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Difficulty with 1 or more of the following: falling asleep, staying asleep, or waking up early with the inability to return to sleep that persists 3x or more per week for longer than 3 months.
- causes clinically significant distress or impairment
- cannot be explained by the effects of a substance or existing medical condition

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Hypersomnolence disorder is characterized by self-reported excessive sleepiness although an individuals sleep has spanned at least 7 hours. It must include at least one of the following symptoms:
- recurrent periods of sleep or lapses into sleep within the same day
- a prolonged main sleep episode of more than 9 hours per day that is non-restorative
- difficulty being fully awake after abrupt awakening

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The diagnostic criteria for narcolepsy can be found on p. 372 in the DSM-5. Rather than explaining the diagnostic criteria myself, I found this video from Harvard Medical School that does a wonderful job of explaining how a diagnosis is made along with a firsthand account from a mother and teenage daughter about going through the diagnostic process.

Respond to the following prompt: How did Liza's symptoms impact her daily functioning?

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Obstructive Sleep Apnea Hypopnea (p. 378) includes either (1) or (2):
1. Evidence by polysomnography of at least 5 obstructive apneas or hypopneas per hour of sleep and either of the following sleep symptoms:
A. nocturnal breathing disturbances (i.e. snoring, snorting, gasping, or pauses in breathing during sleep)
B. Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep
2. Evidence by polysomnography of 15 of more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms

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Circadian Rhythm Sleep-Wake Disorders - p. 390

A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual's physical environment

The sleep disruption leads to excessive sleepiness or insomnia, or both and causes clinically significant distress or impairment.

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Simple explanation - people acting out their dreams during the REM phase of sleep

DSM-5 Diagnostic Criteria:
-Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors that occur during REM sleep (normally 90+ minutes into sleep) and uncommonly occur during daytime naps.

-Upon awakening, the person is completely awake and not disoriented. Either of the following occurs:
1) REM sleep without polysomnographic recording
2) a history of REM sleep behavior disorder and an established synucleinopathy (Parkinson's disease or multiple system atrophies, for examples)

-Disturbances cause clinically significant distress or impairment (to possibly include injuries to self or sleep partner) and are not better explained by the use of a substance or a coexisting mental or medical disorder

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Non-REM Sleep Arousal Disorder - p. 399

A. Recurring episodes of incomplete awakening from sleep, usually occurring during first third of the major sleep episode that must include either:

sleepwalking

sleep terrors

B. no or little dream imagery is recalled
C. amnesia for the episodes
D. clinically significant distress or impairment in functioning
E. cannot be explained by the effects of a substance
F. cannot be explained by a coexisting mental or medical disorder

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"Nightmares" from the animated movie, Rise of the Guardians.

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Diagnostic Criteria:
Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity and that generally occur during the second half of the major sleep episode. When the person awakes, they are typically alert and oriented.

The disturbances in sleep cause clinically significant distress and impairment and are not better explained by:
- the effects of a substance
- another mental health disorder
- another medical condition

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An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs that worsens during periods of rest or inactivity, the urge is relieved by movement, and the urge to move the legs is worse in the evening or at night.

must occur 3x per week for at least 3 months

symptoms create significant distress or impairment

not caused by another medical condition or the use of a    substance

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A. a prominent and severe disturbance in sleep
B. evidence from history, physical exams, or laboratory findings of both

symptoms developed during or soon after substance intoxication or after withdrawal

the involved substance/medication is capable of producing the symptoms

C. the disturbance is not better explained by another sleep disorder
D. the disturbance does not occur only during the course of a delirium
E. the disturbance causes clinically significant distress or impairment in functioning

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Watch the video, click "add comment," and reply to the following prompt: How would your life look differently if you suffered from insomnia?

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Watch the video, click "add comment," and reply to the following prompt: How would your life look differently if you suffered from insomnia?

