Literature has frequently made references to the phenomenology of sleep, as in the line from Virgil’s Aeneid, “That sweet, deep sleep, so near to death.” Even mythology has weighed in on our enduring interest in sleep. The deity Hypnos represented sleep in ancient Greece, whereas Somnos was his Roman equivalent. The specific origin of the phenomenology of sleep is still a mystery, leaving it with a lingering aura of mysticism.
One of the most frequent appearances in the outpatient clinic is sleep problems. In fact, inadequate sleep patterns are correlated with up to fifty percent of the most common problems in the primary care environment. REM (rapid eye movement) & NREM (non-REM) are both components of the normal sleep architecture. Stages 0, 1, 2, & Stage 3 are further classified into NREM.
In a cycle that lasts around 120 minutes, NREM & REM alternate. The first phase of REM sleep lasts about 5 to 10 minutes before becoming increasingly prolonged & frequent. Under the nosology of “parasomnias,” disturbances to this sleep schedule are classified as occurring perhaps during continued sleep or when the transition from sleep to wakefulness occurs. Henri Roger was the first to use the term “parasomnias” in 1932.
The word’s derivation comes from the Latin word Somnus, which means “to sleep,” and the Greek prefix para, which means “next to.” Aberrant behavioral, physiological, or phenomenological sleep-related phenomena are the hallmark of parasomnias. The “REM sleep behavior illness,” “NREM sleep arousal illness,” & “nightmare disorder” are the most common abnormal sleep arousal patterns and those that are important for this academic endeavor.
Epidemiology
Younger people are more likely to experience NREM sleep diseases than older people, who are more frequently affected by REM sleep abnormalities. Children experience sleepwalking more frequently than adults do.
According to experts, fifteen percent of children will have at least one incident of sleepwalking; however, by puberty, the majority will outgrow this illness, reducing the frequency to just 2–4%. According to one study, sleepwalking occurs in 47% of kids with one parent who has a history of it, while it occurs in 61.5% of kids with 2 sleepwalking parents.
Estimates of the prevalence of sleep terrors in children range as low as 3 percent. Up to six percent of people have nightmare disorders. Just 1% of people in the general population have REM sleep behavior disease, but at least fifty percent of those who do have it also have concomitant neurodegenerative diseases such as Parkinson’s, delirium with Lewy bodies, & atrophy of numerous systems.
Anatomy
Pathophysiology
Etiology
Although no definitive genesis for parasomnias has been identified, the etiology is still unknown; nonetheless, many theories have emerged. Recent research reveals that NREM sleep abnormalities can worsen one’s condition by interfering with stage 3 slow-wave sleep.
Genetic predisposition, sleep deprivation, restless leg syndrome, noise, periodic limb movements, breathing issues associated with touch, sleep, stress, alcohol, drugs, & fever are some of the circumstances that might disrupt slow-wave sleep.
Some specialists speculate a connection between REM sleep disorders, neurodegenerative illnesses with decreased dopamine activity in the striatum, trauma-related stress disorder, & narcolepsy, albeit this is currently unproven.
Genetics
Prognostic Factors
Thankfully, the majority of parasomnias seem to either go away by adolescence or manifest as isolated events. If comorbidities are the cause of the parasomnias, then as the comorbid disease is addressed, the parasomnias will also get better. Of note, it is possible for a patient to relapse after stopping benzodiazepines or under stressful circumstances.
Clinical History
Clinical History
Children frequently experience sporadic nightmares, which typically happen in the middle of the night or early the next morning when REM sleep is more prevalent. Children between the ages of 7 and 9 are most likely to experience imaginary creatures in their dreams, while those between the ages of 10 and 12 are more likely to experience kidnappings.
Loss of power & fear of harm is two other recurring themes. There may be vocalizations, but there is little to no movement or autonomic symptomatology. When a child wakes up, they frequently remember the specifics of their dream and can be comforted. The doctor can rule out additional sleep problems, such as night terrors, with a thorough history.
Physical Examination
Physical examination
There are no particular physical characteristics connected to nightmares. Before the child wakes up from a nightmare, the heart rate & breathing rate may rise or become more variable.
When awakening, there may be brief mild autonomic arousal, including tachypnea, sweating, and tachycardia. Due to atonia brought on by REM sleep, movement is infrequent.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential diagnosis
As parasomnias frequently present as sequelae, the healthcare provider should assess the patient for underlying comorbidities. For example, the onset of first-episode sleeplessness in adults should prompt the examination of nocturnal epilepsy, breathing-related sleep sickness, & medication profiles.
