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Teme Parasomnias

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PARASOMNIAS By; TEMESGEN REGASAoutlineDefinitionClassificationDiscussion of important ParasomniasManagement8/19/2015TEMESGEN REGASA(SMS) the last step of the journey....DefinitionParasomnias are abnormal experiences , movements, behaviors, emotions, perceptions, and dreams that occur during sleepnot abnormalities of the processes responsible for sleep and awake statesare disorders of arousal, partial arousal, and sleep-stage transition

8/19/2015TEMESGEN REGASA(SMS) the last step of the journey....ICSD Classification of Parasomnias

NonRapid Eye Movement Sleep Arousal Disorders Sleepwalking Sleep Terrors confusional arousalsRapid Eye Movement Sleep Behavior Disorder REM Sleep Behavior Disorder (RBD) sleep-related groaning (catathrenia) Nightmare DisorderOther parasomnias;Sleep-Related Dissociative DisorderSleep EnuresisSleep-Related Eating Disorder (SRED)Parasomnias Related to Drug or Substance UseSleep paralysisSleep talkingSleep bruxism etc8/19/2015TEMESGEN REGASA(SMS) International Classification of Sleep Disorders (ICSD)Arousal Disorders B. Sleep-Wake Transition D/o 1. Confusional Arousals 1. Rhythmic movement D/o 2. Sleepwalking 2. Sleep Starts 3. Sleep Terrors 3. Sleep Talking 4. Nocturnal Leg Cramps C. Parasomnias Usually Associated with REM 1. Nightmares D. Other Parasomnias 2. Sleep Paralysis 1. Sleep Bruxism 3. Impaired Sleep-Related Penile Erections 2. Sleep Enuresis 4. Sleep-Related Painful Erections 3. Primary Snoring 5. REM Sleep-Related Sinus Arrest 4. Infant Sleep Apnea 6. REM Sleep Behavior Diso 5. Sleep-Related Abnormal Swallowing Syndrome 6.Nocturnal Paroxysmal Dystonia 7. Sudden Unexplained Nocturnal Death Syndrome 8. Congenital Central Hypoventilation Syndrome 9. Sudden Infant Death Syndrome 10. Benign Neonatal Sleep Myoclonus 11. Other Parasomnia NOS

8/19/2015TEMESGEN REGASA(SMS) Disorders of arousals Abnormal arousal (motor activity is restored without an accompanying full consciousness )Occur during NREM sleep stage N3Predisposing factors (febrile illness ,sleep derivation irregular sleep wake schedules ,stress,alcohol ,distended bladder ,OSA,neuroleptics ,hypnotics ,stimulants)

Types of disorders of arousals 1-confusional arousals 2- sleepwalking 3-sleep terrors.8/19/2015TEMESGEN REGASA(SMS) Diagnostic Criteria

A. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either one of the following: 1. Sleepwalking: Repeated episodes of rising from bed during sleep and walking about. While sleepwalking, the individual has a blank, staring face; is relatively unresponsive to the efforts of others to communicate with him or her; and can be awakened only with great difficulty. 2. Sleep terrors: Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream. There is intense fear and signs of autonomic arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode. There is relative unresponsiveness to efforts of others to comfort the individual during the episodes.B. No or little (e.g., only a single visual scene) dream imagery is recalled.C. Amnesia for the episodes is present.D. The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).F. Coexisting mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors.8/19/2015TEMESGEN REGASA(SMS) Sleep walking (somnambulism)refers to ambulation that occurs during sleep.associated with an altered LOC, arousability, impaired judgment and inappropriate behavior (eg, shouting or climbing out of a window). The behavior can either be calm or agitated and violentEach episode varies widely from minutes to over an houreyes are usually open (described as a blank stare), but attempts to communicate with the sleepwalker are generally unsuccessfulRisk factorsEnvironmental; Sedative use, sleep deprivation, sleep-wake schedule disruptions, fatigue, Fever and stressGenetic; +ve family history in up to 80%8/19/2015TEMESGEN REGASA(SMS) Sleep TerrorsRecurrent abrupt awakenings with profound fear usually from NREM stages III. suddenly bolt upright from their beds with a loud cry, or scream, and in rare instances, sleepwalking or running Associated with misperception of the environment, confusion, amnesia for the episode, autonomic and behavioral manifestations of intense fearPersons with sleep terrors then spontaneously calm down and return rapidly to sleep.Risk factorsEnvironmental; Sedative use, sleep deprivation, sleep-wake schedule disruptions, fatigue, Fever and stressGenetic; more in monozygotic, 10-fold increase among first-degree biological relatives8/19/2015TEMESGEN REGASA(SMS) Rapid Eye Movement Sleep Behavior Disorderdevelop during REM sleep and are accompanied by loss of REM-related muscle atonia or hypotonia.can result in sleep disruption or injury to the sleeper or bed partner. There is often no history of violent or aggressive behavior during the day while awake.Range from simple motions to highly elaborate activities (eg, screaming, punching, kicking, jumping, or running). Affected individuals appear to be acting out their dreams. dream content often involving defense of the sleeper against attack. The eyes are usually closed, in contrast to the sleepwalker, whose eyes are open during the episode. good dream recall on awakening.8/19/2015TEMESGEN REGASA(SMS) DSM-5Diagnostic Criteria of RSBD

A. Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.B. These behaviors arise during rapid eye movement (REM) sleep and therefore usually occur more than 90 minutes after sleep onset, are more frequent during the later portions of the sleep period, and uncommonly occur during daytime naps.C. Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented.D. Either of the following: 1. REM sleep without atonia on polysomnographic recording. 2. A history suggestive of REM sleep behavior disorder and an established synucleinopathy diagnosis (e.g., Parkinsons disease, multiple system atrophy).E. The behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (which may include injury to self or the bed partner).F. The disturbance is not attributable to the physiological effects of a substance8/19/2015TEMESGEN REGASA(SMS) Nightmare DisorderNightmares are typically lengthy, elaborate, story like sequences of dream imagery that seem real and that incite anxiety, fear, or other dysphoric emotions.terminate with awakening and rapid return of full alertnessdysphoric emotions may persist into wakefulnessAssociated with sweating, tachycardia, and tachypneaoften begin between ages 3 and 6 yearsRisk Factors Sleep deprivation or fragmentation personality disturbances or psychiatric diagnosis. medications, Gender8/19/2015TEMESGEN REGASA(SMS) CONT DSM-5 Diagnostic CriteriaA. Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity and that generally occur during the second half of the major sleep episode.B. On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert.C. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.D. The nightmare symptoms are not attributable to the physiological effects of asubstance e.g., a drug of abuse, a medication).E. Coexisting mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams8/19/2015TEMESGEN REGASA(SMS) contSpecify if: Acute: Duration of period of nightmares is 1 months Subacute: 1 month but less than 6 months. Persistent: Duration of 6 months or more.Specify current severity(by the frequency ): Mild: Less than one episode per week on average. Moderate: 1 episodes/week but less than nightly. Severe: Episodes nightly.8/19/2015TEMESGEN REGASA(SMS) Differences between nightmares and sleep terrorsCharacteristics Nightmares Sleep terrors

Time of night Latter half of night First half of night Sleep stage REM sleep NREM sleep

consciousness Alert Confused

Memory of episode Full recall Partial/complete amnesia

Subsequent Delayed Rapid return to sleep8/19/2015TEMESGEN REGASA(SMS) Sleeptalking (Somniloquy)

found in all stages of sleep. involves a few words that are difficult to distinguish. involve the sleeper's life and concerns, Dont ( relate their dreams or reveal deep secrets) accompany night terrors and sleepwalking. Sleeptalking alone requires no