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What keeps you up at night? Pondering deep questions? Excitement about a big trip? Stress about unfinished work? What if the very thing keeping you awake was stress about losing sleep? This seemingly unsolvable loop is at the heart of insomnia, the world's most common sleep disorder. So what is insomnia?

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Insomnia must be differentiated from the following diagnoses:
- normal sleep variations
- situational/acute insomnia
- delayed sleep phase and shift work types of circadian rhythm sleep-wake disorder
-restless legs syndrome
-breathing-related sleep disorders
-narcolepsy
- parasomnias
- substance/medication-induced sleep disorder, insomnia type

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The Athens Insomnia Scale is a commonly used 8 question tool to diagnose insomnia. If a patient scores higher than 10 on this instrument, clinicians consider other factors (listed on source link) to rule out differential diagnoses before an insomnia diagnosis is made.

source: https://www.camh.ca/en/professionals/treating-conditions-and-disorders/sleep-disorders/sleep-disorders---screening-and-assessment

Click here to explore the psychometric information for the Athens Insomnia Scale:
https://pubmed.ncbi.nlm.nih.gov/12932801/

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Hypersomnolence must be distinguished from:
- normative variation in sleep
- poor sleep quality and fatigue
- breathing-related sleep disorders
- circadian rhythm sleep-wake disorders
- parasomnias
- other mental disorders

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The Epworth Sleep Scale is commonly used as a screening tool to evaluate for a diagnosis of Hypersomnolence.

Follow the links below to explore psychometric data related to this instrument in various population groups:

https://hqlo.biomedcentral.com/articles/10.1186/s12955-019-1098-9

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693185/

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According to the Centre for Addiction and Mental Health (CAMH), common methods of treatment for insomnia include:
- psychoeducation
- Cognitive Behavioral Therapy (CBT)
- medication

CAMH offers a one stop shop for comparing different medications for sleep-related disorders. Each medication has a drop down list to include dosage information, benefits, potential drawbacks, drug interactions, and side effects. Click on the image link in this post to explore potential medications.

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Text adapted from: “The adult patient with a sleep disorder,” in Psychiatry in primary care by Dora Zalai, M.R. Goolam Hussain and Colin Shapiro (CAMH, 2019).

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According to the Cleveland Clinic, treatment for Hypersomnolence disorder often includes medication and lifestyle habits that are conducive to restful sleep.

Source: https://my.clevelandclinic.org/health/diseases/21591-hypersomniahttps://my.clevelandclinic.org/health/diseases/21591-hypersomnia

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Hypersomnia: Symptoms, Causes & Treatment

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Hypersomnia is the inability to stay awake and alert during the day despite an adequate amount of nighttime sleep. There are several types of hypersomnia and treatment options.

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Based on the information provided in this graphic, what are your barriers to following these 10 pointers for more restful sleep? (If you don't feel comfortable sharing your own, share about barriers that may impact a truly restful sleep for a hypothetical student or client.) Reply with a comment.

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Narcolepsy Differential Diagnosis - audio

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Narcolepsy must be differentiated from the following:
- other hypersomnias
- sleep deprivation and insufficient nocturnal sleep
- major depressive disorder
- sleep apnea syndromes
- conversion disorder
- ADHD
- seizures
- chorea and movement disorders
- Schizophrenia

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Narcolepsy Differential Diagnosis - audio

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The following link provides insightful information from Harvard Med regarding the Epworth Sleepiness Scale as a screening tool to evaluate for narcolepsy. It includes a self assessment tool that you are welcome to try to see where your results land. It also provides information about understanding your results.

https://healthysleep.med.harvard.edu/narcolepsy/diagnosing-narcolepsy/epworth-sleepiness-scale#

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Link: https://healthysleep.med.harvard.edu/narcolepsy/treating-narcolepsy/self-care

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Obstructive Sleep-Apnea must be differentiated from the following:
- primary snoring and other sleep disorders
- Insomnia
- panic attacks
- ADHD
- substance/medication-induced insomnia or hypersomnia

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The STOP-BANG instrument is one assessment instrument used to assess for obstructive sleep apnea. The letters stand for:

Snoring: Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

Tired: Do you often feel tired, fatigued, or sleepy during daytime?