Variant parasomnias share characteristics, making it challenging to distinguish between the many diseases. Nonetheless, some salient characteristics can aid the doctor in defining parasomnias. For instance, patients with NREM sleep disorders typically have open eyes, but those with REM sleep problems typically have closed eyelids.
While dreams have been linked to delirium, febrile sickness, withdrawal from alcohol and drugs, & chronic illness, sleep terrors are frequently linked to obsessive-compulsive, depression, anxiety, & phobic diseases.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Benzodiazepines can be used to treat the majority of parasomnias. There have been theories that BZDs’ therapeutic benefits come from their capacity to inhibit REM and deep sleep periods, which have been linked to parasomnias. Alternatives are frequently advised, though, due to their unfavorable side effect profile and propensity for addiction; these alternatives include melatonin, tricyclic antidepressants, & SSRIs (selective serotonin reuptake blockers).
Prazosin is one alpha-1 antagonist that has been particularly effective in treating problems of nightmares. The range of non-pharmacological therapeutic approaches includes counseling, hypnosis, planned awakenings, & relaxation techniques.”Imagery rehearsal” is yet another treatment strategy tailored to the disorder of nightmares.
In this psychotherapeutic technique, the plot of a repeated nightmare is identified, and then it is replaced with a more pleasing thematic sequence. The patient will unintentionally alter subsequent dream images as they practice this original plot.
Literature has frequently made references to the phenomenology of sleep, as in the line from Virgil’s Aeneid, “That sweet, deep sleep, so near to death.” Even mythology has weighed in on our enduring interest in sleep. The deity Hypnos represented sleep in ancient Greece, whereas Somnos was his Roman equivalent. The specific origin of the phenomenology of sleep is still a mystery, leaving it with a lingering aura of mysticism.
One of the most frequent appearances in the outpatient clinic is sleep problems. In fact, inadequate sleep patterns are correlated with up to fifty percent of the most common problems in the primary care environment. REM (rapid eye movement) & NREM (non-REM) are both components of the normal sleep architecture. Stages 0, 1, 2, & Stage 3 are further classified into NREM.
In a cycle that lasts around 120 minutes, NREM & REM alternate. The first phase of REM sleep lasts about 5 to 10 minutes before becoming increasingly prolonged & frequent. Under the nosology of “parasomnias,” disturbances to this sleep schedule are classified as occurring perhaps during continued sleep or when the transition from sleep to wakefulness occurs. Henri Roger was the first to use the term “parasomnias” in 1932.
The word’s derivation comes from the Latin word Somnus, which means “to sleep,” and the Greek prefix para, which means “next to.” Aberrant behavioral, physiological, or phenomenological sleep-related phenomena are the hallmark of parasomnias. The “REM sleep behavior illness,” “NREM sleep arousal illness,” & “nightmare disorder” are the most common abnormal sleep arousal patterns and those that are important for this academic endeavor.
Younger people are more likely to experience NREM sleep diseases than older people, who are more frequently affected by REM sleep abnormalities. Children experience sleepwalking more frequently than adults do.
According to experts, fifteen percent of children will have at least one incident of sleepwalking; however, by puberty, the majority will outgrow this illness, reducing the frequency to just 2–4%. According to one study, sleepwalking occurs in 47% of kids with one parent who has a history of it, while it occurs in 61.5% of kids with 2 sleepwalking parents.
Estimates of the prevalence of sleep terrors in children range as low as 3 percent. Up to six percent of people have nightmare disorders. Just 1% of people in the general population have REM sleep behavior disease, but at least fifty percent of those who do have it also have concomitant neurodegenerative diseases such as Parkinson’s, delirium with Lewy bodies, & atrophy of numerous systems.
Although no definitive genesis for parasomnias has been identified, the etiology is still unknown; nonetheless, many theories have emerged. Recent research reveals that NREM sleep abnormalities can worsen one’s condition by interfering with stage 3 slow-wave sleep.
Genetic predisposition, sleep deprivation, restless leg syndrome, noise, periodic limb movements, breathing issues associated with touch, sleep, stress, alcohol, drugs, & fever are some of the circumstances that might disrupt slow-wave sleep.
