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Abnormal things happening during sleep: parasomnias.

S Stieglitz1,2, H J Heppner3, N Netzer4

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PubMed
Summary

Parasomnias involve abnormal sleep behaviors like REM sleep behavior disorder, which can lead to injury. Many patients later develop Parkinson's disease, highlighting the need for safe sleep environments and treatments like melatonin or clonazepam.

Keywords:
Parkinson’s diseaseREM sleep without atoniaRapid eye movementSleep behavior disorderSleep paralysis

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Area of Science:

  • Neurology
  • Sleep Medicine
  • Neuroscience

Background:

  • Parasomnias are abnormal sleep events occurring during REM (rapid eye movement) or NREM (non-rapid eye movement) sleep, or transitions.
  • REM sleep behavior disorder (RBD) is characterized by increased muscle tone, contrasting with typical REM atonia.
  • Aggressive dreams in RBD can cause self-injury or harm to bed partners.

Purpose of the Study:

  • To describe the clinical features of parasomnias, particularly REM sleep behavior disorder.
  • To highlight the significant association between RBD and the development of synucleinopathies, such as Parkinson's disease.
  • To outline management strategies including environmental safety and pharmacotherapy.

Main Methods:

  • Clinical observation and case description of parasomnias.
  • Longitudinal follow-up of patients with REM sleep behavior disorder.
  • Review of existing literature and treatment guidelines.

Main Results:

  • REM sleep behavior disorder patients exhibit increased muscle tone during REM sleep.
  • A high rate of phenoconversion to synucleinopathies is observed: over 30% within 5 years and nearly 100% within 15 years.
  • Safe sleeping environments and medications like melatonin or clonazepam are recommended treatments.

Conclusions:

  • Parasomnias, especially RBD, represent a significant risk factor for developing neurodegenerative synucleinopathies.
  • Early recognition and management of RBD are crucial for patient safety and potentially for understanding neurodegenerative disease progression.
  • Pharmacological interventions and environmental safety measures are key components of managing RBD.