Observed: Has anyone observed you stop breathing during your sleep?

Blood Pressure: Do you have or are you being treated for high blood pressure?

BMI: BMI more than 35 kg/m²?

Age over 50 years old?

Neck circumference greater than 40 cm (around 16in, measured by staff)?

Gender male?

Check out the pdf to see the questions on the STOP-BANG assessment as well as scoring information. Click on the following link to explore psychometric information:

https://www.acc.org/latest-in-cardiology/articles/2015/07/14/11/04/screeing-tools-for-the-obstructive-sleep-apnea-for-the-cardiovascular-clinician#:~:text=Screening%20Tools%20for%20Sleep%20Apnea&text=There%20are%20four%20screening%20tools,four%20and%20eight%20questions%2C%20respectively.

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https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea

Scroll to the bottom of the link to explore conservative methods, mechanical treatments, and medical procedures that are often used to treat sleep apnea.

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Understand Pap Therapy for Your Sleep Apnea

How is sleep apnea treated, and is there a cure?

There are many approaches to treating sleep apnea, depending on the specific type of sleep apnea and how severe it is. While none of these is a cure, they can help prevent apnea events or reduce how often they happen or how severe they are.

Many treatments should be a part of your daily (or nightly) routine. That can ultimately reduce or even eliminate sleep apnea's effects on your life for as long as you use these treatments.

Possible treatments include:

Conservative (nonmedical) treatments.

Positive airway pressure and adaptive ventilation devices.

Oral appliances (mouthpieces).

Nerve stimulators.

Surgery.

Medications (central sleep apnea only).

Conservative treatments

These nonmedical treatments or approaches can typically improve obstructive sleep apnea or resolve it. They aren't cures, but they can reduce apnea to the point where it stops happening or isn't severe enough to cause symptoms. These include:

Weight loss. A 10% decrease in body weight can significantly improve sleep apnea for people who have excess weight or obesity.

Position changes while sleeping and sleep aid items. Sleeping on your back makes sleep apnea more likely to happen. Special support pillows and similar items can help change the position in which you sleep, keeping you off your back so soft tissue doesn't press on your windpipe and block breathing.

Nasal sprays, adhesive strips, etc.These over-the-counter products improve breathing by making it easier for air to travel through your nose. While they can't help moderate or severe sleep apnea, they can sometimes help snoring and mild sleep apnea.

Treating the underlying condition.Treating conditions such as heart failure can often improve central sleep apnea.

Medication changes.Working with your doctor to decrease or stop opioid pain medications may be able to improve or even resolve central sleep apnea.

Positive airway pressure (PAP) and adaptive ventilation

Positive airway pressure is a method that uses a specialized device to increase the air pressure inside of your airway while you inhale. This method can treat obstructive, central and mixed sleep apneas.

Pushing pressurized air down your windpipe keeps it open so you can breathe. These devices push air through a hose that attaches to a special mask you wear on your face while you sleep. Masks can cover your nose, mouth or both, and there are many different types and styles to choose from.

The best-known PAP device is the Continuous Positive Airway Pressure (CPAP) machine. However, there are other types of PAP machines, too (see our CPAP Machine article for more about the different types of devices, including adaptive servo-ventilation devices). These devices increase the air pressure inside of your airway and lungs when you inhale, keeping surrounding tissue from pressing your airway shut.

Oral devices

Obstructive sleep apnea happens when soft tissue in your head or neck, especially around your mouth and jaw, press downward on your windpipe. Special mouthpiece devices can help hold your jaw and tongue in a position that keeps pressure off your windpipe. Dentists and sleep medicine specialists often work together to make these for people who need them.

