described. When conducting polysomnography, there are no specific changes. Parasomnias associated with FBS must be differentiated from narcolepsy, catalepsy, psychogenic paralysis, atonic seizures, hypokalemic paralysis, morning local paralysis due to compression of the peripheral nerve during sleep.

Nightmares

Nightmares are complex and long-lasting fabulous dreams of a threatening nature. Predominantly in children. May occur with alcoholism, barbituromania, methylphenidate or amphetamine abuse; when taking psychostimulants for medical purposes. The scary component of nightmares grows over time. As a rule, the emotional-affective reaction of fear is combined with some vegetative symptoms (hyperhidrosis, palpitations, feeling short of breath, etc.)).

Distinctive features of this type of parasomnia are: rapid restoration of complete clarity of consciousness upon awakening and distinct memories of the content of the nightmare. Polysomnography shows the onset of an attack during REM sleep, which makes it possible to differentiate nightmares from parasomnias in the form of night fears that occur during REM sleep.

Other disorders

Behavioral disorders associated with FBS are complex physical activity that occurs during REM sleep and is closely related to dreaming.More common in men. Motor phenomena range from simple (for example, moving with only one hand) to very complex motor acts, accompanied by dreaming or screaming; in some cases, they resemble sleepwalking. Approximately 60% of this type of parasomnia are idiopathic cases, which are observed mainly in people over 60 years of age.

Symptomatic (secondary) episodes of behavioral disturbances during FBS occur in dementia, chronic cerebral ischemia, subarachnoid hemorrhage, intracerebral tumors, olivoponto-cerebellar degeneration.

Other parasomnias

Sleepy enuresis

Sleepy enuresis – involuntary urination occurring during sleep. Parasomnia can be characterized by sporadic episodes of nocturnal enuresis in a week or by nightly involuntary urination. It occurs mainly in childhood, and with increasing age, the frequency of occurrence decreases. So, among 4-year-old children, bedwetting is observed in 30 children out of 100, and at the age of 12 – only in 3. This is associated with the gradual maturation of the regulatory mechanisms of both sleep and nocturnal urination.It was noted that the latter has other regulatory mechanisms than daytime urination, and is closely related to the regulation of sleep.

Polysomnography reveals the occurrence of sleepy enuresis during the transition from FMS to FBS, which is preceded by a high-amplitude delta wave discharge, accompanied by increased respiration and pulse rate, as well as motor activity during sleep. Secondary nocturnal enuresis usually develops several years after similar episodes of parasomnia in early childhood. It is a symptom of some urological diseases (cystitis, urethritis), sickle cell anemia, diabetes mellitus.

Eating Disorders

Sleep-Related Eating Disorders are repeated unconscious episodes of drinking water and eating that occur on awakening at night. 65-80% of cases are women. As a rule, parasomnias with eating disorders occur on the background of prolonged depression; are possible with encephalitis, hepatitis, during the period of smoking cessation, cessation of drug or alcohol use in the presence of addiction.

Usually episodes of parasomnia proceed in a state of incomplete awakening, partially or completely amnesic.During paroxysm, strange combinations of foods and even poisonous substances (for example, household chemicals) can be eaten, the patient can be injured with a knife and get burned. Such parasomnias can lead to anorexia, increased blood cholesterol, obesity, allergies and problems with the digestive tract (gastritis, peptic ulcer, acute pancreatitis).

Dissociative disorders

Dissociative disorders associated with sleep are emotional-behavioral psychogenic reactions that occur before going to sleep or immediately after the transition to wakefulness.They are recorded in victims of violence and represent a reconstruction of a case of violence. Accompanied by automatisms and confusion. Lasts from minutes to 1 hour. Usually they are completely amnesiac.

Night moans

Night moans are serial loud enough sounds made by the patient during sleep. The causes of this parasomnia have not yet been determined. The duration of a series can vary from 1 minute to an hour; there can be several such series per night. The peculiarity is the preservation of a calm expression on the face of the moaning person, the end of a series of moans with a “hum” or a sigh, and the absence of complaints of sleep disturbances.

Exploding Head Syndrome

Exploding Head Syndrome is a sensation of a loud, harsh noise, as described by patients, resembling an “explosion” or “loud bang” that “comes straight from the head”. Episodes of parasomnia occur before falling asleep or during nighttime awakenings. The reasons have not been established. It is known that similar paroxysms were observed in healthy people after severe stress or overwork.

Parasomnias also include bruxism, nocturnal cramps, sleep-related hallucinations, nocturnal paroxysmal dystonia, restless legs syndrome, paroxysmal nocturnal hemoglobinuria, etc.

