Parasomnia Sleeping Disorders

Sleep Disorders

• Sleep disorders related to sleep quantity, quality, and timing are categorized as insomnia and hypersomnia disorders.

Parasomnias

• Parasomnias are characterized by abnormal movements or behaviors that occur during sleep.
• The hallmark of NREM arousal disorder, a type of parasomnia, is partial arousal from deep sleep, often accompanied by automatic behaviors.
• NREM arousal disorders most often occur during the first third of the night.
• A common trigger for NREM arousal disorders is stress, which can lead to partial awakenings.
• The occurrence of NREM arousal disorders is likely explained by a stress-diathesis model, where stress triggers an underlying predisposition to the disorder.

Characteristics of Parasomnias

• The brain's state during parasomnias like NREM arousal disorder is characterized by a mixture of wakefulness and sleep.
• Individuals with NREM arousal disorders may perform complex tasks, such as cooking or driving, during deep sleep episodes.
• A common characteristic of individuals experiencing NREM arousal disorders is that they are often unaware of their actions during these episodes.
• Individuals with NREM arousal disorders typically have little to no recall of the episodes the following morning.

NREM Parasomnia Sleep Terrors

• Sleep terrors are characterized by intense fear, screaming, and thrashing during deep sleep.
• Behaviors exhibited during sleep terrors may include sitting up, walking, or running.
• The sleeper typically responds to attempts to wake them during sleep terrors by becoming agitated or violent.
• Memory recall for individuals who experience sleep terrors after being woken is often fragmented or non-existent.
• Individuals with sleep terrors typically have little to no recall of the episodes the following morning.

Management of NREM Arousal Disorders

• A potential reason for not requiring treatment for NREM arousal disorders is that they are often not frequent or severe enough to cause significant distress.
• Individuals experiencing occasional NREM arousal disorder episodes are recommended to practice good sleep hygiene and avoid sleep deprivation.
• The suggested action for someone witnessing an individual experiencing an NREM arousal episode is to gently restrain them to prevent injury.
• Benzodiazepines are typically considered the first-line treatment for NREM arousal disorders.
• Good sleep hygiene and avoiding sleep deprivation can contribute to the management of NREM arousal disorders by reducing triggers.

REM-Sleep Behavior Disorder

• REM-Sleep Behavior Disorder is characterized by the acting out of dreams during REM sleep.
• Examples of movements and vocalizations commonly associated with REM-Sleep Behavior Disorder include talking, laughing, and violent behaviors.
• The key mechanism that goes awry in REM-Sleep Behavior Disorder is the paralysis that normally accompanies REM sleep.
• Approximately 0.5% of adults are estimated to be affected by REM-Sleep Behavior Disorder.
• REM-Sleep Behavior Disorder is more common in men than women.

Nightmare Disorder

• Nightmare Disorder is distinguished from other REM Parasomnias by the occurrence of disturbing, vivid dreams that cause significant distress.
• Upon waking from a nightmare, individuals typically experience a cognitive state of rapid alertness.
• Disturbing, vivid dreams must occur at least once a week for a month to meet the diagnostic criteria for Nightmare Disorder.
• Children and adolescents are more likely to experience regular nightmares.
• Individuals with Nightmare Disorder are more likely to have a history of trauma or PTSD.
• The recommended treatments for individuals with Nightmare Disorder include Imagery Rehearsal Therapy and Lucid Dreaming Therapy.

Imagery Rehearsal Therapy

• The foundational concept of Imagery Rehearsal Therapy is to rework the nightmare scenario to reduce its distressing nature.
• The approach commonly used to select a specific nightmare for imagery rehearsal therapy is to identify the most distressing nightmare.
• The first step in the actual process of imagery rehearsal therapy is to write down the details of the selected nightmare.
• When selecting a way to change the nightmare, possibilities include changing the setting, characters, or outcome.
• The step that follows selecting a way to change the nightmare is to rehearse the dream with the selected change in a vivid, imaginal way.
• The rehearsal of the dream with the selected change is conducted in a relaxed, awake state, often with the guidance of a therapist.
• As individuals progress through Imagery Rehearsal Therapy, the occurrence of nightmares decreases, and the distress associated with them is reduced.