Non-Rapid Eye Movement (NREM) Parasomnias (ICSD-3), also referred to as NREM Sleep Arousal Disorders (DSM-5) includes sleepwalking and sleep terrors (night terrors). Both of these conditions consist of repeated occurrence of incomplete arousals, usually beginning during the first third of the major sleep episode, that typically are brief, lasting 1-10 minutes, but may be protracted, lasting up to 1 hour. The maximum duration of an event is unknown. The eyes are typically open during these events.
Isolated or infrequent NREM sleep arousal disorders are very common in the general population. The most common non-rapid eye movement (NREM) parasomnias in children are the disorders of arousal (e.g., sleepwalking, night terrors, and confusional arousals), which occur most commonly in the first half of the night.
Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either one of the following:
No or little (e.g., only a single visual scene) dream imagery is recalled.
Amnesia for the episodes is present.
The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
Co-existing mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors.
Specify if:
Many individuals exhibit both subtypes of arousals (sleepwalking and night terrors) on different occasions, which suggests a unifying underlying pathophysiology. Sleepwalking and night terrors reflect varying degrees of simultaneous occurrence of wakefulness and NREM sleep, resulting in complex behaviours arising from sleep with varying degrees of conscious awareness, motor activity, and autonomic activation.
REM
ember events (i.e. - no confusion, no amnesia) in REM parasomnias!
Parasomnia Type | Stage of Arousal | Time of Night | EEG during event | EMG during event | Unresponsive during event | Autonomic activity | Anmesia | Confusion post-episode | Family history of parasomnias | |
---|---|---|---|---|---|---|---|---|---|---|
Confusional Arousal | NREM | NREM Stage 2-4 | Anytime | N/A | Low | Yes | Low | Yes | Yes | Yes |
Sleepwalking | NREM | NREM Stage 3-4 | First 2 hours | Mixed | Low | Yes | Low | Yes | Yes | Yes |
Sleep terrors | NREM | NREM Stage 3-4 | First 2 hours | Mixed | Low | Yes | High | Yes | Yes | Yes |
REM sleep behaviour disorder | REM | REM | Anytime (but more likely later half) | Characteristic of REM | High | Yes | High | No | No (can remember the dreams!) | No |
Nightmare disorder | REM | REM | Anytime | N/A | N/A | Yes | High | No | No (can remember the dreams!) | No |