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Narcolepsy

Narcolepsy is a chronic sleep disorder characterized by pervasive, uncontrolled sleepiness and other sleep disturbances. One of its hallmark symptoms is an abrupt transition to REM sleep upon falling asleep, which causes symptoms typically associated with this phase to occur unexpectedly during wakefulness. These include the following symptoms, which typically last from a minute or two to half an hour.
REM Sleep Behavior Disorder01:15

REM Sleep Behavior Disorder

REM Sleep Behavior Disorder (RBD) is a sleep disorder characterized by the absence of muscle paralysis that normally occurs during the REM phase of sleep. This absence allows individuals to physically act out their dreams, which are often vivid and disturbing. Common behaviors exhibited during episodes include kicking, punching, and yelling. These actions can be dangerous, potentially leading to injuries for the person with RBD or their bed partner.
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NREM Sleep
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Parasomnias: an updated review.

Michael J Howell1

  • 1Department of Neurology, University of Minnesota Medical Center, Sleep Disorders Center, University of Minnesota, Minnesota, MN, USA. howel020@umn.edu

Neurotherapeutics : the Journal of the American Society for Experimental Neurotherapeutics
|September 12, 2012
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Parasomnias are abnormal sleep behaviors. Management focuses on preventing injury and treating sleep disorders, with specific medications showing promise for certain conditions like REM Sleep Behavior Disorder.

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Area of Science:

  • Neurology
  • Sleep Medicine
  • Behavioral Science

Background:

  • Parasomnias encompass abnormal behaviors during sleep, stemming from incomplete sleep-wake dissociation.
  • Non-rapid eye movement (NREM) parasomnias arise from impaired arousal mechanisms, while rapid eye movement (REM) Sleep Behavior Disorder (RBD) involves a loss of muscle paralysis during REM sleep.
  • Sleep-related eating disorder (SRED) and RBD have associations with medications and neurodegenerative diseases like Parkinson's.

Purpose of the Study:

  • To review the pathophysiology and management of NREM and REM parasomnias.
  • To highlight the link between parasomnias, arousal instability, and central pattern generators.
  • To discuss current therapeutic strategies and the need for further research.

Main Methods:

  • Literature review of parasomnias, focusing on NREM and REM disorders.
  • Analysis of the role of arousal mechanisms and cyclic alternating patterns in NREM parasomnias.
  • Examination of the association between RBD, synucleinopathies, and potential treatments.

Main Results:

  • NREM parasomnias are linked to impaired arousal, with cyclic alternating pattern changes observed in sleepwalking.
  • SRED is associated with sedative-hypnotics and potentially Restless Legs Syndrome (RLS).
  • RBD is characterized by dream enactment due to loss of atonia and may precede Parkinson's disease.

Conclusions:

  • Parasomnias result from CPG activation or disinhibition, requiring management focused on safety and comorbid conditions.
  • Clonazepam and melatonin are effective for RBD; paroxetine shows efficacy for sleep terrors.
  • Pharmacotherapy for other parasomnias requires further investigation.