Nerve stimulators

The hypoglossal nerve (the name comes from Greek and means "under the tongue") is what controls your tongue's movements. A nerve stimulator attached to this nerve can stimulate it, pushing your tongue slightly forward when you breathe while you're sleeping. That keeps your tongue from relaxing and pressing backward on your windpipe while you sleep, which is one of the ways that obstructive sleep apnea happens.

An electrode attaches to the nerve under your jaw and connects to a device implanted under the skin in your chest. You can turn the stimulator on before you sleep and turn it off after you wake up. The electrical current is strong enough to keep your tongue from relaxing too much, but mild enough that it's not uncomfortable.

A similar kind of nerve stimulation is also possible with central sleep apnea. This type of stimulation affects the phrenic nerves. This pair of nerves connect your spinal cord to the diaphragm, a layer of muscle underneath your lungs that controls your ability to inhale and exhale. Stimulating the phrenic nerve causes those muscles to flex, helping you breathe.

Surgery

Surgeries on your nose, mouth and throat can help prevent blockages of your nose, throat and windpipe. However, the impact of these in adults is usually limited and varies from person to person. These surgeries include:

Somnoplasty. This procedure uses radiofrequency (RF) to reduce soft tissue around the upper parts of your windpipe.

Tonsillectomy/adenoidectomy. Removing your tonsils and adenoids can widen the opening where your mouth, throat and nasal passages connect. That makes it easier for air to pass through and reduces soft tissue that can block your breathing. This procedure is most helpful for children with obstructive sleep apnea.

Uvulopalatopharyngoplasty (UPPP). This procedure removes your uvula (the teardrop-shaped soft tissue that hangs at the back of your mouth). It also removes soft tissue from your soft palate and pharynx. These widen the area where your mouth and throat meet, making it easier for air to pass through.

Jaw surgery. Different surgery procedures can subtly change the position of your jaw so soft tissue can't easily press back on your airway. These procedures are especially helpful for people who have sleep apnea for structural reasons like micrognathia.

Nasal surgery. One common form of nasal surgery is septoplasty, which straightens the soft tissue in your nose, making it easier for air to travel through your nose and nasal passages.

Medications for central sleep apnea

In addition to positive airway pressure, adaptive ventilation and phrenic nerve stimulators, there are some medications that may help central sleep apnea. Some examples of these medications include hypnotic (sleep-promoting) medications, respiratory-stimulating drugs and more. However, none of these medications are formally approved or definitively accepted for this use.

What can or can't I eat or drink with sleep apnea?

People who have sleep apnea should avoid heavy drinking, and frequent use of sleeping pills or other drugs (recreational and otherwise) that cause heavy sedation. These can make sleep apnea worse. Your healthcare provider can talk to you about drugs that can cause that and how you can avoid the effects.

Complications/side effects of the treatment

The complications and side effects of the treatments depend on many factors, especially the treatments themselves. Your healthcare provider is the best source of information for what you can do to minimize the side effects or prevent them when possible.

How to take care of myself/manage symptoms?

Sleep apnea is a condition that can severely disrupt your life and put you at risk for life-threatening complications and events (see more about these under the Outlook/Prognosis section below). Because of this, you shouldn't try to self-diagnose or self-treat it. If you think you have sleep apnea, you should schedule an appointment with a sleep specialist or ask a primary care provider to refer you to a sleep specialist.

How you can help with diagnosis

If you suspect you or a loved one has sleep apnea, you might be able to help a healthcare provider diagnose it. Video and audio recordings of a person sleeping, especially where the provider can hear breathing, can give a provider key evidence they need to speed up the diagnostic process.

How soon after treatment will I feel better?

The time it takes to recover or feel better after treatment for sleep apnea depends on the treatments themselves. Some people will feel better almost immediately, while others may need three to six months of consistent nightly treatment to see the full benefits. Your healthcare provider can tell you more about the timeline for your recovery and when you should expect to feel better.

