Summary about Disease
Non-Rapid Eye Movement (NREM) sleep arousal disorders are a group of parasomnias characterized by incomplete awakenings from NREM sleep, typically occurring during the deepest stages of sleep (stages N3). These disorders manifest as abnormal behaviors, experiences, or physiological events that disrupt sleep and can pose risks to the individual and others. The primary types of NREM sleep arousal disorders include sleepwalking (somnambulism), sleep terrors (night terrors), and confusional arousals. While generally benign, they can cause significant distress and disruption.
Symptoms
Symptoms vary depending on the specific type of NREM sleep arousal disorder:
Sleepwalking: Getting out of bed and walking around, often with a blank stare; difficulty waking up; lack of awareness of surroundings; performing complex activities such as eating, dressing, or even leaving the house; potential for injury.
Sleep Terrors: Abrupt awakenings from sleep with intense fear, screaming, and panic; rapid heart rate and breathing; sweating; dilated pupils; unresponsiveness to comfort; difficulty remembering the event afterward.
Confusional Arousals: Disorientation and confusion upon awakening; slow speech and thinking; impaired cognitive function; difficulty answering questions or following instructions; wandering around aimlessly. Other symptoms may include: Aggression during an event Injury to self or others during an event *Daytime drowsiness because sleep is interrupted
Causes
The exact causes are not fully understood, but several factors are believed to contribute:
Genetics: There is a strong genetic component to NREM sleep arousal disorders.
Sleep Deprivation: Insufficient sleep can trigger or worsen these disorders.
Stress: Psychological stress can increase the frequency of events.
Fever: Especially in children, fever can trigger sleep terrors.
Medications: Some medications, such as sedatives and antidepressants, have been linked to these disorders.
Underlying Medical Conditions: Sleep apnea, restless legs syndrome, and other medical conditions can contribute.
Alcohol and Drug Use: Alcohol and illicit drugs can trigger episodes.
Environmental Factors: Changes in sleep environment or disruptions to sleep schedule.
Medicine Used
Medication is not always necessary, but may be used to reduce the frequency or severity of episodes. Common medications include:
Benzodiazepines: Such as clonazepam or diazepam, to suppress sleep arousal and reduce anxiety.
Selective Serotonin Reuptake Inhibitors (SSRIs): Such as paroxetine, sertraline to manage underlying anxiety or depression.
Tricyclic Antidepressants: Such as imipramine, to suppress sleep arousal.
Melatonin: A hormone that regulates sleep-wake cycles, may be helpful in some cases.
Is Communicable
NREM sleep arousal disorders are not communicable. They are not caused by infectious agents and cannot be transmitted from person to person.
Precautions
Safety Measures: Secure the environment to prevent injury during episodes, such as locking doors and windows, removing sharp objects, and installing alarms.
Sleep Hygiene: Maintain a regular sleep schedule, create a relaxing bedtime routine, and avoid caffeine and alcohol before bed.
Stress Management: Practice relaxation techniques such as meditation, yoga, or deep breathing exercises.
Medical Evaluation: Consult a healthcare provider to rule out underlying medical conditions.
Family Education: Educate family members and caregivers about the disorder and how to respond during episodes.
Avoid triggers: Identify and avoid any known triggers, such as sleep deprivation or alcohol consumption.
How long does an outbreak last?
An "outbreak" is not applicable as this is not an infectious disease. Episodes of NREM sleep arousal disorders are typically brief, lasting from a few seconds to several minutes. The overall duration of the disorder can vary widely, from a few weeks or months to chronic, lifelong symptoms. Frequency of episodes can also vary.
How is it diagnosed?
Diagnosis typically involves:
Medical History: Detailed information about sleep habits, symptoms, and family history.
Physical Examination: To rule out underlying medical conditions.
Polysomnography (Sleep Study): Overnight monitoring of brain waves, heart rate, breathing, and muscle activity to identify abnormal sleep patterns.
Video EEG Monitoring: Capturing and recording the brain activity along with video to document the events.
Sleep Diary: Patient records of sleep patterns, duration, and any associated events.
Clinical Interview: Discussion with a healthcare provider about symptoms, triggers, and impact on daily life.
Timeline of Symptoms
The timeline of symptoms is variable and depends on the individual.
Childhood Onset: Sleep terrors are most common in childhood (ages 3-12), often resolving by adolescence. Sleepwalking can also start in childhood.
Adolescent/Adult Onset: Can begin in adolescence or adulthood, often triggered by stress, sleep deprivation, or underlying medical conditions.
Episodic: Symptoms may occur sporadically, with periods of remission.
Chronic: Symptoms may persist over many years.
Triggers: Episodes are often triggered by specific events or conditions, such as stress, fever, or sleep deprivation.
Fluctuating Severity: The severity of symptoms can vary over time.
Important Considerations
Safety: Prioritize the safety of the individual and others during episodes.
Co-morbidities: NREM sleep arousal disorders can co-exist with other sleep disorders or mental health conditions.
Impact on Quality of Life: Episodes can disrupt sleep, cause daytime drowsiness, and impair cognitive function, affecting daily life.
Psychological Impact: Can lead to anxiety, fear, and embarrassment.
Differential Diagnosis: It is important to differentiate NREM sleep arousal disorders from other sleep disorders, such as nightmares, REM sleep behavior disorder, and seizures.
Long-term Management: Requires a comprehensive approach involving lifestyle modifications, therapy, and, in some cases, medication.