Amila Weerasinghe21st BatchFaculty of Medical SciencesUniversity of Sri JayewardenepuraSri Lanka.

22/10/2015

Parasomnia Definition :- abnormal behaviour/psychological

events, associated with

sleep specific sleep stages sleep-wake transition

1.Nightmares (dream anxiety disorder)

2.Night terror disorder

3.Sleepwalking disorder

4.Other parasomnias

1. Nightmares (dream anxiety disorder)

An awakening from REM sleep to full conciousness with detailed dream recall.

Children – peak age 5-6 years

Main stimulations for nightmares

Frightening experiences during day

Frequent nightmares usually,

during a period of anxiety

Other causes for nightmaresPTSD

Fever

Psychogenic drugs

Alcohol detoxification

2. Night terror disorder

Less common than

nightmares

Sometimes familial

Usually limited to

childhood

Sometimes persists into

adult life

Clinical picture – Night terror disorder

A few hours after going to sleep/ whlist in stage 3-4 non-REM sleep ;

The childSits up and appears terrified.Screams and appears confused.

Increased HR & Respiratory rate

Cnt . Clinical picture – Night terror disorder

After a few minutes , the child slowly settles and returns to normal calm sleep.

A little/no dream recall

Mx – Night terror disorder

A regular bedtime routineImproved sleep hygieneBenzodiazepines and imipramine – effective in preventing night terrors

But avoid prolonged use

3.Sleep walking disorder

3.Sleep walking disorderAn automatism during deep non-REM sleep, usually early part of the sleep.

Common in 5 – 12 age group

15% of this age group walked at least once during the sleep.

Occasionally persists in to the adult life.

May be familial

Cont... Sleep walking disorders

Most children don’t actually walk.

But sit up and make repetitive movements.

Some walk around

Eyes openIn a mechanical manner but avoiding familiar objects

Don’t respond to questionsVery difficult to wake upUsually led back to bedMostly few seconds – minutes. But rarely an hour.

Mx - Sleep walking disorders Sleep walkers can harm themselvesHence need to be protected from

injury Lock doors and windows Remove dangerous objects Advice about safety Avoid sleep deprivation Avoid other circumstances that might

make them excessively sleepy, Eg. Drinking alcohol before going to bed

4.Other parasomnias

1. Rapid eye movement (REM) sleep behaviour disorder

2. Sleep paralysis

1.Rapid eye movement (REM) sleep behaviour disorder

When behavioural problems (agitation/aggression) occur during night.

Normal atonia of REM sleep is lost. So dreams are acted out.

Commonly in elder menAssociated with neurological disorders

Eg – Parkinsonism

Clonazipam & donepezil

2.Sleep paralysis

Inability to perform voluntary movements in the transition between sleep and wakefulness,

EitherAt sleep onset (hypnagogic)At awakening (hypnopompic)

Episodes are accompanied with extreme fear.