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'''Parasomnias ''' are a category of [[sleep disorders]] that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Most parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness and [[NREM]] sleep, or wakefulness and [[REM sleep]].
'''Parasomnias ''' are a category of [[sleep disorders]] that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, [[NREM]] sleep, and [[REM sleep]], and their combinations.


== Classification ==
== Classification ==
The newest version of the International Classification of Sleep Disorders (ICSD, 3rd. Ed.) uses State Dissociation as the paradigm for parasomnias. Unlike before, where wakefulness, non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep were considered exclusive states, research has shown that combinations of these states are possible and thus, may result in unusual unstable states that could eventually manifest as parasomnias or as altered levels of awareness.<ref name=":3">{{Cite book|title=International Classification of Sleep Disorders|last=|first=|publisher=American Academy of Sleep Medicine|year=2014|isbn=|location=Darien, IL|pages=}}</ref><ref>Mahowald MW, Schenk CH. Dissociated states of wakefulness and sleep. In: Lydic R, Baghdoyan HA, editors. Handbook of behavioral state control: cellular and molecular mechanisms. Boca Raton: CRC Press; 1999. p. 143-58.</ref><ref>Mahowald MW, Schenk CH. dissociated states of wakefulness and sleep. Neurology. 1992; 42(7 Suppl 6):44-51. </ref><ref>{{Citation|last=Nobili|first=Lino|title=Local aspects of sleep|date=2012|url=https://linkinghub.elsevier.com/retrieve/pii/B9780444594273000137|work=Progress in Brain Research|volume=199|pages=219–232|publisher=Elsevier|language=en|doi=10.1016/b978-0-444-59427-3.00013-7|isbn=9780444594273|access-date=2019-06-23|last2=De Gennaro|first2=Luigi|last3=Proserpio|first3=Paola|last4=Moroni|first4=Fabio|last5=Sarasso|first5=Simone|last6=Pigorini|first6=Andrea|last7=De Carli|first7=Fabrizio|last8=Ferrara|first8=Michele}}</ref><ref>{{Cite journal|last=Nobili|first=Lino|last2=Ferrara|first2=Michele|last3=Moroni|first3=Fabio|last4=De Gennaro|first4=Luigi|last5=Russo|first5=Giorgio Lo|last6=Campus|first6=Claudio|last7=Cardinale|first7=Francesco|last8=De Carli|first8=Fabrizio|date=2011|title=Dissociated wake-like and sleep-like electro-cortical activity during sleep|url=https://linkinghub.elsevier.com/retrieve/pii/S1053811911006501|journal=NeuroImage|language=en|volume=58|issue=2|pages=612–619|doi=10.1016/j.neuroimage.2011.06.032|via=}}</ref><ref>{{Cite journal|last=Peter-Derex|first=Laure|last2=Magnin|first2=Michel|last3=Bastuji|first3=Hélène|date=2015|title=Heterogeneity of arousals in human sleep: A stereo-electroencephalographic study|url=https://linkinghub.elsevier.com/retrieve/pii/S1053811915006771|journal=NeuroImage|language=en|volume=123|pages=229–244|doi=10.1016/j.neuroimage.2015.07.057|via=}}</ref>
The newest version of the International Classification of Sleep Disorders (ICSD, 3rd. Ed.) uses State Dissociation as the paradigm for parasomnias.<ref name=":3" /><ref name=":4" />Unlike before, where wakefulness, non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep were considered exclusive states, research has shown that combinations of these states are possible and thus, may result in unusual unstable states that could eventually manifest as parasomnias or as altered levels of awareness.<ref name=":3">{{Cite book|title=International Classification of Sleep Disorders|last=|first=|publisher=American Academy of Sleep Medicine|year=2014|isbn=|location=Darien, IL|pages=}}</ref><ref>Mahowald MW, Schenk CH. Dissociated states of wakefulness and sleep. In: Lydic R, Baghdoyan HA, editors. Handbook of behavioral state control: cellular and molecular mechanisms. Boca Raton: CRC Press; 1999. p. 143-58.</ref><ref>Mahowald MW, Schenk CH. dissociated states of wakefulness and sleep. Neurology. 1992; 42(7 Suppl 6):44-51. </ref><ref>{{Citation|last=Nobili|first=Lino|title=Local aspects of sleep|date=2012|url=https://linkinghub.elsevier.com/retrieve/pii/B9780444594273000137|work=Progress in Brain Research|volume=199|pages=219–232|publisher=Elsevier|language=en|doi=10.1016/b978-0-444-59427-3.00013-7|isbn=9780444594273|access-date=2019-06-23|last2=De Gennaro|first2=Luigi|last3=Proserpio|first3=Paola|last4=Moroni|first4=Fabio|last5=Sarasso|first5=Simone|last6=Pigorini|first6=Andrea|last7=De Carli|first7=Fabrizio|last8=Ferrara|first8=Michele}}</ref><ref>{{Cite journal|last=Nobili|first=Lino|last2=Ferrara|first2=Michele|last3=Moroni|first3=Fabio|last4=De Gennaro|first4=Luigi|last5=Russo|first5=Giorgio Lo|last6=Campus|first6=Claudio|last7=Cardinale|first7=Francesco|last8=De Carli|first8=Fabrizio|date=2011|title=Dissociated wake-like and sleep-like electro-cortical activity during sleep|url=https://linkinghub.elsevier.com/retrieve/pii/S1053811911006501|journal=NeuroImage|language=en|volume=58|issue=2|pages=612–619|doi=10.1016/j.neuroimage.2011.06.032|via=}}</ref><ref>{{Cite journal|last=Peter-Derex|first=Laure|last2=Magnin|first2=Michel|last3=Bastuji|first3=Hélène|date=2015|title=Heterogeneity of arousals in human sleep: A stereo-electroencephalographic study|url=https://linkinghub.elsevier.com/retrieve/pii/S1053811915006771|journal=NeuroImage|language=en|volume=123|pages=229–244|doi=10.1016/j.neuroimage.2015.07.057|via=}}</ref>