Some specialists speculate a connection between REM sleep disorders, neurodegenerative illnesses with decreased dopamine activity in the striatum, trauma-related stress disorder, & narcolepsy, albeit this is currently unproven.
Thankfully, the majority of parasomnias seem to either go away by adolescence or manifest as isolated events. If comorbidities are the cause of the parasomnias, then as the comorbid disease is addressed, the parasomnias will also get better. Of note, it is possible for a patient to relapse after stopping benzodiazepines or under stressful circumstances.
Clinical History
Children frequently experience sporadic nightmares, which typically happen in the middle of the night or early the next morning when REM sleep is more prevalent. Children between the ages of 7 and 9 are most likely to experience imaginary creatures in their dreams, while those between the ages of 10 and 12 are more likely to experience kidnappings.
Loss of power & fear of harm is two other recurring themes. There may be vocalizations, but there is little to no movement or autonomic symptomatology. When a child wakes up, they frequently remember the specifics of their dream and can be comforted. The doctor can rule out additional sleep problems, such as night terrors, with a thorough history.
Physical examination
There are no particular physical characteristics connected to nightmares. Before the child wakes up from a nightmare, the heart rate & breathing rate may rise or become more variable.
When awakening, there may be brief mild autonomic arousal, including tachypnea, sweating, and tachycardia. Due to atonia brought on by REM sleep, movement is infrequent.
Differential diagnosis
As parasomnias frequently present as sequelae, the healthcare provider should assess the patient for underlying comorbidities. For example, the onset of first-episode sleeplessness in adults should prompt the examination of nocturnal epilepsy, breathing-related sleep sickness, & medication profiles.
Variant parasomnias share characteristics, making it challenging to distinguish between the many diseases. Nonetheless, some salient characteristics can aid the doctor in defining parasomnias. For instance, patients with NREM sleep disorders typically have open eyes, but those with REM sleep problems typically have closed eyelids.
While dreams have been linked to delirium, febrile sickness, withdrawal from alcohol and drugs, & chronic illness, sleep terrors are frequently linked to obsessive-compulsive, depression, anxiety, & phobic diseases.
Benzodiazepines can be used to treat the majority of parasomnias. There have been theories that BZDs’ therapeutic benefits come from their capacity to inhibit REM and deep sleep periods, which have been linked to parasomnias. Alternatives are frequently advised, though, due to their unfavorable side effect profile and propensity for addiction; these alternatives include melatonin, tricyclic antidepressants, & SSRIs (selective serotonin reuptake blockers).
Prazosin is one alpha-1 antagonist that has been particularly effective in treating problems of nightmares. The range of non-pharmacological therapeutic approaches includes counseling, hypnosis, planned awakenings, & relaxation techniques.”Imagery rehearsal” is yet another treatment strategy tailored to the disorder of nightmares.
In this psychotherapeutic technique, the plot of a repeated nightmare is identified, and then it is replaced with a more pleasing thematic sequence. The patient will unintentionally alter subsequent dream images as they practice this original plot.
Literature has frequently made references to the phenomenology of sleep, as in the line from Virgil’s Aeneid, “That sweet, deep sleep, so near to death.” Even mythology has weighed in on our enduring interest in sleep. The deity Hypnos represented sleep in ancient Greece, whereas Somnos was his Roman equivalent. The specific origin of the phenomenology of sleep is still a mystery, leaving it with a lingering aura of mysticism.
One of the most frequent appearances in the outpatient clinic is sleep problems. In fact, inadequate sleep patterns are correlated with up to fifty percent of the most common problems in the primary care environment. REM (rapid eye movement) & NREM (non-REM) are both components of the normal sleep architecture. Stages 0, 1, 2, & Stage 3 are further classified into NREM.
In a cycle that lasts around 120 minutes, NREM & REM alternate. The first phase of REM sleep lasts about 5 to 10 minutes before becoming increasingly prolonged & frequent. Under the nosology of “parasomnias,” disturbances to this sleep schedule are classified as occurring perhaps during continued sleep or when the transition from sleep to wakefulness occurs. Henri Roger was the first to use the term “parasomnias” in 1932.
The word’s derivation comes from the Latin word Somnus, which means “to sleep,” and the Greek prefix para, which means “next to.” Aberrant behavioral, physiological, or phenomenological sleep-related phenomena are the hallmark of parasomnias. The “REM sleep behavior illness,” “NREM sleep arousal illness,” & “nightmare disorder” are the most common abnormal sleep arousal patterns and those that are important for this academic endeavor.