Devices that treat sleep apnea, especially positive airway pressure devices, often bring very fast results. Older devices may take some tweaking and adjusting (a process known as "titration") of the settings, but many newer devices can often adjust automatically to meet your needs (especially if your sleep apnea is mild or on the low end of moderate).

While some people may need to get used to wearing a mask to sleep, most people can overcome that fairly quickly. Many people see improvements immediately when they sleep through the night using a positive airway pressure device.

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Sleep Apnea: What It Is, Causes, Symptoms & Treatment

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Sleep apnea is a disorder that causes you to stop breathing while asleep. This disrupts and prevents restful sleep, which can have a severe impact on your life.

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This condition must be differentiated from the following:
- depressive disorders
- normative variations in sleep
- other medical conditions or mental disorders
- normative variations in sleep with shift work

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Understanding Circadian Rhythm Sleep Disorders

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The Epworth Sleep Scale is commonly used as a screening tool to evaluate for a diagnosis of circadian rhythm sleep-wake disorders.

Follow the links below to explore psychometric data related to this instrument in various population groups:

https://hqlo.biomedcentral.com/articles/10.1186/s12955-019-1098-9

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693185/

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Treatment Options - screenshare with audio

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https://my.clevelandclinic.org/health/diseases/12115-circadian-rhythm-disorders#:~:text=Medications%3A%20Medications%20such%20as%20melatonin,cycle%20to%20the%20desired%20schedule.

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REM Sleep Disorder must be differentiated from the following:

- other parasomnias
- nocturnal seizures
- obstructive sleep apnea
- other specified dissociative disorder
- malingering

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Reply in the comments to the following prompt: Based on the diagnostic criteria and the information you learned in this video, how could sleep walking create clinically significant impairment?

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Reply in the comments to the following prompt: Based on the diagnostic criteria and the information you learned in this video, how could sleep walking create clinically significant impairment?

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How Does Sleepwalking Work And Should You Wake Up A Sleepwalker??

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NREM Sleep - differential diagnosis audio

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Non REM sleep arousal disorder must be differentiated from:
- nightmare disorder
- breathing-related sleep disorders
- REM sleep behavior disorder
- parasomnia overlap syndrome
- sleep-related seizures
- alcohol-induced blackouts
- dissociative amnesia, with dissociative fugue
- malingering or other voluntary behavior occurring during wakefulness
- panic disorder
- medication-induced complex behaviors
- night eating syndrome

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NREM Sleep - differential diagnosis audio

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The Paris Arousal Sleep Disorder scale has recently (2021) been evaluated as an assessment instrument for this sleep disorder. Click on the link to explore findings published in the Journal of Clinical Sleep Medicine.

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Study Objectives:

We created a Dutch version of the Paris Arousal Disorders Severity Scale, which assesses non-rapid eye movement (NREM) parasomnia symptoms over the past year (PADSS-year). This questionnaire was previously validated in patients with sleep walking and/or sleep terrors ('SW/ST'). We validated the questionnaire in SW/ST patients, and in a broader population, including patients with confusional arousals, co-morbidities, and medication-users ('other NREM parasomnias'). Furthermore, we introduced a version covering the past month (PADSS-month), with the potential purpose of evaluating symptom evolution and treatment response.

Methods:

We compared PADSS scores among 54 SW/ST patients, 34 age-matched controls, and 23 patients with other NREM parasomnias. We evaluated discriminative capacity, internal consistency and construct validity. Furthermore, we assessed the test-retest reliability and treatment response of PADSS-month.

Results:

Healthy controls scored significantly lower than both patient groups. We found an excellent diagnostic accuracy (AUC PADSS-year 0.990, PADSS-month 0.987) and an acceptable internal consistency. Exploratory factor analysis identified three components: 'behaviors outside the bed', 'behaviors in/around the bed', and 'violent behaviors', the former two factors reflecting the distinction between SW and ST. PADSS-month showed an acceptable test-retest reliability (0.75). Additionally, PADSS-month significantly decreased after pharmaceutical and/or behavioral treatment. This change was correlated with the clinical impression of the caregiver, implying that PADSS-month is sensitive to treatment effects.

