Parasomnias

Federica Provini MD (Dr. Provini of the University of Bologna and IRCCS Institute of Neurological Sciences of Bologna received speaker's fees from Bial, Fidia, and Vanda Pharmaceuticals.)
Giuseppe Loddo MD (Dr. Loddo of the University of Bologna has no relevant financial relationships to disclose.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released October 11, 1993; last updated April 1, 2017; expires April 1, 2020

This article includes discussion of parasomnias, NREM parasomnias, arousal disorders, REM parasomnias, confusional arousals, sleep terror, sleepwalking, sleep-related eating disorder, REM sleep behavior disorder, nightmares disorder, recurrent isolated sleep paralysis, and nocturnal enuresis. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Parasomnias are undesirable but not always pathological events. They consist in abnormal behaviors during sleep due to the inappropriate activation of the cognitive process or physiological systems such as the motor and/or autonomic nervous system. For this reason, parasomnias are conditions constituting a window into brain function during sleep. Parasomnias are common in the general population, occurring more frequently in children. When episodes are frequent they can result in sleep disruption and injuries with adverse health or psychosocial consequences for the patients, bed-partners, or both. It is thus necessary for clinicians to recognize, evaluate, and manage these sleep disorders. Many problems hamper a differential diagnosis between non-REM parasomnias and epileptic seizures occurring during sleep. In this article, the authors describe the characteristics of the most frequent parasomnias, suggesting the key points for a decisive diagnostic workup.

Key points

 

• Parasomnias are common, especially among children.

 

• The large number of parasomnias underscores that sleep is not simply a quiescent state, but can involve more or less complex behaviors.

 

• Some parasomnias are usually benign phenomena (eg, sleep terrors); other parasomnias (eg, REM sleep behavior disorder) could lead to injuries affecting not only the patient but also the bed partner.

 

• Parasomnias must be distinguished from epileptic seizures arising from sleep.

 

• Video-polysomnography remains the most useful support for the final diagnosis.

Historical note and terminology

Parasomnias have attracted the interest of writers and scholars for centuries. Their sometimes dramatic manifestations have been described by many. Perhaps the most famous literary examples of parasomnia are the sleepwalking and sleeptalking events by Lady Macbeth in Shakespeare's Macbeth, Moncrieff's Somnambulist, a play regarding a nighttime walking phantom, and Bellini's La Sonnambula, an innocent girl who suffers from a quirk of nature, hence eliciting sympathy and compassion. In the novel Tess of the d'Urbervilles Thomas Hardy describes 1 of the most fascinating and convincing scenes of sleepwalking ever written (Parrino 2016). The description of the monstrous metamorphosis of Gregor Samsa, the protagonist of The Metamorphosis by Kafka, has been interpreted as a nightmare (Perciaccante and Coralli 2016).

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