Diagnosis of parasomnia

Diagnostic search for parasomnia is carried out jointly by a neurologist and a somnologist. It is aimed at both establishing a diagnosis and identifying the secondary nature of parasomnia and the underlying disease behind it. The latter is of paramount importance in adult patients, since it is in them in the vast majority of cases that parasomnia is secondary.

The main diagnostic method is polysomnography with video monitoring.Polysomnography allows you to identify the phases of sleep, analyze their course, identify a failure in the phase change. During the examination, data on the bioelectrical activity of the brain, the state of the cardiovascular and respiratory systems are recorded; night pulse oximetry and capnography are performed. Video surveillance allows you to track emotional-affective reactions and motor phenomena. In terms of the differential diagnosis of parasomnia with epilepsy, daytime EEG monitoring and EEG with provocative tests can be additionally carried out, according to the results of which an epileptologist’s consultation is appointed.

When diagnosing parasomnia in adults, to exclude cerebral organic pathology, CT or MRI of the brain, USDG of extracranial vessels and transcranial USDG are recommended. Assessment of the patient’s psycho-emotional characteristics is carried out through psychological testing, research of the personality structure, neuropsychological examination. If there is a suspicion of the occurrence of parasomnia against the background of a mental disorder, a psychiatrist consultation is prescribed.

Treatment of parasomnia

In cases where parasomnia does not negatively affect the patient’s daily life, it does not require treatment.In other cases, depending on the root cause and characteristics of parasomnia, the presence of an underlying disease, its therapy is carried out by a neurologist, psychologist, psychiatrist or their collegial efforts.

Creation of the correct “ritual” of falling asleep and observance of sleep hygiene is of no small importance. Children practice the so-called. “Programmed awakening” – 15-20 minutes before the time when an episode of parasomnia usually occurs, the child is woken up and then put back to bed. During nocturnal enuresis, patients are specifically awakened to go to the toilet.If the episodes of parasomnia are associated with active motor acts, then measures are taken to protect the patient during sleep. For example, they remove sharp and breakable objects from the room, close the windows.

Among the non-drug methods of treatment, the main ones are psychological counseling, cognitive-behavioral psychotherapy, psychoanalysis, psychoanalytic psychotherapy. Reflexotherapy, electrosleep, medicinal phyto baths with sedative preparations are used. In the pharmacotherapy of parasomnia, the leading place is given to drugs with a GABA-ergic effect, i.e.That is, potentiating the inhibitory effect of GABA in the central nervous system. These include benzodiazepines: clonazepam, lorazepam, diazepam, gidazepam, etc. According to indications, it is possible to use sedatives (valerian root, motherwort, peony tincture and combined phytopreparations), antidepressants (imipramine) and anxiolytics (meprobamate, benzoinactizine). In the complex therapy of parasomnia in children, nootropic drugs are used to accelerate the maturation of sleep regulation mechanisms.

doctor’s appointment – DokDok St. Petersburg

Neurologists of St. Petersburg – latest reviews

The reception went well.Natalya Igorevna gave me recommendations and prescribed medications. I think her recommendations are effective. She is a very attentive doctor. I am very grateful to her for the attention that was given to me at the reception.

Alexey,

October 14, 2021

A very pleasant doctor, professional, polite, kind, inspiring confidence.Sergei Alexandrovich explained everything clearly. It was just a consultation, but I already prescribed medications, suggested where to get an MRI scan, and buy everything you need. I liked the welcome, I will go a little later. I recommend this specialist.

Elizabeth,

07 October 2021

I liked everything.Competent, good doctor. Yulia Anatolyevna at the reception conducted an examination and prescribed me medicines. We talked about 40 minutes in time. If necessary, I will apply again, again. Because she is the only specialist who has given me so much time. And she helped solve my question.

Irina,

September 29, 2021

My mother was the patient at the appointment.Everything was very tactful and logical. First, the doctor listened fully to our problems, looked at the medical record and analyzes. I understood what’s what. He examined and gave recommendations not only from his side, but also from the side of a cardiologist, gastroenterologist. Competently explained all the information. We will now follow all the steps outlined. Alexander Alekseevich is very pleasant, attentive and benevolent. Even when his mother interrupted him and asked questions, the doctor patiently listened to everything and answered everything, clung to every little thing to understand the whole picture.

Tatiana,

August 19, 2021

The doctor examined me, made a diagnosis, and additional manipulations had to be paid separately.As a cunning person, but he was attentive, perhaps as a good specialist, but what hurts me, I myself knew, did not like the approach. I do not recommend the clinic.