Although, the previous definition is technically correct, it contains flaws. The consideration of the State Dissociation paradigm facilitates the understanding of the sleep disorder and provides a classification of 10 core categories. <ref name=":3" /><ref name=":4">{{Cite journal|last=Kazaglis|first=Louis|last2=Bornemann|first2=Michel A. Cramer|date=2016|title=Classification of Parasomnias|url=http://link.springer.com/10.1007/s40675-016-0039-y|journal=Current Sleep Medicine Reports|language=en|volume=2|issue=2|pages=45–52|doi=10.1007/s40675-016-0039-y|issn=2198-6401|via=}}</ref>
Although, the previous definition is technically correct, it contains flaws. The consideration of the State Dissociation paradigm facilitates the understanding of the sleep disorder and provides a classification of 10 core categories. <ref name=":3" /><ref name=":4">{{Cite journal|last=Kazaglis|first=Louis|last2=Bornemann|first2=Michel A. Cramer|date=2016|title=Classification of Parasomnias|url=http://link.springer.com/10.1007/s40675-016-0039-y|journal=Current Sleep Medicine Reports|language=en|volume=2|issue=2|pages=45–52|doi=10.1007/s40675-016-0039-y|issn=2198-6401|via=}}</ref>
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{{main article|Sleepwalking}}
{{main article|Sleepwalking}}
Sleepwalking has a prevalence of 1%-17% in childhood, with the most frequent occurrences around the age of eleven to twelve. About 4% of adults experience [[somnambulism]].<ref>Mahowald & Schenck. 1283.</ref>
Sleepwalking has a prevalence of 1%-17% in childhood, with the most frequent occurrences around the age of eleven to twelve. About 4% of adults experience [[somnambulism]].<ref>Mahowald & Schenck. 1283.</ref>
Normal sleep cycles include states varying from drowsiness all the way to deep sleep. Every time an individual sleeps, he or she goes through various sequences of non-REM and REM sleep. Anxiety and fatigue are often connected with sleepwalking. For adults, alcohol, sedatives, medications, medical conditions and mental disorders are all associated with sleepwalking. Sleep walking may involve sitting up and looking awake when the individual is actually asleep, and getting up and walking around, moving items or undressing themselves. They will also be confused when waking up or opening their eyes during sleep. Some individuals also [[Somniloquy|talk while in their sleep]], saying meaningless words and even having arguments with people who are not there.<ref>ADAMinc.2012.</ref>
Normal sleep cycles include states varying from drowsiness all the way to deep sleep. Every time an individual sleeps, he or she goes through various sequences of non-REM and REM sleep. Anxiety and fatigue are often connected with sleepwalking. For adults, alcohol, sedatives, medications, medical conditions and mental disorders are all associated with sleepwalking. Sleep walking may involve sitting up and looking awake when the individual is actually asleep, and getting up and walking around, moving items or undressing themselves. They will also be confused when waking up or opening their eyes during sleep. Sleep walking can be associated with sleeptalking.<ref>ADAMinc.2012.</ref>


===Sleep terrors (night terrors)===
===Sleep terrors (night terrors/ pavor nocturnus)===
{{main article|Night terror}}
{{main article|Night terror}}
[[Night terror|Sleep terror]] is the most disruptive arousal disorder since it may involve loud screams and panic; in extreme cases, it may result in bodily harm or [[property damage]] by running about or hitting walls. All attempts to console the individual are futile and may prolong or intensify the victim’s confused state. Usually the victim experiences [[amnesia]] after the event but it may not be complete amnesia. Up to 3% of adults suffer from sleep terrors and exhibited behavior of this parasomnia can range from mild to extremely violent. This is very prevalent in those who suffer violent post-traumatic stress disorder (PTSD).<ref name="auto"/> They typically occur in stage 3 sleep.<ref>Katugampola, M. (2005) Health & Human Development, Pearson Education.</ref>
[[Night terror|Sleep terror]] is the most disruptive arousal disorder since it may involve loud screams and panic; in extreme cases, it may result in bodily harm or [[property damage]] by running about or hitting walls. All attempts to console the individual are futile and may prolong or intensify the victim’s confused state. Usually the victim experiences [[amnesia]] after the event but it may not be complete amnesia. Up to 3% of adults suffer from sleep terrors and exhibited behavior of this parasomnia can range from mild to extremely violent. This is very prevalent in those who suffer violent post-traumatic stress disorder (PTSD).<ref name="auto"/> They typically occur in stage 3 sleep.<ref>Katugampola, M. (2005) Health & Human Development, Pearson Education.</ref>


===Sleep-related eating disorder (SRED)===
===Sleep-related eating disorder (SRED)===
{{main article|Nocturnal sleep related eating disorder}}The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) classifies sleep-related eating disorder under sleepwalking, while ICSD classifies it as NREM-related parasomnia.<ref name=":3" /><ref name=":6">{{Cite book|url=http://worldcat.org/oclc/1031488488|title=Diagnostic and statistical manual of mental disorders.|last=American Psychiatric Association.|date=2013|publisher=American Psychiatric Publishing|isbn=9780890425558|oclc=1031488488}}</ref> It is conceptualized as a mixture of binge-eating behavior and arousal disorder.<ref name=":3" /><ref name=":6" /> Thereby, preferentially high-caloric food is consumed in an uncontrolled manner.<ref name=":7">{{Cite journal|last=Fleetham|first=J. A.|last2=Fleming|first2=J. A. E.|date=2014-05-13|title=Parasomnias|url=http://www.cmaj.ca/cgi/doi/10.1503/cmaj.120808|journal=Canadian Medical Association Journal|language=en|volume=186|issue=8|pages=E273–E280|doi=10.1503/cmaj.120808|issn=0820-3946}}</ref> However, SRED should not be confused with nocturnal eating syndrome, which is characterized by an excessive consumption of food before or during sleep in full consciousness.<ref name=":7" /><ref>{{Cite journal|last=O???Reardon|first=John P|last2=Peshek|first2=Andrew|last3=Allison|first3=Kelly C|date=2005|title=Night Eating Syndrome|url=http://dx.doi.org/10.2165/00023210-200519120-00003|journal=CNS Drugs|volume=19|issue=12|pages=997–1008|doi=10.2165/00023210-200519120-00003|issn=1172-7047}}</ref> Since sleep-related eating disorders are associated with other sleep disorders, successful treatment of the latter can reduce symptoms of this parasomnia.<ref name=":7" />
{{main article|Nocturnal sleep related eating disorder}}


==Rapid eye movement (REM)-related parasomnias==
==Rapid eye movement (REM)-related parasomnias==
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===REM sleep behavior disorder===
===REM sleep behavior disorder===


