Doctor's Notes on Disruptive Sleep Disorders (Parasomnias)
Parasomnias are sleep-related disorders that disrupt sleep. They are characterized by undesirable physical or verbal behaviors or experiences. The most common types of parasomnias include nightmare disorder (also called dream anxiety attack), sleep terror disorder, sleepwalking disorder, REM sleep behavior disorder (RBD), and restless legs syndrome, and periodic limb movement disorder.
Symptoms of parasomnias depend on the disorder.
- Symptoms of nightmare disorder include
- frightening dreams and
- arousal during the dream.
- Symptoms of sleep terror disorder include
- sudden arousal,
- crying out or screaming when the person is aroused,
- increased heart rate,
- rapid breathing,
- muscle spasms,
- incoherent speech,
- unresponsive to external stimuli,
- the passing of urine, and,
- when awakened, is confused, disoriented, and does not remember the event.
- Symptoms of the sleepwalking disorder include
- behaviors that range from simply sitting up in bed to walking, eating, or talking.
- Upon awakening, the person often is confused and does not remember the event.
- Symptoms of REM sleep behavior disorder include
- acting out of dreams that can include punching, kicking, leaping, and running from the bed.
- Arousals from sleep to alertness occur rapidly, and dreams can be vividly recalled.
- Symptoms of restless legs syndrome and periodic limb movement disorder discomfort in the legs (described as pulling, searing, crawling, creeping, and boring) that is relieved by moving the legs, walking about, rubbing the legs, squeezing or stroking the legs, and by taking hot showers or baths.
What Is the Treatment for Disorders that Disrupt Sleep (Parasomnias)?
Treatment for parasomnias consists of a combination of behavioral therapies and medications. Common treatments for parasomnias include:
- Keeping a sleep log to learn and avoid triggers such as certain foods and beverages
- Make the bedroom only for sleeping
- Medications to help promote healthy sleep
- Dopamine agonists
- Alpha-2-delta calcium channel ligands
- Medications used to treat restless legs syndrome
Some parasomnias are actually caused by the side effects of medications. Selective serotonin reuptake inhibitor (SSRI) antidepressants and antihistamines such as diphenhydramine (Benadryl) may actually cause symptoms that make the quality of sleep worse in some patients. They may need to be discontinued, however, do not stop taking prescribed medications without first talking to your health care provider.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.