Andrey,

04 August 2021

The doctor tested, prescribed an MRI scan, answered questions and repeated my appointment.Tatyana Sergeevna disposes to herself. A pleasant, kind and sociable doctor. In the clinic, it is difficult for sick people to climb to the second floor.

Victor,

July 14, 2021

An attentive and polite doctor.She asked about my complaints and made the necessary manipulations. The doctor also diagnosed me and wrote a prescription. Another specialist advised me to contact a special center.

Mark,

May 16, 2021

The doctor is very friendly, helpful, understanding and correct.The patient has a severe complication. The doctor said she had cerebral edema and told her to go to a more specialized hospital. We are grateful to Tatyana Evgenievna for your understanding!

Anonymous,

07 December 2020

Everything is good

Moderation,

October 17, 2021

Polite, attentive doctor.Olga Arievna listened to my complaints, carried out an examination and gave a referral for the necessary examination. The reception lasted 30 minutes. I was pleased with the reception.

Moderation,

October 17, 2021

Show 10 reviews of 3026 90 000 Where to go for parasomnia in Nizhny Novgorod on DocDoc.ru

Neurologists of Nizhny Novgorod – latest reviews

Neurologist Elena Nikolaevna, a polite, attentive specialist. At the reception, the doctor told me everything after the fact. Nice welcome. If necessary, I will recommend it to my friends.

Anastasia,

04 August 2021

The reception went well, I liked everything.The doctor examined me thoroughly, sent me to do an X-ray, prescribed the necessary treatment. In general, I was given enough time to resolve my question. Liliana Vladimirovna is polite.

Moderation,

October 18, 2021

A good doctor.Prescribed the correct treatment. She listened to our complaints, conducted an examination, gave excellent recommendations. The most important thing is that it contributed to the recovery of the child. Polite and competent specialist. She communicated wonderfully with the child. I was completely satisfied with the reception.

Moderation,

October 15, 2021

The doctor is competent, attentive.Everything went well. I was given a reception. As a result, she received recommendations for treatment. Marina Nikolaevna devoted enough time to my problem. Would apply again if necessary.

Angelica,

October 11, 2021

We turned to a specialist with our daughter.At the reception, the doctor listened carefully to the problem, conducted an examination and prescribed a course of treatment, which is already helping. This month we are planning to come to her for a second appointment. The doctor is attentive, explains everything clearly and easily. I can recommend this specialist to my friends, if necessary, and if necessary, we can apply again. We were satisfied with the quality of the reception.

Maria,

07 October 2021

The doctor is young, did everything competently, attentive, excellent.Skvortsova Veronika Olegovna answered all my questions. I not only had headaches, but also a pinched nerve in my legs. She listened to me, made a complete diagnosis, wrote out appointments, analyzes. I am satisfied, I think that it is absolutely correct. Considered all the problems associated with neurology.

Tatiana,

September 29, 2021

A professional and empathic doctor who can make accurate diagnoses very quickly.She listened to me, gave recommendations and carried out diagnostics. I am 5+ satisfied. If necessary, I would refer to her again.

Leonid,

September 24, 2021

I liked everything.The doctor is calm, friendly and professional in his field. Liliana Vladimirovna examined me completely. The doctor prescribed treatment for me. I will go again after the treatment, as the specialist said to come to see the effect.

Natalia,

September 24, 2021

I liked everything.At the reception, I asked specific questions, Marina Nikolaevna answered clearly. As a result, I received a certificate for the kindergarten that it is really possible to visit the kindergarten. For this I went. I will not apply again, I am being observed by another specialist.

Catherine,

September 21, 2021

I liked the appointment, I am satisfied with the doctor.At the reception, Alexander Vasilyevich conducted an examination, a survey. The doctor was attentive to the child, explained everything clearly. As a result, the doctor prescribed treatment. If necessary, I will apply again. I would recommend a specialist to my friends.

Edward,

September 17, 2021

Show 10 reviews of 438 90,000 Sleep disorders.Patient Information Material

Ravijuhendite nõukoja poolt kinnitatud 28.05.2019.

Good sleep is very important for our daily well-being, performance, mood and well-being. Most people experience short-term sleep disturbances during their lives, for example due to stress or grief. Short-term insomnia is the most common sleep problem in people of all ages. However, sleep disturbances can last for a long time, interfering with both daily activities and general health.A person with a sleep disorder himself may not be aware of the fact that he has it. If you suspect sleep disturbance, you should first visit your family doctor. The family doctor will conduct additional examinations and prescribe primary treatment. If necessary, he will write a referral to a sleep specialist. Smart device sleep and wake time monitoring applications do not replace healthcare professional recommended sleep diaries or as-needed sleep tests.Sleep diary is a scientifically based tool for assessing sleep patterns, lifestyle choices and potential sleep disturbances . Sleep disorders are divided into six groups, which are diagnosed and treated in different ways. Below are descriptions of the most common forms of sleep disorders.

