Rapid eye movement sleep behavior disorder
Sep. 01, 2022
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This article includes discussion of idiopathic insomnia, childhood-onset insomnia, and lifelong insomnia. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
The following article discusses a rare form of insomnia: idiopathic or childhood-onset insomnia. It is a chronic and serious inability to initiate and maintain sleep, often observed as early as the first few weeks of life. The most recent advancement in the treatment of this condition is the demonstration that melatonin not only improves sleep, but also improves overall health status in these patients.
• The onset of idiopathic insomnia is usually in childhood, but not every case of childhood-onset insomnia is idiopathic insomnia.
• Its course is chronic and life-long, and there is no clearly identifiable cause.
• Polysomnography offers little diagnostic value in idiopathic insomnia; actigraphy might be more helpful.
• Benzodiazepine receptor agonists or melatonin, in addition to strict sleep hygiene practices, may be effective in treating idiopathic insomnia patients.
In the 1979 Sleep Nosology developed by the Association of Sleep Disorders Centers, now the American Academy of Sleep Medicine, a new category titled "childhood onset insomnia" was presented. It was described as "a sleep-onset and sleep-maintenance insomnia, resulting in daytime symptoms of inadequate sleep, that is characterized by a distinctive history of (unexplained) development before puberty and persistence into adulthood." It was postulated that this new entity represented "a CNS shift or dysfunction of the sleep-arousal equilibrium" (06). Research in the 1980s documented the existence of such an insomnia by showing that childhood-onset insomnia was different from adult-onset insomnia on polysomnographic grounds and that it could be distinguished from other types of insomnia in a cluster analysis. The International Classification of Sleep Disorders defines idiopathic insomnia as a lifelong sleep difficulty with insidious onset occurring during infancy or early childhood that causes distress or functional impairment and is not better explained by another sleep disorder, medical or neurologic condition, psychiatric disorder, medication use, or substance use (01). However, not everyone agrees that this disorder is a separate and unique type of insomnia. For example, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders regards the apparent neurologic predisposition toward insomnia described here as a component of a broader entity named "primary insomnia disorder" that includes idiopathic insomnia, psychophysiological insomnia, and sleep state misperception (paradoxical insomnia). The International Classification of Sleep Disorders, third edition (ICSD-3) describes idiopathic insomnia as a pathophysiological subtype of chronic insomnia disorder (02).
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