medical dysfunction of an individual’s sleep pattern

sub-category of sleep disorder

abnormal and unnatural movments, behaviours, emotions, perceptions, dreams that occur flaling, during, between, sleep stages or upon waking

• most people experience parasomnia during their lifetime

• most common non-rem

  • bruxism (teeth grinidng)

  • somnambulism (sleep walking)

  • conufsional arousals

  • sleep terros

  • first third of night

  • when non-rem sleep deepest

• REM

  • night mares

  • REM behviour disore

  • recurrent sleep paralysis

General managment principles

exclusion of underlying cuase

• use of medication with cns related adverse effects

  • sedative hypnotics

  • ssri

  • beta blockeker

  • TCA

• use of non-pharmacologicla drugs

  • caffeine, nicotine, eoth, illicit drugs

• anxiety or stress

• depression or other mental illness

• demential or confusion in older people

• other sleep disorders

  • Restless leg syndrome

  • sleep apnoea

  • narcolepsy

reassurance

• parasomnia = common

• should not be owken up

  • may increase disturbance

  • lead to violent behaviour

  • gently directed back to bed

  • if violence

    • observed/left alone

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sleep hygiene

• go to be when sleepy and get up at same time each day

• avoid daytime napping - especially after 1400hrs

• avoid excesiive light exposure prior to bed

• ensure that sleep and sex only sues of bed

• regular exercise - ideally mid-late afternoon

• limi caffeine, etoh and tobacoc intake

• hot drink - prior to bed

• avoid school/work prior to bed

• get out of bed if sleep onset doens’t occur wihtin 20 mins

  • perform short relaxing activity and then return

• make sleep environment safe

scheduled wakening

• may help to reduce incidence of episodeso f non-rem parasomnia

  • somnambulism

  • gently and breifly woken 15-30min prior to normal episdoe time

• repeated nightly for 1mo

• tiral without waking done

Pharmacological treatment

• may be considered

• not terribly evidence based

• BDZ

  • clonazepam 1mg nocte

  • best evidence

• TCA

• Melatonin

  • first-line for REM parasomnia

  • supplied under section 29 so costs vary

Non-REM parasomnia

Somnambulism

• changes body posiiotn, gesturing, plaing with sheets, sitting up in bd/resting on knees

• leaving bed and moving around with altered state of consciousness and impaired judgement

• may be communicative

• often receptive to commands

• may last for mroe than 30 minutes

• usually end with person returning to bed and resuming normal sleep

• 17% of children

• 1-4% adults

Treatment

• ID and eliminate underlying trigger

  • stress, fatigue, febrile illness

  • medications

    • zopiclone, antihistamine

Confusional arousals

• partial awakenings with imparied consciousness and memory

• \< 5 mins

• unusual violent/sexual behaviours and vocalisations

• indication of depression or other mentla ilness

sleep terros

• extreme and upsetting fors of parasomnia

• intense fear, motor agitiatoin, vocalisation, high levels of autonomic activity

• last \<3 min

• end with spontaneous return to normal sleep or waking with no memomry

• 6.5% of children

Treatment

• id and managme any potnetial trigger

• reassure and good slpeep hygiene

• tiral of scheduled waking may be useful

Narcolepsy

• sleep disorder characterised by excessiive sleepiness and daytime sleep atacks

• unkown cause

• 15-30yo

• periods of extreme drowsiness during day with strong urge to sleep

  • short “sleep attack” -15min

• Visual and auditory hallucinations between sleep and wakefulness

• sleep paralysis

• cataplexy

  • sudden loss of muscle tone

Nocturnal frontal lobe epilepsy

• 9-20yo at onset

• repetitive behaviours of short duration

• asymetric, abnormal body movmeents

  • dystonic and dyskinetic postures

• grimacing and vocalisation may be present

• tongue biting/urinary incontinence rare

  • presence significantly increase likelihood of a diagnosis

• compared to parasomina which

  • earlier age

  • longer duration

  • rarely same night occurance

  • decrease frequencey or cessaiton after puberty

• last seconds - 1min

• almost nightly

• sterotyped movment

• autonomi activity

• increase in frequency

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