[[Rapid eye movement sleep behavior disorder]] (RBD) is the most common REM sleep parasomnia in which muscle [[atonia]] is absent. This allows the individual to act out their dreams and may result in repeated [[injury]]—[[bruises]], [[lacerations]], and [[fractures]]—to themselves or others. Patients may take self-protection measures by tethering themselves to bed, using pillow [[barricades]], or sleeping in an empty room on a mattress.<ref>Mahowald & Schenck:1284.</ref> Besides ensuring the sleep environment is a safe place, pharmacologic therapy using [[melatonin]] and [[clonazepam]] is also recommended as a treatment for RBD, even though might not eliminate all abnormal behaviours.<ref name=":0" /> However, clonazepam needs to be manipulated carefully because its significant side effects, mainly in patients with neurodegenerative disorders with dementia.<ref>Aurora, R., Zak, R., Maganti, R., Auerbach, S., Casey, K., Chowdhuri, S., . . . Morgenthaler, T. (2010). Best practice guide for the treatment of REM sleep behavior disorder (RBD). Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 6(1), 85-95.</ref>
Unlike other parasomnias, [[Rapid eye movement sleep behavior disorder|rapid eye movement sleep behavior disorder (RBD)]] in which muscle [[atonia]] is absent is most common in older adults.<ref>{{Cite web|url=https://www.tuck.com/rem-parasomnias/|title=Tuck Sleep|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> This allows the individual to act out their dreams and may result in repeated [[injury]]—[[bruises]], [[lacerations]], and [[fractures]]—to themselves or others. Patients may take self-protection measures by tethering themselves to bed, using pillow [[barricades]], or sleeping in an empty room on a mattress.<ref>Mahowald & Schenck:1284.</ref> Besides ensuring the sleep environment is a safe place, pharmacologic therapy using [[melatonin]] and [[clonazepam]] is also common as a treatment for RBD, even though might not eliminate all abnormal behaviours.<ref name=":0" /> Before starting a treatment with clonazepam, a screening for obstructive sleep apnea should performed.<ref name=":7" /> However, clonazepam needs to be manipulated carefully because of its significant side effects, i.e., morning confusion or memory impairment<ref name=":7" />, mainly in patients with neurodegenerative disorders with dementia.<ref>Aurora, R., Zak, R., Maganti, R., Auerbach, S., Casey, K., Chowdhuri, S., . . . Morgenthaler, T. (2010). Best practice guide for the treatment of REM sleep behavior disorder (RBD). Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 6(1), 85-95.</ref>


Demographically, 90% of RBD patients are males, and most are older than 50 years of age.<ref>Mahowald & Schenck :1284.</ref> However, this prevalence in males could be biased due to the fact that women tends to have a less violent type of RBD, which leads to lower reports at sleep centres and different clinical characteristics.<ref name=":1" /><ref name=":2" /> While men might have more aggressive behaviour during dreaming, women have presented more disturbance in their sleep. <ref name=":1">Bjørnarå, Dietrichs, & Toft. (2013). REM sleep behavior disorder in Parkinson's disease – Is there a gender difference? Parkinsonism and Related Disorders, 19(1), 120-122.</ref><ref name=":2">Bjørnarå, K., Dietrichs, E., & Toft, M. (2015). Longitudinal assessment of probable rapid eye movement sleep behaviour disorder in Parkinson's disease. European Journal of Neurology, 22(8), 1242-1244.</ref> RBD may be also influenced by a genetic compound, since primary relatives seem to have significantly more chance to develop RBD compared with non-relatives control group. <ref name=":0" /><ref>Dauvilliers, B., Yves, Postuma, Livia, Ronald, Ferini-Strambi, Livia, Luigi, Arnulf, Livia, Isabelle, Högl, Livia, Birgit, Manni, Livia, Raffaele, . . . Montplaisir, Livia, Jacques. (2013). Family history of idiopathic REM behavior disorder: A multicenter case-control study. Neurology, 80(24), 2233-2235.</ref>
Demographically, 90% of RBD patients are males, and most are older than 50 years of age.<ref>Mahowald & Schenck :1284.</ref> However, this prevalence in males could be biased due to the fact that women tends to have a less violent type of RBD, which leads to lower reports at sleep centres and different clinical characteristics.<ref name=":1" /><ref name=":2" /> While men might have more aggressive behaviour during dreaming, women have presented more disturbance in their sleep. <ref name=":1">Bjørnarå, Dietrichs, & Toft. (2013). REM sleep behavior disorder in Parkinson's disease – Is there a gender difference? Parkinsonism and Related Disorders, 19(1), 120-122.</ref><ref name=":2">Bjørnarå, K., Dietrichs, E., & Toft, M. (2015). Longitudinal assessment of probable rapid eye movement sleep behaviour disorder in Parkinson's disease. European Journal of Neurology, 22(8), 1242-1244.</ref> RBD may be also influenced by a genetic compound, since primary relatives seem to have significantly more chance to develop RBD compared with non-relatives control group. <ref name=":0" /><ref>Dauvilliers, B., Yves, Postuma, Livia, Ronald, Ferini-Strambi, Livia, Luigi, Arnulf, Livia, Isabelle, Högl, Livia, Birgit, Manni, Livia, Raffaele, . . . Montplaisir, Livia, Jacques. (2013). Family history of idiopathic REM behavior disorder: A multicenter case-control study. Neurology, 80(24), 2233-2235.</ref>
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* May be associated with neurodegenerative disease <ref>Boeve et al.</ref>
* May be associated with neurodegenerative disease <ref>Boeve et al.</ref>


Acute RBD occurs mostly as a result of a side-effect in prescribed [[medication]]—usually [[antidepressants]]. But if not, then 55% of the time the cause is unknown, while the other 45% of the time the cause is associated with alcohol.<ref>http://www.emedicinehealth.com/rem_sleep_behavior_disorder/page2_em.htm#REM Sleep Disorder Causes</ref>
Acute RBD occurs mostly as a result of a side-effect in prescribed [[medication]]—usually [[antidepressants]]. Furthermore, substance abuse or withdrawal can result in RBD.<ref name=":7" />


Chronic RBD is [[idiopathic]], meaning of unknown origin, or associated with [[neurological disorders]]. There is a growing association of [[Chronic (medicine)|chronic]] RBD with [[neurodegenerative]] disorders—[[Parkinson's disease]], [[multiple system atrophy]] (MSA), or [[dementia]]—as an early indicator of these conditions by as much as 10 years. RBD associated with neurological disorders is frequently related to abnormal accumulation of [[alpha-synuclein]], and more than 80% of patients with idiopathic RBD might develop [[Dementia with Lewy bodies|Lewy body disease]] (LBD).<ref name=":0">McCarter, S., & Howell, J. (2017). REM Sleep Behavior Disorder and Other Sleep Disturbances in Non-Alzheimer Dementias. Current Sleep Medicine Reports, 3(3), 193-203.</ref> Patients with [[narcolepsy]] are also more likely to develop RBD.
Chronic RBD is [[idiopathic]], meaning of unknown origin, or associated with [[neurological disorders]].<ref name=":7" /> There is a growing association of [[Chronic (medicine)|chronic]] RBD with [[neurodegenerative]] disorders—[[Parkinson's disease]], [[multiple system atrophy]] (MSA), or [[dementia]]—as an early indicator of these conditions by as much as 10 years. RBD associated with neurological disorders is frequently related to abnormal accumulation of [[alpha-synuclein]], and more than 80% of patients with idiopathic RBD might develop [[Dementia with Lewy bodies|Lewy body disease]] (LBD).<ref name=":0">McCarter, S., & Howell, J. (2017). REM Sleep Behavior Disorder and Other Sleep Disturbances in Non-Alzheimer Dementias. Current Sleep Medicine Reports, 3(3), 193-203.</ref> Patients with [[narcolepsy]] are also more likely to develop RBD.