Conclusions:

The Dutch PADSS questionnaire can be used as a screening tool in a broad population of NREM parasomnia patients, not only SW/ST. Furthermore, we validated a PADSS-month version, to assess the evolution of symptoms and treatment effect.

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We created a Dutch version of the Paris Arousal Disorders Severity Scale, which assesses non-rapid eye movement (NREM) parasomnia symptoms over the past year (PADSS-year). This questionnaire was previously validated in patients with sleep walking and/or sleep terrors ('SW/ST').

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The Cleveland Clinic presented multiple treatment options for both adults and children for both REM and NREM sleep disorders here. Follow the link to explore treatment options.

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Overview

What is a parasomnia?

A parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep. A parasomnia can occur before or during sleep or during arousal from sleep. If you have a parasomnia, you might have abnormal movements, talk, express emotions or do unusual things. You are really asleep, although your bed partner might think you're awake.

Are there different types of parasomnia?

Yes. Parasomnias are grouped by the stage of sleep in which they happen. There are two main stages of sleep - non-rapid eye movement (Non-REM) sleep and rapid eye movement (REM) sleep. There are other parasomnias that fall into an "other" category.

What is non-rapid eye movement (Non-REM) sleep? What parasomnias happen during this sleep stage?

Non-rapid eye movement (Non-REM) sleep are the first three stages of sleep - from first falling asleep to about the first half of the night. Non-REM sleep disorders are also called arousal disorders.

Non-REM parasomnias involve physical and verbal activity. You are not completely awake or aware during these events, are not responsive to others' attempts to interact with you and you usually don't remember or only partially remember the event the next day. Non-REM parasomnias usually occur in individuals between five and 25 years of age. Non-REM parasomnias often occur in people who have a family history of similar parasomnias.
Parasomnias that happen during Non-REM sleep include:

Sleep terrors: If you experience this sleep disorder, you wake up suddenly in a terrified state. You may scream or cry in fright. Sleep terrors are usually brief (30 seconds), but can last up to a few minutes. Other features of this disorder are a racing heart rate, open eyes with dilated pupils, fast breathing and sweating.

Sleepwalking (somnambulism): If you're a sleepwalker, you get out of bed, move about with your eyes wide open, but you're actually asleep. You may mumble or talk (sleep talking). You may perform complex activities - such as driving or playing a musical instrument - or do strange things like pee in a closet or move furniture. Sleepwalking can be dangerous and lead to injuries because you're unaware of your surroundings. You can bump into objects or fall down.

Confusional arousals: If you have this sleep disorder, you appear to be partially awake, but you are confused and disoriented to time and space. You remain in bed, may sit up, have your eyes open, and may cry. You speak slowly, have trouble understanding questions that are asked or responding in a sensible way. The episode may last from a few minutes to hours. Confusional arousals are common in childhood and tend to decrease in frequency with increasing age.

Sleep-related eating disorder: If you have this sleep disorder, you eat and drink while you're partially awake. You may eat foods or food combinations you wouldn't eat if awake (such as uncooked chicken or slabs of butter). Dangers include eating inedible or toxic foods, eating unhealthy or too much food, or injuries from preparing or cooking foods.

What is rapid eye movement (REM) sleep? What parasomnias happen during this sleep stage?

Rapid eye movement (REM) sleep follows the three non-REM stages of the sleep cycle. During REM sleep, your eyes rapidly move under your eyelids and your heart rate, breathing and blood pressure are all increased. This is a time when vivid dreaming occurs. Your body cycles through and repeats non-REM and REM sleep about every 90 to 110 minutes.

