Parasomnias Occurring in Non–Rapid Eye Movement Sleep

Michael H. Silber, MBChB, FAAN Sleep Neurology p. 946-962 August 2020, Vol.26, No.4 doi: 10.1212/CON.0000000000000877
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PURPOSE OF REVIEW This article discusses the clinical manifestations, diagnosis and differential diagnosis, pathophysiology, and management of parasomnias occurring in non–rapid eye movement (REM) sleep.

RECENT FINDINGS Disorders of arousal are characterized by dissociated sleep, with wake and sleep phenomena intermingling, and local sleep, in which different areas of the brain exist simultaneously in different states of wakefulness or sleep. The frequency of arousals from slow-wave sleep with delta or mixed-frequency activity has a high sensitivity but relatively low specificity for the diagnosis of arousal parasomnias.

SUMMARY Disorders of arousal (sleepwalking, sleep terrors, and confusional arousals) are characterized by incomplete awakenings from slow-wave sleep, limited recall of imagery, and partial or complete amnesia. They occur most frequently in childhood. Management includes correction of precipitating factors, attention to safety, behavioral techniques, and medications. Sleep-related eating disorder is a variant of arousal disorders and may be associated with the use of short-acting hypnotics and restless legs syndrome. Complex nocturnal visual hallucinations can occur with visual loss, dementia with Lewy bodies, use of β-adrenergic receptor antagonists, and anxiety. Exploding head syndrome occurs at wake-sleep transition or on waking during the night, is usually benign, and requires treatment only if significant sleep disruption occurs.

Address correspondence to Dr Michael H. Silber, Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN 55905,

RELATIONSHIP DISCLOSURE: Dr Silber has served on the scientific and medical advisory board of the Restless Legs Syndrome Foundation and as a book review editor for Sleep Medicine. Dr Silber has received publishing royalties from Oakstone and UpToDate, Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Silber discusses the unlabeled/investigational use of antidepressants, benzodiazepines, pramipexole, and topiramate for the management of non–rapid eye movement parasomnias.

© 2020 American Academy of Neurology.