The diagnosis is often taken based on [[polysomnography]] (PSG) records, mainly for its accuracy in differentiating RBD from other sleep disorders. However, screening questionnaires, such as [[REM Sleep Behavior Disorder Screening Questionnaire|RBDSQ,]] are also very useful for diagnosing RBD.<ref name=":0" /><ref name=":1" /><ref name=":2" />
The diagnosis is based on clinical history, including partner's account and needs to be confirmed by [[polysomnography]] (PSG), mainly for its accuracy in differentiating RBD from other sleep disorders, since there is a loss of REM atonia with excessive muscle tone.<ref name=":7" /> However, screening questionnaires, such as [[REM Sleep Behavior Disorder Screening Questionnaire|RBDSQ,]] are also very useful for diagnosing RBD.<ref name=":0" /><ref name=":1" /><ref name=":2" />


===Recurrent isolated sleep paralysis===
===Recurrent isolated sleep paralysis===
Recurrent isolated [[sleep paralysis]] is an inability to perform voluntary movements at sleep onset, or upon waking from sleep.<ref name=":7" /> Although, the affected individual is conscious and recall is present, the person is not able to speak nor to move at first, respiration however remains unimpaired.<ref name=":7" />The episodes last seconds to minutes and diminish spontaneously.<ref name=":7" /> The lifetime prevalence is 7%.<ref>{{Cite journal|last=Sharpless|first=Brian A.|last2=Barber|first2=Jacques P.|date=2011|title=Lifetime prevalence rates of sleep paralysis: A systematic review|url=https://linkinghub.elsevier.com/retrieve/pii/S1087079211000098|journal=Sleep Medicine Reviews|language=en|volume=15|issue=5|pages=311–315|doi=10.1016/j.smrv.2011.01.007|via=}}</ref> Sleep paralysis is associated with sleep-related hallucinations.<ref name=":7" /> Predisposing factors for the development of recurrent isolated sleep paralysis are sleep deprivation, an irregular sleep-wake cycle, e.g. caused by shift work, or stress.<ref name=":7" /> A possible cause could be the prolongation of REM sleep muscle atonia upon awakening.<ref name=":8">{{Cite journal|last=Singh|first=Shantanu|last2=Kaur|first2=Harleen|last3=Singh|first3=Shivank|last4=Khawaja|first4=Imran|date=2018-12-31|title=Parasomnias: A Comprehensive Review|url=https://www.cureus.com/articles/16963-parasomnias-a-comprehensive-review|journal=Cureus|language=en|doi=10.7759/cureus.3807|issn=2168-8184}}</ref>
Recurrent isolated [[sleep paralysis]] is an inability to perform voluntary movements at sleep onset, or upon waking from sleep.

Lifetime prevalence of 7%.<ref>{{Cite journal|last=Sharpless|first=Brian A.|last2=Barber|first2=Jacques P.|date=2011|title=Lifetime prevalence rates of sleep paralysis: A systematic review|url=https://linkinghub.elsevier.com/retrieve/pii/S1087079211000098|journal=Sleep Medicine Reviews|language=en|volume=15|issue=5|pages=311–315|doi=10.1016/j.smrv.2011.01.007|via=}}</ref>


=== Nightmare disorder ===
=== Nightmare disorder ===
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===Catathrenia===
===Catathrenia===


Until the ICSD-3 [[Catathrenia]] was classified as a rapid-eye-movement sleep parasomnia, but is now classified as sleep-related breathing disorder.<ref name=":3" /><ref>{{Cite web|url=https://www.alaskasleep.com/blog/what-is-catathrenia-groaning-in-sleep|title=Alaska Sleep Clinic|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> It consists of breath holding and expiratory groaning during sleep, is distinct from both [[somniloquy]] and [[obstructive sleep apnea]]. The sound is produced during exhalation as opposed to snoring which occurs during inhalation. It is usually not noticed by the person producing the sound but can be extremely disturbing to sleep partners, although once aware of it, sufferers tend to be woken up by their own groaning as well. Bed partners generally report hearing the person take a deep breath, hold it, then slowly exhale; often with a high-pitched squeak or groaning sound.
Before the ICSD-3, [[Catathrenia]] was classified as a rapid-eye-movement sleep parasomnia, but is now classified as sleep-related breathing disorder.<ref name=":3" /><ref>{{Cite web|url=https://www.alaskasleep.com/blog/what-is-catathrenia-groaning-in-sleep|title=Alaska Sleep Clinic|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> It consists of breath holding and expiratory groaning during sleep, is distinct from both [[somniloquy]] and [[obstructive sleep apnea]]. The sound is produced during exhalation as opposed to snoring which occurs during inhalation. It is usually not noticed by the person producing the sound but can be extremely disturbing to sleep partners, although once aware of it, sufferers tend to be woken up by their own groaning as well. Bed partners generally report hearing the person take a deep breath, hold it, then slowly exhale; often with a high-pitched squeak or groaning sound.


== Other parasomnias ==
== Other parasomnias ==
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=== Sleep-related hallucinations ===
=== Sleep-related hallucinations ===
Sleep-related hallucinations are a brief episodes of dream-like imagery that can be of any sensory modality, e.g. visual or tactile. They are differentiated between [[Hypnagogia|hypnagogic hallucination]], that occur at sleep onset, and [[Hypnopompic|hypnapompic hallucinations]], which occur at the transition of sleep to awakening. Although, normal individuals have reported nocturnal hallucinations, they are more frequent in comorbidity with other sleep disorders, e.g. narcolepsy.<ref name=":3" /><ref name=":4" /><ref>{{Citation|last=Ivanenko|first=Anna|title=Sleep-Related Hallucinations|date=2013|url=http://link.springer.com/10.1007/978-1-4614-7627-6_14|work=Parasomnias|pages=207–220|editor-last=Kothare|editor-first=Sanjeev V.|publisher=Springer New York|language=en|doi=10.1007/978-1-4614-7627-6_14|isbn=9781461476269|access-date=2019-06-23|last2=Relia|first2=Sachin|editor2-last=Ivanenko|editor2-first=Anna}}</ref>
Sleep-related hallucinations are brief episodes of dream-like imagery that can be of any sensory modality, i.e., auditory, visual, or tactile.<ref name=":4" /> They are differentiated between [[Hypnagogia|hypnagogic hallucination]], that occur at sleep onset, and [[Hypnopompic|hypnapompic hallucinations]], which occur at the transition of sleep to awakening.<ref name=":4" /> Although, normal individuals have reported nocturnal hallucinations, they are more frequent in comorbidity with other sleep disorders, e.g. narcolepsy.<ref name=":3" /><ref name=":4" /><ref>{{Citation|last=Ivanenko|first=Anna|title=Sleep-Related Hallucinations|date=2013|url=http://link.springer.com/10.1007/978-1-4614-7627-6_14|work=Parasomnias|pages=207–220|editor-last=Kothare|editor-first=Sanjeev V.|publisher=Springer New York|language=en|doi=10.1007/978-1-4614-7627-6_14|isbn=9781461476269|access-date=2019-06-23|last2=Relia|first2=Sachin|editor2-last=Ivanenko|editor2-first=Anna}}</ref>


