Episodic sleep disorders (parasomnias)

In the vast majority of patients with parasomnias, the evaluation can be accomplished in the office setting, based on information from the patients themselves and family members or other observers of the nocturnal events. Parasomnias are episodic sleep disorders that include sleepwalking, night terrors, and nightmares. All three conditions are more prevalent in childhood, when developmental factors appear to be responsible for their occurrence; in the much less frequent cases of a delayed onset or persistence in adulthood, psychopathologic states are often primary in their cause. Based on a number of clinical, physiologic, and etiopathogenetic similarities between sleepwalking and night terrors, these two conditions appear to fall along the same pathophysiologic and therefore nosologic continuum. They are both disorders of impaired arousal, characterized by various degrees of confusion, and they occur early in the night when slow-wave sleep predominates, whereas nightmares may occur at any time of the night, because they are closely associated with REM sleep. Another important issue relating to the assessment of parasomnias is to differentiate between nightmares and night terrors: in addition to the different time of night for their occurrence, nightmares are accompanied by much less anxiety, vocalization, motility, and autonomic discharge. Also, nightmare patients usually have vivid and elaborate recall for the event, whereas patients with night terrors are typically amnesic for their episodes, as are patients who sleepwalk. A mainstay in the management of sleepwalking and night terrors is instructing the patients and their family members to provide for adequate safety measures to prevent accidents that may occur during these events.(ABSTRACT TRUNCATED AT 250 WORDS)