Non-Rapid Eye Movement Sleep Arousal Disorders

Non-rapid eye movement (NREM) sleep arousal disorders involve repeated episodes of incomplete awakening from sleep, most commonly ... Skiptomaincontent Non-RapidEyeMovementSleepArousalDisorders ReviewedbyPsychologyTodayStaff Non-rapideyemovement(NREM)sleeparousaldisordersinvolverepeatedepisodesofincompleteawakeningfromsleep,mostcommonlysleepwalkingornightterrors(alsoknownassleepterrors),butoccasionallymorecomplexbehaviors.Theseepisodesusuallyhappenduringthefirstthirdofthenight,andpeoplehavenomemoryoftheepisodesinthemorning.NREMsleeparousaldisordersoccurmostcommonlyinchildhoodandlessoftenaspeopleage. Contents Symptoms Causes Treatment Symptoms PeopleexperiencingNREMsleeparousalareconsideredpartiallyasleepandpartiallyawakeduringepisodes,whichusuallylastnomorethan10minutes,althoughonecanoccasionallyextendtoanhour.Astheindividual’seyesaretypicallyopenduringtheseepisodes,theycanbedisconcertingforpartnersorfamilymemberswhowitnessthem. ForadiagnosisofNREMsleeparousaldisorderstobemade,episodesmustcausetheindividualclinicallysignificantdistressorimpairment—orsignificantlydisruptthelivesofmembersoftheirhouseholds.Episodescanindeeddisruptsocial,romantic,orfamilialrelationships,andcausesignificantembarrassmenttothepersonexperiencingthem.Aclinicianwillgenerallyconsiderthedisruptiveeffectsoftheepisodesmorethantheirfrequencywhendeterminingadiagnosisortreatmentpath. Whatarethemajorsymptomsofsleepwalking? CreatedwithSketch. Thetermsleepwalkingdoesnotonlyrefertowalkingbutcanapplytoarangeofbehaviors,somecomplex,whichcanalsoincludetalkinginone’ssleepandusingthebathroom.Generallysleepwalkinginvolvesrisingfrombedandwalkingaround;aswithotherNREMsleeparousalepisodes,thesearemostlikelytooccurinthefirstthirdofthenight,duringslow-wavesleep. Anindividualwhoissleepwalkinghasreducedalertnessandresponsivenessandablankstare.Theywillgenerallynotrespondtoeffortsbyotherstowakethemortalktothem.Iftheyareawakenedduringanepisodetheycouldbedisorientedforatime,andwilllikelyhavenoorlimitedrecallfortheepisode,butwillthenexperienceafullrecoveryofcognitivefunctionandappropriatebehavior. Canpeopleinjurethemselveswhilesleepwalking? CreatedwithSketch. Yes,butitisnotcommon.Sleepwalkershavebeenreportedtodrivecars—evenmotorcycles—orotherwiseventureoutintotheworldwhilebeingbasicallyunconscious.Onrareoccasions,sleepwalkershavecommittedviolentacts,includingmurder.Someindividualshavefallenoffofroofsorseemedtodiebysuicidewhileapparentlysleepwalking,althoughitisextremelyrareandtheindividual’sstateofmindinsuchepisodesisdifficulttoconfirm. Dosomepeopleactuallyeatorhavesexwhilesleepwalking? CreatedwithSketch. Yes.Sleep-relatedeatingbehaviorandsleep-relatedsexualbehavior(knownassexsomnia)arespecific,less-commonformsofsleepwalking.Individualswithsleep-relatedeatingcanexperiencerepeated,unintentionalepisodesofeating.Inthesecases,manywillhavenomemoryoftheepisodes,aswithotherformsofsleepwalking,butsomepeoplereportbeingfullyawareofthebehaviorwhilebeingpowerlesstostopit.Duringepi­sodes,peoplemayconsumeinappropriatefoods.   Whatissexsomnia? CreatedwithSketch. Apersonwhoexperiencessexsomniamayengageinmasturbation,fondling,groping,oractualsexualintercoursewhilesleeping,withoutconsciousawareness:Theindividualengaginginthesebehaviorsmayhavetheireyesopenandmayspeakormakenoises,buttheywillgenerallyappearvacantorblank,“glassy-eyed,”and/ornonresponsive,andtheywilltypicallynotremembertheepisodewhentheyawaken.Inwomen,theconditionmostoftenmanifestsasmasturbationwhilesleeping.Menexihibitawiderrangeofbehaviorsincludingengaginginintercourse.Theprevalenceofsexsomniaisunknownbecausesofewpeoplewiththeconditionareawaretheyhaveit,butitismorecommoninmalesanditcanhaveseriousnegativesocialandevenlegalconsequences.  Whatarethemajorsymptomsofnightterrors? CreatedwithSketch. Nightterrorsinvolverepeatedawakeningsfromdeepsleepbyintensefear,usuallybeginningwithacryorscreamofpanic;aswithotherNREMsleeparousalepisodes,thesearemostlikelytooccurinthefirstthirdofthenight,duringslow-wavesleep.Episodestypicallybeginwiththeindividualabruptlysittingupinbedandscreamingorcrying.Anightterrorgenerallylasts1-10minutesbutsomechildrenmayexperiencesignificantlylongerepisodes. Thebehavioralmanifestationofanightterrorisdrivenbyintensefearand,often,asenseofdreadandanurgetoescape.Theindividualexperiencingitwillhaveafrightenedexpressionanddisplaysignsofintenseanx­ietylikesweatingorrapidbreathing.Thepersonisdifficulttoawakenorcomfortandiftheydoawakenorareawakened,theywillgenerallyrememberverylittleabouttheexperience,althougholderchildrenandadultsareincreasinglylikelytorecallthefearfulimagessometimesassociatedwithnightterrors.