=== Sleep enuresis ===
=== Sleep enuresis ===
{{Main articles|Nocturnal enuresis}}<br />
{{Main articles|Nocturnal enuresis}}


=== Parasomnias due to medical disorder ===
=== Parasomnias due to medical disorder ===
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=== Sleep talking (somniloquy) ===
=== Sleep talking (somniloquy) ===
According to ICSD-3 it is not considered a disorder. It is rather an isolated symptom or normal variant. With a lifetime prevalence of 69% is it considered fairly common.<ref name=":5" /> Sleep talking is associated with REM Sleep Behavior Disorder as well as with disorders or arousal.<ref name=":3" /><ref name=":4" />
According to ICSD-3 it is not defined a disorder in particular. It is rather an isolated symptom or normal variant and ranges from isolated speech to full conversations without recall.<ref name=":3" /><ref name=":4" /><ref name=":7" /> With a lifetime prevalence of 69% is it considered fairly common.<ref name=":5" /> Sleep talking is associated with REM-related parasomnias as well as with disorders or arousal.<ref name=":3" /><ref name=":4" /> It occurs in all sleep states. Until now, there is no specific treatment for sleeptalking available. <ref name=":7" />
<br />


== Diagnosis ==
== Diagnosis ==
Parasomnias are most commonly diagnosed by means of questionnaires.<ref name=":7" /> These questionnaires include a detailed analyses of the clinical history and contain questions to:
<br />

# Rule out sleep deprivation
# Rule out effects of intoxication or withdrawal
# Rule out sleep disorders causing sleep instability
# Rule out medical disorders or treatments associated with sleep instability
# Confirm presence of NREM parasomnias in other family members and during the patient's childhood
# Determine the timing of the events
# Determine the morphology of the events.<ref name=":7" />

Furthermore, a sleep diary is helpful to exclude that sleep deprivation could be a precipitating factor.<ref name=":7" /> An additional tool could be the partner's log of the events.<ref name=":7" />

The following questions should therefore be considered:

# Do you or your bed partner believe that you move your arms, legs, or body too much, or have unusual behaviors during sleep?
# Do you move while dreaming, as if you are simultaneously attempting to carry out the dream? l Have you ever hurt yourself or your bed partner during sleep?
# Do you sleepwalk or have sleep terrors with loud screaming?
# Do your legs feel restless or begin to twitch a lot or jump around when you are drowsy or sleepy, either at bedtime or during the day?
# Do you eat food or drink fluids without full awareness during the night? Do you wake up in the morning feeling bloated and with no desire to eat breakfast?<ref>{{Cite journal|last=Mahowald|first=Mark W.|last2=Schenck|first2=Carlos H.|date=2000-01-01|title=Diagnosis and management of parasomnias|url=http://www.sciencedirect.com/science/article/pii/S1098359700900401|journal=Clinical Cornerstone|volume=2|issue=5|pages=48–54|doi=10.1016/S1098-3597(00)90040-1|issn=1098-3597}}</ref>

In potentially harmful or disturbing cases a specialist in sleep disorders should be approached.<ref name=":7" /> Video polysomnographic documentation is necessary only in REM sleep behavior disorder (RBD), since it is an essential diagnostic criteria in the ICSD to demonstrate the absence of muscle atonia and to exclude comorbid sleep disorders.<ref name=":3" /><ref name=":4" /><ref name=":7" /> For most of the other parasomnias, polysomnographic monitoring is a costly, but still supportive tool in the clinical diagnosis.<ref name=":4" /><ref name=":7" />

The use of actigraphy can be promising in the diagnostical assessment of NREM-related parasomnias, for example to rule out sleep deprivation or other sleep disorders, like circadian sleep-wake rhythm disorder which often develops among shift workers.<ref name=":7" /> However, there is currently no generally accepted standardized technique available of identifying and quantifying periodic limb movements in sleep (PLMS) that distinguishes movements resulting from parasomnias, nocturnal seizures, and other dyskinesias.<ref>{{Citation|last=Chokroverty|first=Sudhansu|title=Specialized Techniques|date=2014|url=https://linkinghub.elsevier.com/retrieve/pii/B978145571267000014X|work=Atlas of Sleep Medicine|pages=255–299|publisher=Elsevier|language=en|doi=10.1016/b978-1-4557-1267-0.00014-x|isbn=9781455712670|access-date=2019-06-23|last2=Thomas|first2=Robert J.}}</ref>


== Treatment ==
== Treatment ==
Parasomnias can be considered as potentially harmful to oneself as well as to bed partners, and are associated with other disorders.<ref name=":7" />
<br />

⚫
==See also==
Children with parasomnias do not undergo medical intervention, since they tend to recover the NREM-related disorder with the process of growth.<ref name=":8" /> In those cases, the parents receive education on sleep hygiene to reduce and eventually eliminate precipitating factors.<ref name=":8" />

In adults psychoeducation about a proper sleep hygiene can reduce the risk to develop parasomnia.<ref name=":7" /> Case studies have shown that pharmacological interventions can improve symptoms of parasomnia, however mostly they are accompanied by side-effects.<ref name=":7" /><ref name=":9">{{Cite web|url=https://www.emedicinehealth.com/disorders_that_disrupt_sleep_parasomnias/article_em.htm|title=Disorders That Disrupt Sleep: Parasomnia Causes & Types|website=eMedicineHealth|language=en|access-date=2019-06-23}}</ref> Behavioral treatments, i.e., relaxation therapy, biofeedback, hypnosis, and stress reduction, may also be helpful, but are not considered as universally effective.<ref name=":9" />

⚫
== See also ==

* [[Dyssomnia]]
* [[Dyssomnia]]
* [[Insomnia]]
* [[Insomnia]]

Revision as of 23:23, 23 June 2019

This article is about the disorder. For the 2008 film, see Parasomnia (film).
Parasomnia
SpecialtySleep medicine, psychology Edit this on Wikidata

Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, NREM sleep, and REM sleep, and their combinations.

Classification

The newest version of the International Classification of Sleep Disorders (ICSD, 3rd. Ed.) uses State Dissociation as the paradigm for parasomnias.[1][2]Unlike before, where wakefulness, non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep were considered exclusive states, research has shown that combinations of these states are possible and thus, may result in unusual unstable states that could eventually manifest as parasomnias or as altered levels of awareness.[1][3][4][5][6][7]

Although, the previous definition is technically correct, it contains flaws. The consideration of the State Dissociation paradigm facilitates the understanding of the sleep disorder and provides a classification of 10 core categories. [1][2]

NREM parasomnias are arousal disorders that occur during stage 3 (or 4 by the R&K standardization) of NREM sleep—also known as slow wave sleep (SWS). They are caused by a physiological activation in which the patient’s brain exits from SWS and is caught in between a sleeping and waking state. In particular, these disorders involve activation of the autonomic nervous system, motor system, or cognitive processes during sleep or sleep-wake transitions.[8]

Some NREM parasomnias (sleep-walking, night-terrors, and confusional arousal) are common during childhood but decrease in frequency with increasing age. They can be triggered in certain individuals, by alcohol, sleep deprivation, physical activity, emotional stress, depression, medications, or a fevered illness. These disorders of arousal can range from confusional arousals, somnambulism, to night terrors. Other specific disorders include sleepeating, sleep sex, teeth grinding, rhythmic movement disorder, restless legs syndrome, and somniloquy.

