Neurotherapeutics. 2012 Sep 11. [Epub ahead of print]
Howell MJ.
Source
Department
of Neurology, University of Minnesota Medical Center, Sleep Disorders
Center, University of Minnesota, Minnesota, MN, USA
Abstract
Parasomnias
are abnormal behaviors emanating from or associated with sleep.
Sleepwalking and related disorders result from an incomplete
dissociation of wakefulness from nonrapid eye movement (NREM) sleep.
Conditions that provoke repeated cortical arousals, or promote sleep
inertia lead to NREM parasomnias by impairing normal arousal
mechanisms. Changes in the cyclic alternating pattern, a biomarker of
arousal instability in NREM sleep, are noted in sleepwalking disorders.
Sleep-related eating disorder (SRED) is characterized by a disruption
of the nocturnal fast with episodes of feeding after an arousal from
sleep. SRED is often associated with the use of sedative-hypnotic
medications; in particular, the widely prescribed benzodiazepine
receptor agonists. Recently, compelling evidence suggests that
nocturnal eating may in some cases be a nonmotor manifestation of
Restless Legs Syndrome (RLS). rapid eye movement (REM) Sleep Behavior
Disorder (RBD) is characterized by a loss of REM paralysis leading to
potentially injurious dream enactment. The loss of atonia in RBD often
predates the development of Parkinson's disease and other disorders of
synuclein pathology. Parasomnia behaviors are related to an activation
(in NREM parasomnias) or a disinhibition (in RBD) of central pattern
generators (CPGs). Initial management should focus on decreasing the
potential for sleep-related injury followed by treating comorbid sleep
disorders. Clonazepam and melatonin appear to be effective therapies in
RBD, whereas paroxetine has been reported effective in some cases of
sleep terrors. At this point, pharmacotherapy for other parasomnias is
less certain, and further investigations are necessary.
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