Last reviewed: November 2017
Last updated: December  2017

Summary

Definition

History and exam

Key diagnostic factors

  • known condition causing sleep fragmentation/deprivation
  • normal physical exam between episodes
  • cognitive disturbance during event (confusional arousals, sleep terrors, and sleepwalking)
  • cognitive disturbances in between episodes (rapid eye movement sleep behavior disorder [RBD])
  • sensation of a sudden loud noise in the head (exploding head syndrome)
  • vigorous or violent behavior (confusional arousals, sleepwalking, sleep terrors, and rapid eye movement sleep behavior disorder [RBD])
  • episodes of inability to move (recurrent isolated sleep paralysis)
  • eating behavior during the night (sleep-related eating disorder)
  • evidence of external injuries (rapid eye movement sleep behavior disorder [RBD])
  • autonomic hyperactivity during event (sleep terrors, nightmare disorder)
  • low socioeconomic status and low educational level (rapid eye movement sleep behavior disorder [RBD])
  • cardiovascular risk factors (rapid eye movement sleep behavior disorder [RBD])

Other diagnostic factors

  • abnormal facial expression (confusional arousals, sleepwalking, sleep terrors, rapid eye movement sleep behavior disorder [RBD])
  • parkinsonian signs (rapid eye movement sleep behavior disorder [RBD])

Risk factors

  • hx of childhood parasomnias (nonrapid eye movement [NREM] parasomnias)
  • age >60 years (rapid eye movement sleep behavior disorder [RBD])
  • male gender (rapid eye movement sleep behavior disorder [RBD])
  • female gender (nightmare disorder, isolated recurrent sleep paralysis)
  • family history (confusional arousals, sleepwalking, sleep terrors)
  • presence of HLA gene DQB1 (sleepwalking)
  • obstructive and central sleep apnea (mainly nonrapid eye movement sleep parasomnias)
  • enuresis
  • periodic limb movement disorder (mainly nonrapid eye movement sleep parasomnias)
  • sleep deprivation (sleepwalking and sleep paralysis)
  • stress (nightmare disorder)
  • psychiatric disorders (nightmare disorder, sleep paralysis)
  • neurologic disorders (rapid eye movement sleep behavior disorder [RBD])
  • medications such as venlafaxine, SSRIs (rapid eye movement sleep behavior disorder [RBD], nightmare disorder)
  • forced awakenings
  • eating disorder (sleep-related eating disorder)
  • hx of sleepwalking, sleeptalking, and periodic limb movements of sleep (sleep-related eating disorder)

Diagnostic investigations

1st investigations to order

  • polysomnography (PSG) (in rapid eye movement sleep behavior disorder [RBD])
Full details

Investigations to consider

  • polysomnography (PSG) (in confusional arousals)
  • polysomnography (PSG) (in sleepwalking)
  • polysomnography (PSG) (in nightmare disorder)
  • polysomnography (PSG) (in sleep terrors)
  • polysomnography (PSG) (in all other parasomnias)
  • EEG
  • urine drug screen
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor

Director of the Sleep Fellowship Program

Neurology Department

Northwestern University

Chicago

IL

Disclosures

HA is an author of a number of references cited in this monograph.

Dr Hrayr Attarian would like to gratefully acknowledge Dr Pierre Giglio, a previous contributor to this monograph. PG declares that he has no competing interests.

Peer reviewers VIEW ALL

Baylor College of Medicine

Texas Children's Hospital

Clinical Care Center

Houston

TX

Disclosures

BH declares that she has no competing interests.

Professor and Chairman

Department of Neurology

Hennepin County Medical Center

Minneapolis

MN

Disclosures

MM is an author of a number of references cited in this monograph.

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