  • Sleep-disordered breathing
  • REM-related parasomnias
  • Nocturnal seizures
  • Psychogenic dissociative disorders

Confusional arousals

Confusional arousal is a condition when an individual awakens from sleep and remains in a confused state. It is characterized by the individual's partial awakening and sitting up to look around. They usually remain in bed and then return to sleep. These episodes last anywhere from seconds to minutes and may not be reactive to stimuli.[9] Confusional arousal is more common in children than in adults. It has a lifetime prevalence of 18.5% in children and a lifetime prevalence of 2.9-4.2% in adults.[10][11] [12][13] Infants and toddlers usually experience confusional arousals beginning with large amounts of movement and moaning, which can later progress to occasional thrashings or inconsolable crying. In rare cases, confusional arousals can cause injuries and drowsy driving accidents, thus it can also be considered dangerous.[14] Another sleeping disorder may be present triggering these incomplete arousals.[15]

Main article: Sleep sex

Sleep-related abnormal sexual behavior, Sleep sex, or sexsomnia, is a form of confusional arousal that may overlap with somnambulism.[1] Thereby, a person will engage in sexual acts while still asleep. It can include such acts as masturbation, inappropriate fondling themselves or others, having sex with another person; and in more extreme cases, sexual assault. [16] These behaviors are unconscious, occur frequently without dreaming, and bring along clinical, social, and legal implications.[17] It has a lifetime prevalence of 7.1% and an annual prevalence of 2.7%.[11]

Sleepwalking (somnambulism)

Main article: Sleepwalking

Sleepwalking has a prevalence of 1%-17% in childhood, with the most frequent occurrences around the age of eleven to twelve. About 4% of adults experience somnambulism.[18] Normal sleep cycles include states varying from drowsiness all the way to deep sleep. Every time an individual sleeps, he or she goes through various sequences of non-REM and REM sleep. Anxiety and fatigue are often connected with sleepwalking. For adults, alcohol, sedatives, medications, medical conditions and mental disorders are all associated with sleepwalking. Sleep walking may involve sitting up and looking awake when the individual is actually asleep, and getting up and walking around, moving items or undressing themselves. They will also be confused when waking up or opening their eyes during sleep. Sleep walking can be associated with sleeptalking.[19]

Sleep terrors (night terrors/ pavor nocturnus)

Main article: Night terror

Sleep terror is the most disruptive arousal disorder since it may involve loud screams and panic; in extreme cases, it may result in bodily harm or property damage by running about or hitting walls. All attempts to console the individual are futile and may prolong or intensify the victim’s confused state. Usually the victim experiences amnesia after the event but it may not be complete amnesia. Up to 3% of adults suffer from sleep terrors and exhibited behavior of this parasomnia can range from mild to extremely violent. This is very prevalent in those who suffer violent post-traumatic stress disorder (PTSD).[10] They typically occur in stage 3 sleep.[20]

Main article: Nocturnal sleep related eating disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) classifies sleep-related eating disorder under sleepwalking, while ICSD classifies it as NREM-related parasomnia.[1][21] It is conceptualized as a mixture of binge-eating behavior and arousal disorder.[1][21] Thereby, preferentially high-caloric food is consumed in an uncontrolled manner.[22] However, SRED should not be confused with nocturnal eating syndrome, which is characterized by an excessive consumption of food before or during sleep in full consciousness.[22][23] Since sleep-related eating disorders are associated with other sleep disorders, successful treatment of the latter can reduce symptoms of this parasomnia.[22]

REM sleep behavior disorder

Unlike other parasomnias, rapid eye movement sleep behavior disorder (RBD) in which muscle atonia is absent is most common in older adults.[24] This allows the individual to act out their dreams and may result in repeated injury—bruises, lacerations, and fractures—to themselves or others. Patients may take self-protection measures by tethering themselves to bed, using pillow barricades, or sleeping in an empty room on a mattress.[25] Besides ensuring the sleep environment is a safe place, pharmacologic therapy using melatonin and clonazepam is also common as a treatment for RBD, even though might not eliminate all abnormal behaviours.[26] Before starting a treatment with clonazepam, a screening for obstructive sleep apnea should performed.[22] However, clonazepam needs to be manipulated carefully because of its significant side effects, i.e., morning confusion or memory impairment[22], mainly in patients with neurodegenerative disorders with dementia.[27]

Demographically, 90% of RBD patients are males, and most are older than 50 years of age.[28] However, this prevalence in males could be biased due to the fact that women tends to have a less violent type of RBD, which leads to lower reports at sleep centres and different clinical characteristics.[29][30] While men might have more aggressive behaviour during dreaming, women have presented more disturbance in their sleep. [29][30] RBD may be also influenced by a genetic compound, since primary relatives seem to have significantly more chance to develop RBD compared with non-relatives control group. [26][31]

Typical clinical features of REM sleep behavior disorder are:

  • Male gender predilection
  • Mean age of onset 50–65 years (range 20–80 years)
  • Vocalisation, screaming, swearing that may be associated with dreams
  • Motor activity, simple or complex, that may result in injury to patient or bed-partner
  • Occurrence usually in latter half of sleep period (REM sleep)
  • May be associated with neurodegenerative disease [32]

Acute RBD occurs mostly as a result of a side-effect in prescribed medication—usually antidepressants. Furthermore, substance abuse or withdrawal can result in RBD.[22]

Chronic RBD is idiopathic, meaning of unknown origin, or associated with neurological disorders.[22] There is a growing association of chronic RBD with neurodegenerative disorders—Parkinson's disease, multiple system atrophy (MSA), or dementia—as an early indicator of these conditions by as much as 10 years. RBD associated with neurological disorders is frequently related to abnormal accumulation of alpha-synuclein, and more than 80% of patients with idiopathic RBD might develop Lewy body disease (LBD).[26] Patients with narcolepsy are also more likely to develop RBD.