Insomnia refers to both difficulty falling asleep, interrupted sleep, and early awakening. Insomnia is considered a natural reaction of the human body to any adaptation or stress and can accompany many other diseases.In some people, insomnia continues for a longer period of time, becoming a chronic illness in its own right. To treat long-term insomnia, it is important to maintain proper sleep patterns. For this, psychological methods of treatment are used and, if necessary, the use of sleeping pills is recommended. If insomnia persists, the doctor may decide to further investigate other possible causes.

Sleep breathing disorders may manifest as night snoring and respiratory arrest.These phenomena make sleep intermittent, reducing the oxygen content in the blood, which the sleeper may not feel at night. The first manifestations of sleep-disordered breathing can be daytime fatigue, drowsiness, memory and mood problems. Sleep apnea is the most common type of sleep-related breathing disorder. The risk of sleep apnea is associated with the characteristics of excess weight, facial structure and respiratory tract. In turn, the lack of treatment for sleep apnea can lead to serious health problems such as hypertension and metabolic disorders, as well as accidents at work caused by drowsiness and fatigue.Diagnosis of sleep-related breathing disorder usually requires additional sleep tests. Treatment may include adjusting your lifestyle, wearing a mask or using a mouth guard while you sleep.

Movement disorders during sleep may occur even before falling asleep. For example, symptoms of restless legs syndrome often begin in the evening, manifesting as unpleasant sensations in the legs or arms and causing limb movement. Sometimes the discomfort can be relieved by standing up and walking or by massaging the limbs.The causes of movement disorders during sleep can vary depending on age and health status. For further diagnosis, blood tests and additional tests are needed. Treatment can be very different – from iron supplements to special medications.

Excessive sleepiness can manifest itself as too long a night’s sleep (> 11 hours), and a short daytime sleep, after which the person does not feel rested.Narcolepsy is the most severe, but also the rarest form of excessive sleepiness. The causes of excessive sleepiness are determined by clarifying examinations, which should be followed by appropriate treatment.

Disturbances in the rhythm of sleep and wakefulness. They occur in people whose body clocks do not coincide with their daily cycle and therefore have difficulty sleeping during what is considered normal, generally accepted sleep time. Disturbances in the rhythm of sleep-wakefulness can be caused by environmental and social factors.

Parasomnias are sleep behavior disorders and other short-term symptoms that occur during sleep, such as nightmares.

Unepäeviku, täitmise juhendi ja näidise leiad Siit .

Sleep and wake times are hereditary and individual. From the age of 18, the following regimen is usual

  • sleep time – night;
  • Sleep time 6.5 – 11 hours, most people 7 – 9 hours
  • go to bed: from 21:00 – 1:00
  • waking up from 6 am to 10 am
  • the difference in the duration of sleep and wakefulness (increase or decrease) can be up to 3 hours (within a 2-week observation period)
  • falling asleep within 30 minutes
  • on average 1 – 2 times of awakening episodes during sleep
  • From 55 years of age, daytime naps lasting 30 minutes.

The above standard sleep duration is not valid for shift and night work people.

  • Fatigue can have a variety of causes, but fatigue can also be a manifestation of poor quality sleep. Many of the habitual activities of daily living affect the quality of sleep.

Please bring your completed sleep diary to your doctor.
90,000 In children – Sleep medicine

SLEEP DISORDERS IN CHILDREN

These disorders are diverse and differ significantly in structure from sleep disorders in adults.Their prevalence at the age of 1-5 years is 25%. Most often, children have PARASOMNIES (various phenomena that occur during sleep) and INSOMNII (sleep initiation and maintenance disorders). The most interesting and more common are parasomnias.

Sleeping talk. Represents the uttering of words or sounds during sleep in the absence of subjective awareness of the episode. Sleep-talking episodes occur at any stage of sleep, more often during shallow slow-wave sleep (stages 1 and 2).It is known that they are a benign phenomenon that occurs in most people throughout life, however, in childhood, it is much more common than in adults. Thus, in the “often or every night” category, sleep-speaking occurred in 5-20% of children and in 1-5% of adults in the general population. There is no special treatment.