Younger people are more likely to experience NREM sleep diseases than older people, who are more frequently affected by REM sleep abnormalities. Children experience sleepwalking more frequently than adults do.
According to experts, fifteen percent of children will have at least one incident of sleepwalking; however, by puberty, the majority will outgrow this illness, reducing the frequency to just 2–4%. According to one study, sleepwalking occurs in 47% of kids with one parent who has a history of it, while it occurs in 61.5% of kids with 2 sleepwalking parents.
Estimates of the prevalence of sleep terrors in children range as low as 3 percent. Up to six percent of people have nightmare disorders. Just 1% of people in the general population have REM sleep behavior disease, but at least fifty percent of those who do have it also have concomitant neurodegenerative diseases such as Parkinson’s, delirium with Lewy bodies, & atrophy of numerous systems.
Although no definitive genesis for parasomnias has been identified, the etiology is still unknown; nonetheless, many theories have emerged. Recent research reveals that NREM sleep abnormalities can worsen one’s condition by interfering with stage 3 slow-wave sleep.
Genetic predisposition, sleep deprivation, restless leg syndrome, noise, periodic limb movements, breathing issues associated with touch, sleep, stress, alcohol, drugs, & fever are some of the circumstances that might disrupt slow-wave sleep.
Some specialists speculate a connection between REM sleep disorders, neurodegenerative illnesses with decreased dopamine activity in the striatum, trauma-related stress disorder, & narcolepsy, albeit this is currently unproven.
Thankfully, the majority of parasomnias seem to either go away by adolescence or manifest as isolated events. If comorbidities are the cause of the parasomnias, then as the comorbid disease is addressed, the parasomnias will also get better. Of note, it is possible for a patient to relapse after stopping benzodiazepines or under stressful circumstances.
Clinical History
Children frequently experience sporadic nightmares, which typically happen in the middle of the night or early the next morning when REM sleep is more prevalent. Children between the ages of 7 and 9 are most likely to experience imaginary creatures in their dreams, while those between the ages of 10 and 12 are more likely to experience kidnappings.
Loss of power & fear of harm is two other recurring themes. There may be vocalizations, but there is little to no movement or autonomic symptomatology. When a child wakes up, they frequently remember the specifics of their dream and can be comforted. The doctor can rule out additional sleep problems, such as night terrors, with a thorough history.
Physical examination
There are no particular physical characteristics connected to nightmares. Before the child wakes up from a nightmare, the heart rate & breathing rate may rise or become more variable.
When awakening, there may be brief mild autonomic arousal, including tachypnea, sweating, and tachycardia. Due to atonia brought on by REM sleep, movement is infrequent.
Differential diagnosis
As parasomnias frequently present as sequelae, the healthcare provider should assess the patient for underlying comorbidities. For example, the onset of first-episode sleeplessness in adults should prompt the examination of nocturnal epilepsy, breathing-related sleep sickness, & medication profiles.
Variant parasomnias share characteristics, making it challenging to distinguish between the many diseases. Nonetheless, some salient characteristics can aid the doctor in defining parasomnias. For instance, patients with NREM sleep disorders typically have open eyes, but those with REM sleep problems typically have closed eyelids.
While dreams have been linked to delirium, febrile sickness, withdrawal from alcohol and drugs, & chronic illness, sleep terrors are frequently linked to obsessive-compulsive, depression, anxiety, & phobic diseases.
Benzodiazepines can be used to treat the majority of parasomnias. There have been theories that BZDs’ therapeutic benefits come from their capacity to inhibit REM and deep sleep periods, which have been linked to parasomnias. Alternatives are frequently advised, though, due to their unfavorable side effect profile and propensity for addiction; these alternatives include melatonin, tricyclic antidepressants, & SSRIs (selective serotonin reuptake blockers).
Prazosin is one alpha-1 antagonist that has been particularly effective in treating problems of nightmares. The range of non-pharmacological therapeutic approaches includes counseling, hypnosis, planned awakenings, & relaxation techniques.”Imagery rehearsal” is yet another treatment strategy tailored to the disorder of nightmares.
In this psychotherapeutic technique, the plot of a repeated nightmare is identified, and then it is replaced with a more pleasing thematic sequence. The patient will unintentionally alter subsequent dream images as they practice this original plot.
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