Parasomnias happen during the latter part of the night. If awakened during the event, it's likely you'd be able to recall part or all of the dream.
Parasomnias that happen during REM sleep include:

Nightmare disorder: These are vivid dreams that cause feelings of fear, terror and/or anxiety. You may feel a threat to your survival or security. If you are awakened during your nightmare, you'd be able to describe your dream in detail. You often have trouble falling back to sleep. Nightmare disorder is more likely to occur if you're under stress or experience a traumatic event, illness/fever, extreme tiredness or after alcohol consumption

Recurrent isolated sleep paralysis: If you have this sleep disorder, you can't move your body or limbs during sleep. Scientists think the paralysis might be caused by an extension of REM sleep - a stage in which muscles are already in a relaxed state. This happens either before you fall asleep or as you are waking up. Episodes last seconds to a few minutes and are distressing, usually causing anxiety or fear. Sleep paralysis can be stopped if your bed partner speaks to you or touches you.

REM sleep behavior disorder (RSBD): If you have this sleep disorder, you act out, vocalize (e.g., talk, swear, laugh, shout), or make aggressive movements (e.g., punching, kicking, grabbing) as a reaction to a violent dream. This sleep disorder is more common among older adults. Many people with this disorder have neurodegenerative disease, such as Parkinson's disease, Lewy body dementia, multiple system atrophy or stroke.

Other parasomnias include:

Exploding head syndrome: If you have this sleep disorder, you hear a loud noise or explosive crashing sound in your head as you're falling asleep or waking up. You may also see an imaginary flash of light or have a sudden muscle jerk.

Sleep enuresis (bedwetting): This is not the bedwetting that occurs in young children. To be a parasomnia, this bedwetting must happen in children age five and older and must occur at least two times a week for at least three months.

Sleep-related hallucinations: If you have this sleep disorder, you experience hallucinations as you're falling asleep or waking up. You may see things, hear things, feel things or feel movement that doesn't really exist. You may leave your bed to escape what you're experiencing.

Sleep-related groaning (catathrenia): With this sleep disorder, you have repeat episodes of groaning noises (long groans followed by sighs or grunts) during sleep.

Sexsomnia: Persons with this sleep disorder carry out sexual behaviors during their sleep. These may include intercourse, masturbation, sexual assault, fondling your bed partner or sexual vocalizations.

Are certain parasomnias more common to a certain gender?

Nightmares appear to happen more often in females. Sexsomnia is seen more often in males. REM sleep behavior disorder is more commonly reported in males over age 50. Sleep terrors, confusional arousals and sleepwalking occur in a similar number of males and females.

Do parasomnias occur in children?

Yes. Parasomnias are more common in children than in adults. Non-REM sleep disorders are more common in children than REM disorders. The most common parasomnias in children under the age of 15 are:

Parasomnias are seen more often in children who have neurologic or psychiatric health issues including epilepsy, attention-deficit hyperactive disorder (ADHD) or developmental issues.

Symptoms and Causes

What are the causes of parasomnias?

Causes of parasomnias can be grouped into those that disrupt sleep and other general health issues.
Issues that disrupt sleep:

Incomplete transition from being awake to the stages of sleep.

Lack of sleep, irregular sleep-wake schedules (jet lag or shift work).

Medications including those that cause sleep (benzodiazepines: zolpidem), treat depression (amitriptyline, bupropion, paroxetine, mirtazapine), treat psychotic disorders (quetiapine, olanzapine), treat high blood pressure (propranolol, metoprolol), treat seizures (topiramate), treat asthma/allergy (montelukast) treat infections (fluoroquinolones).

Medical issues that disrupt sleep, such as restless leg syndrome, obstructive sleep apnea, pain, narcolepsy, sleep deprivation, circadian rhythm disorders, or periodic limb movement disorder.

Lack of maturity of the sleep-wake cycle (in children with parasomnias).

Other health issues:

Fever.

Stress.

Alcohol or substance abuse.

Head injury.

Pregnancy or menstruation.