The diagnosis is based on clinical history, including partner's account and needs to be confirmed by polysomnography (PSG), mainly for its accuracy in differentiating RBD from other sleep disorders, since there is a loss of REM atonia with excessive muscle tone.[22] However, screening questionnaires, such as RBDSQ, are also very useful for diagnosing RBD.[26][29][30]

Recurrent isolated sleep paralysis

Recurrent isolated sleep paralysis is an inability to perform voluntary movements at sleep onset, or upon waking from sleep.[22] Although, the affected individual is conscious and recall is present, the person is not able to speak nor to move at first, respiration however remains unimpaired.[22]The episodes last seconds to minutes and diminish spontaneously.[22] The lifetime prevalence is 7%.[33] Sleep paralysis is associated with sleep-related hallucinations.[22] Predisposing factors for the development of recurrent isolated sleep paralysis are sleep deprivation, an irregular sleep-wake cycle, e.g. caused by shift work, or stress.[22] A possible cause could be the prolongation of REM sleep muscle atonia upon awakening.[34]

Nightmare disorder

Nightmares are like dreams primarily associated with REM sleep. Nightmare disorder is defined as recurrent nightmares associated with awakening dysphoria that impairs sleep or daytime functioning.[1][2] It is rare in children, however persists until adulthood. About 2/3 of the adult population report experiencing nightmares at least once in their life.[11]

Catathrenia

Before the ICSD-3, Catathrenia was classified as a rapid-eye-movement sleep parasomnia, but is now classified as sleep-related breathing disorder.[1][35] It consists of breath holding and expiratory groaning during sleep, is distinct from both somniloquy and obstructive sleep apnea. The sound is produced during exhalation as opposed to snoring which occurs during inhalation. It is usually not noticed by the person producing the sound but can be extremely disturbing to sleep partners, although once aware of it, sufferers tend to be woken up by their own groaning as well. Bed partners generally report hearing the person take a deep breath, hold it, then slowly exhale; often with a high-pitched squeak or groaning sound.

Other parasomnias

Exploding head syndrome

Main article: Exploding head syndrome


Sleep-related hallucinations are brief episodes of dream-like imagery that can be of any sensory modality, i.e., auditory, visual, or tactile.[2] They are differentiated between hypnagogic hallucination, that occur at sleep onset, and hypnapompic hallucinations, which occur at the transition of sleep to awakening.[2] Although, normal individuals have reported nocturnal hallucinations, they are more frequent in comorbidity with other sleep disorders, e.g. narcolepsy.[1][2][36]

Sleep enuresis

Main article: Nocturnal enuresis

Parasomnias due to medical disorder

Parasomnias due to medication or substance

Parasomnia, unspecific


Isolated symptom/normal variant

Sleep talking (somniloquy)

According to ICSD-3 it is not defined a disorder in particular. It is rather an isolated symptom or normal variant and ranges from isolated speech to full conversations without recall.[1][2][22] With a lifetime prevalence of 69% is it considered fairly common.[11] Sleep talking is associated with REM-related parasomnias as well as with disorders or arousal.[1][2] It occurs in all sleep states. Until now, there is no specific treatment for sleeptalking available. [22]

Diagnosis

Parasomnias are most commonly diagnosed by means of questionnaires.[22] These questionnaires include a detailed analyses of the clinical history and contain questions to:

  1. Rule out sleep deprivation
  2. Rule out effects of intoxication or withdrawal
  3. Rule out sleep disorders causing sleep instability
  4. Rule out medical disorders or treatments associated with sleep instability
  5. Confirm presence of NREM parasomnias in other family members and during the patient's childhood
  6. Determine the timing of the events
  7. Determine the morphology of the events.[22]

Furthermore, a sleep diary is helpful to exclude that sleep deprivation could be a precipitating factor.[22] An additional tool could be the partner's log of the events.[22]

The following questions should therefore be considered:

  1. Do you or your bed partner believe that you move your arms, legs, or body too much, or have unusual behaviors during sleep?
  2. Do you move while dreaming, as if you are simultaneously attempting to carry out the dream? l Have you ever hurt yourself or your bed partner during sleep?
  3. Do you sleepwalk or have sleep terrors with loud screaming?
  4. Do your legs feel restless or begin to twitch a lot or jump around when you are drowsy or sleepy, either at bedtime or during the day?
  5. Do you eat food or drink fluids without full awareness during the night? Do you wake up in the morning feeling bloated and with no desire to eat breakfast?[37]

In potentially harmful or disturbing cases a specialist in sleep disorders should be approached.[22] Video polysomnographic documentation is necessary only in REM sleep behavior disorder (RBD), since it is an essential diagnostic criteria in the ICSD to demonstrate the absence of muscle atonia and to exclude comorbid sleep disorders.[1][2][22] For most of the other parasomnias, polysomnographic monitoring is a costly, but still supportive tool in the clinical diagnosis.[2][22]

The use of actigraphy can be promising in the diagnostical assessment of NREM-related parasomnias, for example to rule out sleep deprivation or other sleep disorders, like circadian sleep-wake rhythm disorder which often develops among shift workers.[22] However, there is currently no generally accepted standardized technique available of identifying and quantifying periodic limb movements in sleep (PLMS) that distinguishes movements resulting from parasomnias, nocturnal seizures, and other dyskinesias.[38]

Treatment

Parasomnias can be considered as potentially harmful to oneself as well as to bed partners, and are associated with other disorders.[22]

Children with parasomnias do not undergo medical intervention, since they tend to recover the NREM-related disorder with the process of growth.[34] In those cases, the parents receive education on sleep hygiene to reduce and eventually eliminate precipitating factors.[34]

In adults psychoeducation about a proper sleep hygiene can reduce the risk to develop parasomnia.[22] Case studies have shown that pharmacological interventions can improve symptoms of parasomnia, however mostly they are accompanied by side-effects.[22][39] Behavioral treatments, i.e., relaxation therapy, biofeedback, hypnosis, and stress reduction, may also be helpful, but are not considered as universally effective.[39]

See also

References

  • Mahowald & Schenck. Insights from studying human sleep disorders. Nature (2005); 437(7063):1279-85.
  • Bassetti et al., Lancet (2000); 356: 484–485
  • Boeve et al. Journal of Geriatr Psychiatry Neurol 2004; 17:146-157
  • Aurora RN et al. Journal of Clinical Sleep Medicine 2010; 6(1):85-95.
  • Aurora RN et al. Journal of Clinical Sleep Medicine 2010; 6(4):398-401.
  • https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001811/

