[Treatment of parasomnias]

In this article the most frequent and interesting treatments for parasomnias are reviewed. Arousal disorders, REM sleep behavior disorders and nightmares, bruxism (which can occur in any sleep state) are considered. The pathophysiological mechanisms of parasomnias are unknown, explaining why there is rarely a specific treatment precipitating. Management depends on the patient's age, the frequency and intensity of the episodes, the familial structure, the presence of precipitating and risk factors, psychological disorders and the parasomnia itself. Different therapeutic approaches are described including (1), explanation and reassurance, (2) counselling to avoid precipitating factors such as irregular sleep patterns, alcohol or drug intake (3) strategies to avoid injury (4) psychological approaches such as behavioral therapies in some parasomnias such as nightmares or arousal disorders. However, very few controlled studies have been done making it difficult to provide recommendations based on controlled clinical trials. Pharmacologic treatments are rarely necessary except in REM sleep behavior disorders; they are most often needed for short term.