Summary about Disease
Non-REM parasomnias are a group of sleep disorders characterized by undesirable physical events, experiences, or behaviors that occur during non-rapid eye movement (NREM) sleep, particularly during the deeper stages of sleep (stage 3 and 4). These behaviors can range from relatively benign events like sleepwalking to more complex and potentially dangerous activities. They often involve a dissociation between sleep and wakefulness, where the individual is partially aroused but not fully conscious.
Symptoms
Symptoms vary depending on the specific type of NREM parasomnia, but common ones include:
Sleepwalking (Somnambulism): Walking or performing other complex behaviors while asleep.
Sleep Terrors: Abrupt awakenings from sleep with intense fear, screaming, rapid heart rate, and heavy breathing. The person may appear terrified and inconsolable.
Confusional Arousals: Disorientation and confusion upon waking, often with slow speech and impaired cognition.
Sleep Talking (Somniloquy): Talking in one's sleep.
Sleep Eating: Consuming food while asleep, often without recollection.
Sexsomnia: Engaging in sexual behaviors while asleep.
Causes
The exact causes of NREM parasomnias are not fully understood, but contributing factors may include:
Genetics: A family history of parasomnias increases the risk.
Sleep Deprivation: Lack of sufficient sleep can trigger or worsen episodes.
Stress: Stressful life events can be a trigger.
Fever: Especially in children.
Alcohol and Drug Use: Certain substances can disrupt sleep architecture.
Certain Medications: Some medications can trigger parasomnias.
Underlying Medical Conditions: Conditions like restless legs syndrome, sleep apnea, migraines, and certain neurological disorders may be associated.
Environmental Factors: Changes in the sleep environment or disruptions to sleep schedule.
Medicine Used
Medications are not always necessary, but when used, they typically aim to improve sleep quality or suppress the abnormal behaviors. Common medications include:
Benzodiazepines: Such as clonazepam, which can suppress stage 3 and 4 sleep.
Selective Serotonin Reuptake Inhibitors (SSRIs): Some SSRIs may be helpful in reducing the frequency of parasomnias.
Tricyclic Antidepressants (TCAs): Such as imipramine, can be used to suppress deep sleep.
Melatonin: May help regulate sleep-wake cycles and improve sleep quality.
Is Communicable
No, NREM parasomnias are not communicable. They are not caused by infectious agents and cannot be transmitted from one person to another.
Precautions
Precautions focus on preventing injury and creating a safe sleep environment:
Safety Measures: Lock doors and windows, remove sharp or dangerous objects from the bedroom and surrounding areas. Install alarms if the individual tends to wander outside.
Sleep Hygiene: Maintain a regular sleep schedule, avoid caffeine and alcohol before bed, create a relaxing bedtime routine.
Stress Management: Practice relaxation techniques, such as meditation or deep breathing exercises.
Medical Evaluation: Rule out any underlying medical conditions that may be contributing to the parasomnias.
Inform Bed Partners: Educate bed partners or family members about the parasomnia and what to do if an episode occurs. The best course of action is generally to gently guide the person back to bed.
How long does an outbreak last?
NREM parasomnias are not outbreaks, they are conditions that can present with varying frequency and duration of events. The duration of an episode can range from a few seconds to 30 minutes or longer. Some individuals may experience parasomnias only occasionally, while others may have them more frequently, even nightly. The overall duration of the condition can vary significantly from person to person. Some individuals may experience parasomnias for a limited period of time, such as during childhood, while others may have them throughout their lives.
How is it diagnosed?
Diagnosis typically involves:
Medical History: A detailed review of the individual's sleep habits, medical history, and family history.
Physical Examination: To rule out any underlying medical conditions.
Sleep Study (Polysomnography): An overnight sleep study in a sleep laboratory to monitor brain waves, eye movements, muscle activity, heart rate, and breathing patterns. This can help identify the specific type of parasomnia and rule out other sleep disorders.
Video EEG Monitoring: Simultaneous video and EEG monitoring can capture the events and correlate them with brain activity.
Sleep Diary: A daily log of sleep patterns and any abnormal behaviors.
Timeline of Symptoms
The timeline of symptoms varies, but generally:
Childhood Onset: Sleep terrors and sleepwalking are more common in children, typically starting between ages 3 and 7. They may decrease or resolve during adolescence.
Adult Onset: Parasomnias can also begin in adulthood, often triggered by stress, sleep deprivation, or underlying medical conditions.
Episodic or Chronic: Symptoms can occur occasionally (episodically) or more frequently (chronically), depending on the individual and the contributing factors.
Variability: The frequency and severity of episodes can fluctuate over time.
Important Considerations
Safety: Prioritize safety to prevent injury during episodes.
Co-existing Conditions: Consider and treat any underlying medical or psychological conditions that may be contributing to the parasomnias.
Impact on Daily Life: Assess the impact of the parasomnias on the individual's quality of life, relationships, and daily functioning.
Legal Implications: Be aware of the potential legal implications of complex behaviors that occur during sleep.
Consultation with a Sleep Specialist: Seek evaluation and treatment from a sleep specialist for accurate diagnosis and management.