Notes

  1. ^ a b c d e f g h i j k l International Classification of Sleep Disorders. Darien, IL: American Academy of Sleep Medicine. 2014.
  2. ^ a b c d e f g h i j k Kazaglis, Louis; Bornemann, Michel A. Cramer (2016). "Classification of Parasomnias". Current Sleep Medicine Reports. 2 (2): 45–52. doi:10.1007/s40675-016-0039-y. ISSN 2198-6401.
  3. ^ Mahowald MW, Schenk CH. Dissociated states of wakefulness and sleep. In: Lydic R, Baghdoyan HA, editors. Handbook of behavioral state control: cellular and molecular mechanisms. Boca Raton: CRC Press; 1999. p. 143-58.
  4. ^ Mahowald MW, Schenk CH. dissociated states of wakefulness and sleep. Neurology. 1992; 42(7 Suppl 6):44-51.
  5. ^ Nobili, Lino; De Gennaro, Luigi; Proserpio, Paola; Moroni, Fabio; Sarasso, Simone; Pigorini, Andrea; De Carli, Fabrizio; Ferrara, Michele (2012), "Local aspects of sleep", Progress in Brain Research, vol. 199, Elsevier, pp. 219–232, doi:10.1016/b978-0-444-59427-3.00013-7, ISBN 9780444594273, retrieved 2019-06-23
  6. ^ Nobili, Lino; Ferrara, Michele; Moroni, Fabio; De Gennaro, Luigi; Russo, Giorgio Lo; Campus, Claudio; Cardinale, Francesco; De Carli, Fabrizio (2011). "Dissociated wake-like and sleep-like electro-cortical activity during sleep". NeuroImage. 58 (2): 612–619. doi:10.1016/j.neuroimage.2011.06.032.
  7. ^ Peter-Derex, Laure; Magnin, Michel; Bastuji, Hélène (2015). "Heterogeneity of arousals in human sleep: A stereo-electroencephalographic study". NeuroImage. 123: 229–244. doi:10.1016/j.neuroimage.2015.07.057.
  8. ^ Bassetti et al., Lancet (2000); 356: 484–485
  9. ^ Brandon Peters. 2011.
  10. ^ a b Mahowald & Schenck: 1283.
  11. ^ a b c d Bjorvatn, Bjørn; Grønli, Janne; Pallesen, Ståle (2010). "Prevalence of different parasomnias in the general population". Sleep Medicine. 11 (10): 1031–1034. doi:10.1016/j.sleep.2010.07.011.
  12. ^ Ohayon MM, Priest RG, Zulley J, Smirne S. The place of confusional arousals in sleep and mental disorders: findings in a general population sample of 13,057 subjects. J Nerv Ment Dis. 2000;188(6):340-8.
  13. ^ Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry. 1999;60(4):268-76.
  14. ^ "Sleep education". {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  15. ^ Durmer & Chervin. 2007.
  16. ^ "R. v. Luedecke, 2008 ONCA 716". CanLII.org. October 17, 2008.
  17. ^ Ingravallo, Francesca; Poli, Francesca; Gilmore, Emma V.; Pizza, Fabio; Vignatelli, Luca; Schenck, Carlos H.; Plazzi, Giuseppe (2014-08-15). "Sleep-Related Violence and Sexual Behavior in Sleep: A Systematic Review of Medical-Legal Case Reports". Journal of Clinical Sleep Medicine. doi:10.5664/jcsm.3976. ISSN 1550-9389.
  18. ^ Mahowald & Schenck. 1283.
  19. ^ ADAMinc.2012.
  20. ^ Katugampola, M. (2005) Health & Human Development, Pearson Education.
  21. ^ a b American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. American Psychiatric Publishing. ISBN 9780890425558. OCLC 1031488488.
  22. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z Fleetham, J. A.; Fleming, J. A. E. (2014-05-13). "Parasomnias". Canadian Medical Association Journal. 186 (8): E273–E280. doi:10.1503/cmaj.120808. ISSN 0820-3946.
  23. ^ O???Reardon, John P; Peshek, Andrew; Allison, Kelly C (2005). "Night Eating Syndrome". CNS Drugs. 19 (12): 997–1008. doi:10.2165/00023210-200519120-00003. ISSN 1172-7047.
  24. ^ "Tuck Sleep". {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  25. ^ Mahowald & Schenck:1284.
  26. ^ a b c d McCarter, S., & Howell, J. (2017). REM Sleep Behavior Disorder and Other Sleep Disturbances in Non-Alzheimer Dementias. Current Sleep Medicine Reports, 3(3), 193-203.
  27. ^ Aurora, R., Zak, R., Maganti, R., Auerbach, S., Casey, K., Chowdhuri, S., . . . Morgenthaler, T. (2010). Best practice guide for the treatment of REM sleep behavior disorder (RBD). Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 6(1), 85-95.
  28. ^ Mahowald & Schenck :1284.
  29. ^ a b c Bjørnarå, Dietrichs, & Toft. (2013). REM sleep behavior disorder in Parkinson's disease – Is there a gender difference? Parkinsonism and Related Disorders, 19(1), 120-122.
  30. ^ a b c Bjørnarå, K., Dietrichs, E., & Toft, M. (2015). Longitudinal assessment of probable rapid eye movement sleep behaviour disorder in Parkinson's disease. European Journal of Neurology, 22(8), 1242-1244.
  31. ^ Dauvilliers, B., Yves, Postuma, Livia, Ronald, Ferini-Strambi, Livia, Luigi, Arnulf, Livia, Isabelle, Högl, Livia, Birgit, Manni, Livia, Raffaele, . . . Montplaisir, Livia, Jacques. (2013). Family history of idiopathic REM behavior disorder: A multicenter case-control study. Neurology, 80(24), 2233-2235.
  32. ^ Boeve et al.
  33. ^ Sharpless, Brian A.; Barber, Jacques P. (2011). "Lifetime prevalence rates of sleep paralysis: A systematic review". Sleep Medicine Reviews. 15 (5): 311–315. doi:10.1016/j.smrv.2011.01.007.
  34. ^ a b c Singh, Shantanu; Kaur, Harleen; Singh, Shivank; Khawaja, Imran (2018-12-31). "Parasomnias: A Comprehensive Review". Cureus. doi:10.7759/cureus.3807. ISSN 2168-8184.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  35. ^ "Alaska Sleep Clinic". {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  36. ^ Ivanenko, Anna; Relia, Sachin (2013), Kothare, Sanjeev V.; Ivanenko, Anna (eds.), "Sleep-Related Hallucinations", Parasomnias, Springer New York, pp. 207–220, doi:10.1007/978-1-4614-7627-6_14, ISBN 9781461476269, retrieved 2019-06-23
  37. ^ Mahowald, Mark W.; Schenck, Carlos H. (2000-01-01). "Diagnosis and management of parasomnias". Clinical Cornerstone. 2 (5): 48–54. doi:10.1016/S1098-3597(00)90040-1. ISSN 1098-3597.
  38. ^ Chokroverty, Sudhansu; Thomas, Robert J. (2014), "Specialized Techniques", Atlas of Sleep Medicine, Elsevier, pp. 255–299, doi:10.1016/b978-1-4557-1267-0.00014-x, ISBN 9781455712670, retrieved 2019-06-23
  39. ^ a b "Disorders That Disrupt Sleep: Parasomnia Causes & Types". eMedicineHealth. Retrieved 2019-06-23.

Further reading

  • Siegel, Ronald (1992). Fire in the Brain: Clinical Tales of Hallucination.
  • Warren, Jeff (2007). The Head Trip: Adventures on the Wheel of Consciousness. ISBN 978-0-679-31408-0.
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