Bruxism. Bruxism refers to episodes of teeth grinding during sleep. Teeth grinding usually occurs once per second and lasts 5 seconds.or longer. These episodes are then repeated throughout the night. They can occur at any stage of sleep; typical motor artifacts are recorded on the EEG and EMG at this time. The reason for the grinding of teeth is unknown. The family character of the inheritance of this disorder is noted – according to our data, 18% of the patients’ relatives had such episodes in childhood or are currently having such episodes. As in the case of dreaming, this phenomenon was more often observed in boys. The association of increased frequency of teeth grinding episodes with daytime emotiogenic situations is also traced.There was no connection between bruxism and the presence of helminthic invasion in a child (a common myth). In children, bruxism very rarely leads to damage (tooth abrasion), so special treatment is usually not given. Nootropics and sedatives are used. Sometimes you have to choose a special dental splint.

Nocturnal enuresis. A disorder characterized by frequent (for boys after 5 years more than 2, for girls – 1 episode per month) cases of involuntary urination during sleep.The prevalence of NE at the age of 12 reaches 3%, more often in boys. Children with this disorder often have very deep sleep (increased delta sleep), but NE episodes occur in all stages. There are primary (enuresis from birth without “dry gaps”) and secondary (interrupted for 3-6 months) forms of the disease. It is assumed that congenital or acquired dysfunction of the autonomic apparatus that control the bladder plays an important role in the development of this condition. There is a fairly close hereditary predisposition.The genes of the familial forms of NE – enur1 and enur2 – were isolated. Treatment uses behavioral techniques (fluid restriction, reward, bladder training), psychotherapy, physiotherapy, nootropics, antidepressants (Melipramine), and pituitary hormones (Minirin).

Sleepwalking. Sleepwalking is a series of episodes of complex behavior that occur during sleep and are manifested by the performance of various actions, most often walking. Most often it is just a “trip” to the corridor, to the kitchen or to the parents’ bedroom.More complex motor acts can also be carried out, imitating habitual actions: searching for toys, trying to open a door with a key. Actions are performed with open eyes, with an expressionless gaze. The child does not respond to questions addressed to him. Such an episode lasts from several seconds to several minutes, on average about 6 minutes. Characteristic is the amnesia of the episode that happened the next morning. The prevalence of sleepwalking in the child population is 10-30%. They most often occur in the first third of the night, when delta sleep is most prevalent.Heredity for these parasomnias was noted in 20% of patients. The plan of therapeutic measures includes conducting a conversation with parents on the organization of sleep patterns and behavior during an attack, courses of sedative and nootropic therapy, psychotherapy. According to the literature, 5-7% of cases of sleepwalking are epileptic in nature, however, most likely, these data are overestimated.

Night fears. These include episodes of awakening with loud screaming and behavioral and vegetative manifestations of fright.The parents’ attention can be attracted by the cry of the child, when they approach, they find him sitting in bed with an expression of fear or confusion on his face. Breathing and palpitations are rapid, and profuse sweating may occur. At the same time, the child does not respond to words addressed to him, and attempts to calm him down can lead to increased fear or resistance. In the morning amnesia of what was happening is observed. Night fears are less common than sleepwalking, their prevalence in children is 1-4%, reaching a peak at the age of 4-12 years.More common in boys. These episodes can be provoked by daytime emotional situations, fever and prolonged lack of sleep. Polysomnographic examination does not reveal a specific pathology. Therapeutic measures include psychotherapy, nootropic and sedative therapy.

Nightmares. Nightmares are terrifying dreams. The content of dreams scares the child, he dreams that he is being threatened, hurt, harassed or attacked. From this he wakes up in excitement, cries or calls out to his parents.Unlike night fears, nightmares more often occur in the morning and are confined to the phase of REM sleep. Nightmares differ from nightmares in that the night awakening is complete, the child is available to contact, tells that he was frightened and in the morning continues to remember about it. The prevalence of nightmares in the child population is 5-30%. The appearance of nightmares in a child can be triggered by stressful situations, feverish conditions, taking psychotropic drugs. An increase in nightmares can be evidence of a distress in the psycho-emotional sphere of a child, a manifestation of an internal conflict that he has.Among the therapeutic measures, psychotherapy with the possible addition of sedatives and nootropics plays a dominant role.

Rhythmic movement disorder. Appears in stereotypical, repetitive movements involving large muscles, usually the neck and head. The pattern of these movements can be quite varied: the child can “butt” the pillow or the headboard with his head, or, standing on his hands and knees, rhythmically sway back and forth. The prevalence of this phenomenon in children under 4 years of age, according to the literature, is 6-10%.It is believed that in this way, through a rhythmic effect on the structures of the vestibular apparatus, children “calm” and “rock” themselves. Indeed, the development of such episodes can be triggered by emotional overexcitation.