Disorders That Disrupt Sleep (Parasomnias) (cont.)
Sat Sharma, MD, FRCPC, FCCP
Sleep Disorder Symptoms
The symptoms associated with each subtype of the parasomnias are as follows:
- Person complains of a frightening dream.
- Arousal during the dream is common.
- The presence of a dream is the essential feature that differentiates nightmare disorder from sleep terror disorder.
Sleep terror disorder
- A sleep terror is characterized by a sudden arousal.
- Commonly, the person cries out or screams as he or she is aroused.
- The person has an increased heart rate, an increase in the respiratory rate, flushing, sweating, and increased muscle tone.
- The person is routinely unresponsive to external stimuli and, when awakened, is confused, disoriented, and does not remember the event.
- Incoherent speech or passing of urine has been reported to accompany the event.
- Episodes of sleepwalking are associated with behaviors that range from simply sitting up in bed to walking, possibly with associated complex behaviors such as eating. Talking behavior has also been noted during episodes of sleepwalking.
- Upon awakening, the person most often is confused and does not remember the event.
- The event may spontaneously terminate, or the person may return to bed or lie down somewhere else and go off to sleep without waking up from sleep.
REM sleep behavior disorder
Restless legs syndrome and periodic limb movement disorder
- The main feature of this disorder is the acting out of dreams. The behavior can include punching, kicking, leaping, and running from the bed. The most common reason for medical consultation is injury to the bed partner, although the effects of sleep disruption can also precipitate such consultation. The event occurs during REM sleep.
- In persons with REM sleep behavior disorder, arousals from sleep to alertness and orientation occur rapidly, and they usually vividly recall their dreams.
- After awakening, the person’s behavior and interactions are normal.
- Acute (short-term) and chronic (long-term) forms exist. The acute form can emerge during withdrawal from ethanol or sedative-hypnotic abuse and with anticholinergic and other drug intoxication states. The chronic form presents for evaluation following observations of bed partners.
- Despite nighttime behavior, few persons develop excessive daytime sleepiness or fatigue.
- Persons with restless legs syndrome describe discomfort in the legs, using terms, such as “pulling, searing, crawling, creeping, and boring” to describe these sensations. The symptoms usually occur at bedtime or during other periods of inactivity. These distressing symptoms are relieved by moving the legs, walking about, rubbing the legs, squeezing or stroking the legs, and by taking hot showers or baths. The symptoms may wax and wane over the person’s lifetime.
- Persons with restless legs syndrome commonly present with complaints of insomnia (inability to sleep), and, in severe cases, the disorder may cause depression and suicidal thoughts.
- Periodic limb movement disorder primarily occurs during sleep. This disorder is described as rhythmic extension of the great toe, associated with dorsiflexion (upward movement) of the ankle and light flexion (bending) of the knee and hip. Because periodic limb movement disorder occurs during sleep, the symptoms are often not noticed by the person. Affected persons often complain of excessive daytime sleepiness, initially during passive activities, such as watching TV, being a passenger in a car, or reading. In later stages, one may have excessive daytime sleepiness during activities requiring alertness, such as driving, operating machinery, or talking with people.
- Restless legs syndrome and periodic limb movement disorder may occur even during childhood and present as attention deficit disorder with hyperactivity or as growing pains.
- Restless legs syndrome and periodic limb movement disorder are present in a significant percentage of pregnant women, and exacerbations are observed during menstruation and menopause.
- These disorders are associated with numerous neurological conditions, such as peripheral neuropathy, postpolio syndrome, and spinal cord pathology (disease).
- Restless legs syndrome and periodic limb movement disorder affect 20-40% of persons with chronic renal (kidney) failure who are on dialysis.
- A history of iron-deficiency anemia is also common in persons with restless legs syndrome and periodic limb movement disorder.
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