Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders

Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders Primer Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders consists of two separate, ... Menu Menu Home On-Call+Resources Psychopharmacology TeachingFiles Psychotherapy CognitiveTesting Neurology PersonalityDisorders TableofContents Non-RapidEyeMovement(NREM)SleepArousalDisorders Primer DSM-5DiagnosticCriteria Specifiers Pathophysiology DifferentialDiagnosis ComparisonofParasomnias Resources ForPatients ForProviders Non-RapidEyeMovement(NREM)SleepArousalDisorders TableofContents Non-RapidEyeMovement(NREM)SleepArousalDisorders Primer DSM-5DiagnosticCriteria Specifiers Pathophysiology DifferentialDiagnosis ComparisonofParasomnias Resources ForPatients ForProviders Primer Non-RapidEyeMovement(NREM)SleepArousalDisordersconsistsoftwoseparate,butrelatedparasomniadisorders:sleepwalkingandsleepterrors(nightterrors).Bothoftheseconditionsconsistofrepeatedoccurrenceofincompletearousals,usuallybeginningduringthefirstthirdofthemajorsleepepisode,thattypicallyarebrief,lasting1-10minutes,butmaybeprotracted,lastingupto1hour.Themaximumdurationofaneventisunknown.Theeyesaretypicallyopenduringtheseevents. ParasomniasNon-RapidEyeMovement(NREM)SleepArousalDisordersSleepTerrorsSleepwalkingRapidEyeMovement(REM)SleepBehaviourDisorderNightmareDisorderPeriodicLimbMovementDisorder(PLMD)RestlessLegsSyndrome(RLS) Prevalence IsolatedorinfrequentNREMsleeparousaldisordersareverycommoninthegeneralpopulation.Themostcommonnon-rapideyemovement(NREM)parasomniasinchildrenarethedisordersofarousal(e.g.,sleepwalking,nightterrors,andconfusionalarousals),whichoccurmostcommonlyinthefirsthalfofthenight. DSM-5DiagnosticCriteria CriterionA Recurrentepisodesofincompleteawakeningfromsleep,usuallyoccurringduringthefirstthirdofthemajorsleepepisode,accompaniedbyeitheroneofthefollowing: Sleepwalking:Repeatedepisodesofrisingfrombedduringsleepandwalkingabout.Whilesleepwalking,theindividualhasablank,staringface;isrelativelyunresponsivetotheeffortsofotherstocommunicatewithhimorher;andcanbeawakenedonlywithgreatdifficulty.Seemainarticle:Sleepwalking Sleepterrors:Recurrentepisodesofabruptterrorarousalsfromsleep,usuallybeginningwithapanickyscream.Thereisintensefearandsignsofautonomicarousal,suchasmydriasis,tachycardia,rapidbreathing,andsweating,duringeachepisode.Thereisrelativeunresponsivenesstoeffortsofotherstocomforttheindividualduringtheepisodes.Seemainarticle:SleepTerrors(NightTerrors) CriterionB Noorlittle(e.g.,onlyasinglevisualscene)dreamimageryisrecalled. CriterionC Amnesiafortheepisodesispresent. CriterionD Theepisodescauseclinicallysignificantdistressorimpairmentinsocial,occupational,orotherimportantareasoffunctioning. CriterionE Thedisturbanceisnotattributabletothephysiologicaleffectsofasubstance(e.g.,adrugofabuse,amedication). CriterionF Co-existingmentalandmedicaldisordersdonotexplaintheepisodesofsleepwalkingorsleepterrors. Specifiers Specifiers Specifyif: Sleepwalkingtype Withsleep-relatedeating sleep-relatedsexualbehavior(sexsomnia) Sleepterrortype Pathophysiology Manyindividualsexhibitbothsubtypesofarousals(sleepwalkingandnightterrors)ondifferentoccasions,whichsuggestsaunifyingunderlyingpathophysiology.SleepwalkingandnightterrorsreflectvaryingdegreesofsimultaneousoccurrenceofwakefulnessandNREMsleep,resultingincomplexbehavioursarisingfromsleepwithvaryingdegreesofconsciousawareness,motoractivity,andautonomicactivation. DifferentialDiagnosis Nightmaredisorder Breathing-relatedsleepdisorders REMsleepbehaviourdisorder Parasomniaoverlapsyndrome Sleep-relatedseizures Alcohol-inducedblackouts Dissociativeamnesia,withdissociativefugue Malingeringorothervoluntarybehaviouroccurringduringwakefulness Panicdisorder Medication-inducedcomplexbehaviours Nighteatingsyndrome ComparisonofParasomnias MnemonicYoucanREMemberevents(i.e.-noconfusion,noamnesia)inREMparasomnias! ComparisonofParasomnias ParasomniaTypeStageofArousalTimeofNightEEGduringeventEMGduringeventUnresponsiveduringeventAutonomicactivityAnmesiaConfusionpost-episodeFamilyhistoryofparasomnias ConfusionalArousalNREMNREMStage2-4AnytimeN/ALowYesLowYesYesYes SleepwalkingNREMNREMStage3-4First2hoursMixedLowYesLowYesYesYes SleepterrorsNREMNREMStage3-4First2hoursMixedLowYesHighYesYesYes REMsleepbehaviourdisorderREMREMAnytime(butmorelikelylaterhalf)CharacteristicofREMHighYesHighNoNo(canrememberthedreams!)No NightmaredisorderREMREMAnytimeN/AN/AYesHighNoNo(canrememberthedreams!)No EEG=electroencephalogram,EMG=electromyogram Resources ForPatients ForProviders Articles Research