(Episodesusuallydon’tinvolvecompletestoriesasdreamsornightmaresmight.) Arenightterrorsthesameasnightmares? CreatedwithSketch. No.Nightmarestendtooccurlaterintheevening,mostoftenduringREMsleep.Peoplecanawakenfromnightmareseasilyandcompletely,andoftencanrememberwhatwasoccurringinthescaryordisturbingdream. Arenightterrorsthesameasrapideyemovement(REM)sleepbehaviordisorder? CreatedwithSketch. No.PeoplewithREMsleepbehaviordisorderreactphysicallytowhattheyaredreaming,vocalizing,screaming,orengagingincomplexandsometimesviolentmotorbehaviors.Such“dreamenactingbehavior”typicallyreflectsthecontentofaction-filledorviolentdreamsinwhichapersonisbeingattackedortryingtoescapedanger,butanysuchepisodewouldbedistinctfromanightterror.Unlikenightterrors,REMsleepbehaviordisordergenerallyoccursinpeopleover50,andthoseindividualscanrememberthecontentoftheinvolveddreams. Cansomeonebothsleepwalkandhavenightterrors? CreatedwithSketch. Yes,butatdifferenttimes.TheunderlyingmechanismcausingNREMsleepdisorders—thesimultaneousoccurrenceofwakefulnessandNREMsleep—isthesameforbothbehaviorssoanindividualcanexperienceboth. articlecontinuesafteradvertisement Causes NREMsleepbehaviordisorderappearstohaveastronggeneticcomponent.Afamilyhistorymaybepresentinupto80percentofpeoplewhoexperiencesleepwalking,andwhenbothparentshaveahistoryofsleepwalking,theirchildrenhavemorethana50/50chanceofdevelopingtheconditionthemselves.Someonewithafirst-degreebiologicalrelativewhohasexperiencednightterrorsmaybeasmuchas10timesmorelikelytoexperiencethemthemselves,ascomparedtothosewithoutsuchafamilyhistory. HowprevalentareNREMsleeparousaldisorders? CreatedwithSketch. OccasionalincidencesofNREMsleeparousalarefairlycommon;10to30percentofchildrenhavehadatleastoneepisodeofsleepwalking,and2to3percentofchildrensleepwalkoften.Theprevalenceofoccasionalsleepwalkingepisodesamongadultsisestimatedbetween1and7percent,butfewerthan1percentofadultsexperiencesleepwalkingasfrequentlyasonceamonth. Therateofsleepterrorsismoredifficulttoestimate.Itmayaffectasmanyasoneinfivechildrenbeforeage3,buttheprevalenceamongadultsisabout2percent. AremenorwomenmorelikelytohaveNREMsleeparousaldisorders? CreatedwithSketch. Sleepwalkingoccursmoreofteninfemalesduringchildhoodandmoreofteninmalesduringadulthood.Eatingduringsleepwalkingepisodesismorecommoninfemales,whilesexsomniaismorecommoninmales.Sleepterrorsaremorecommoninboysthangirls,butamongadults,thesexratioappearstobeeven. DoNREMsleeparousaldisorderseverdevelopinadults? CreatedwithSketch. TheoccurrenceofNREMsleeparousaldisordersinadultswhodidnotexperienceepisodesaschildrenisrare.Whenitoccurs,generallyintheformofsleepwalking,cliniciansshouldinvestigatepotentialcausessuchassleepapnea,nocturnalseizures,orthesideeffectsofmedication. ArethereriskfactorsforepisodesofNREMsleepbehaviordisorder? CreatedwithSketch. Yes,severalriskfactorscanincreasethelikelihoodofepisodesinpeoplewhomaybepronetoepisodesofNREMsleepbehaviordisorder,includingsedativeuse,fever,sleepdeprivation,sleepscheduledisruptions,exhaustion,andphysicaloremotionalstress. CanNREMsleepbehaviorleadtodepression? CreatedwithSketch. Anassociationhasbeenfoundinadultsbetweensleepwalkingandmajordepressiveepisodesandobsessive-compulsivedisorder.Bothchildrenandadultswhoexperiencesleepterrorsmayscorehigheronmeasuresofdepressionandanxiety.  Treatment TreatmentapproachesforNREMsleepbehaviordisorderwilldependontheseverityofthecondition.Mostchildren,forexample,growoutofthedisorderintime.So,whileitmaybedisturbingfortheirparents,sometimesintenselyso,thechildisneitherawareofthebehaviornorinanyphysicaldangerandnotreatmentmaybenecessary. Forthoseofanyageexperiencingepisodes,establishingbettersleephabits,startingwithgettingenoughsleepeachnight,mayhelpreducetheirfrequency.Alcoholuseshouldalsobereducedamongadultswiththiscondition. Whenepisodesarefrequentorcreateadangeroussituationforanindividualortheirbedpartner,changescanbemadeinthesleepenvironmenttopromotesafety.Suchchangescaninclude: Paddingtheflooraroundthebedwithamattressorpillows Paddingcornersofnearbyfurniture Windowprotection Removingdangerousobjects,suchasgunsorsharpobjects,fromthebedroomarea Lockingdoorsandwindows Sleepinginaseparateroomfromthebedpartneruntilsymptomsareundercontrol Inseverecases,medicationmaybeprescribedtoreducethefrequencyofepisodes. References DiagnosticandStatisticalManualofMentalDisorders,FifthEdition Markov,D.,Jaffe,F.,&Doghramji,K.(2006).UpdateonParasomnias:AReviewforPsychiatricPractice. Psychiatry(Edgmont), 3(7),69–76. 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