Parasomnias
Parasomnias are disorders characterized by abnormal behavioral, experiential, or physiological events occurring in association with sleep, specific sleep stages, or sleep-wake transitions.
Non-Rapid Eye Movement Sleep Arousal Disorders, Nightmare Disorder, Rapid Eye Movement Sleep Behavior Disorder, Restless Legs Syndrome
Non-Rapid Eye Movement Sleep Arousal Disorders
Non-rapid eye movement sleep arousal disorders are a group of sleep disorders characterized by incomplete arousals from non-REM sleep, leading to episodes of partial awakening with behaviors such as sleepwalking, night terrors, or confusion.
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:
- 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.
- 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.
Nightmare Disorder
Nightmare disorder is a pattern of repeated frightening and vivid dreams that affects your quality of life. It ranges from mild to severe and can be short-term or chronic. Nightmare disorder is treatable with various psychotherapies and medications. It commonly affects people with post-traumatic stress disorder (PTSD).
Diagnostic Criteria
A. 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 a sub¬ stance (e.g., a drug of abuse, a medication).
E. Coexisting mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams.
Rapid Eye Movement Sleep Behavior Disorder
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by dream-enactment behaviors that emerge during a loss of REM sleep atonia. RBD dream enactment ranges in severity from benign hand gestures to violent thrashing, punching, and kicking.
Diagnostic Criteria
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:
- REM sleep without atonia on polysomnographic recording.
- A history suggestive of REM sleep behavior disorder and an established synucleinopathy diagnosis (e.g., Parkinson’s 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 substance (e.g., a drug of abuse, a medication) or another medical condition.
G. Coexisting mental and medical disorders do not explain the episodes.
Restless leg syndrome (RLS)
A condition characterized by a nearly irresistible urge to move the legs, typically in the evenings.
Restless legs syndrome typically occurs while sitting or lying down. It generally worsens with age and can disrupt sleep. The main symptom is a nearly irresistible urge to move the legs. Getting up and moving around helps the unpleasant feeling temporarily go away. RLS can severely disrupt your sleep, making it difficult to fall asleep or return to sleep after waking up. Moving the legs or walking typically relieves the discomfort but the sensations often recur once the movement stops.
Diagnostic Criteria
A. An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs, characterized by all of the following:
- The urge to move the legs begins or worsens during periods of rest or inactivity.
- The urge to move the legs is partially or totally relieved by movement.
- The urge to move the legs is worse in the evening or at night than during the day, or occurs only in the evening or at night.
B. The symptoms in Criterion A occur at least three times per week and have persisted for at least 3 months.
C. The symptoms in Criterion A are accompanied by significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
D. The symptoms in Criterion A are not attributable to another mental disorder or medical condition (e.g., arthritis, leg edema, peripheral ischemia, leg cramps) and are not better explained by a behavioral condition (e.g., positional discomfort, habitual foot tapping).
E. The symptoms are not attributable to the physiological effects of a drug of abuse or medication (e.g., akathisia).