Genetics. If there's a family history of parasomnias, you're more likely to have them.

Inflammatory disease, such as encephalitis.

Psychiatric illness, including depression, anxiety and post-traumatic stress disorder.

Neurological disease, including Parkinson's disease, Lewy body dementia, stroke, multiple system atrophy, multiple sclerosis, brain tumors, migraines, and spinocerebellar ataxia type three.

What are the symptoms of parasomnias?

Each type of parasomnia has many unique features and triggers. However, some of the more common symptoms include:

Difficulty sleeping through the night.

Waking up confused or disoriented.

Being tired during the day.

Finding cuts and bruises on your body for which you don't remember the cause.

Displaying movements, expressions, vocalizations or activities - as told to you by your bed partner - that you don't remember.

Diagnosis and Tests

How are parasomnias diagnosed?

Your sleep medicine specialist will ask you and your sleep partner about your sleep symptoms. You will also be asked about your medical history, family history, alcohol use and any substance abuse. You'll be asked about your current medications. You may be asked to keep a sleep diary and your bed partner may be asked to keep track of your sleep events.

Other sleep disorders tests include:

Sleep study (polysomnogram): This is a sleeping laboratory in which you'll be monitored as you sleep. Your brain waves, heart rate, eye movements and breathing will be recorded as you sleep. Video will record your movements and behavior. While some sleep studies can be done at home, an in-lab study will be recommended if there's concern for parasomnia.

Video electroencephogram (EEG) or sleep EEG: These tests help your healthcare provider see and record your brain activity during a brain event.

Neurologic exam, CT or MRI scan to detect degeneration of the brain or other possible neurologic causes of your symptoms.

Management and Treatment

How are parasomnias treated?

Treatment starts with identifying and treating other sleep problems and any other health issues as well as reviewing medications that may trigger the parasomnia.

General management strategies for both Non-REM and REM sleep disorders are to:

Follow good sleep hygiene habits (get 7-9 hours of sleep/night; turn off lights, TV and electronic devices; keep room temperature cool; avoid caffeine and strenuous exercise near bedtime).

Maintain your regular sleep-wake schedule. Have a consistent bed time and wake up time.

Limit, or don't use, alcohol or recreational drugs.

Take all prescribed medications as directed by your healthcare provider.

Other treatments for non-REM sleep disorders:

Medication is not usually prescribed for non-REM parasomnias. However, when they are used, benzodiazepines are the medications of choice for parasomnias that are long lasting or potentially harmful. Tricyclic antidepressants are also sometimes tried. Psychological approaches (such as hypnosis, relaxation therapy or cognitive behavioral therapy, psychotherapy) are also considered.
Other treatments for REM sleep disorders:

Clonazepam and melatonin are the medications commonly used to manage REM sleep disorders.

Your healthcare provider will discuss the best treatment options - medications and/or psychologic approaches - for your specific type of parasomnia considering your unique health history and medical issues.
Safety precautions
Another discussion you and your healthcare provider will have are suggestions to keep your sleeping environment safe. Tips include:

Lock or remove any dangerous or sharp items from the bedroom.

Secure tableside lights.

Use floor pads to prevent injuries from falls.

Pad the edges of bedside furniture.

Use plastic bottles and cups if water is needed at the bedside.

Install alarms on windows and doors for sleepwalkers.

Sleep in separate beds if the person with parasomnia displays aggressive behaviors - like punching or kicking.

How are parasomnias in children treated?

Non-REM parasomnias are most common during childhood and normally end during adolescence. Usually all that's needed is calming reassurance from the parents that everything is okay. Medications are rarely needed, but if they are, they're typically only prescribed for three to six weeks. Medications typically tried include benzodiazepines or anti-anxiety drugs.

Prevention

Can parasomnias be prevented?

Although some causes of parasomnias are less likely to be prevented, such as those due to neurological diseases, mental health issues or heredity, others may be prevented by following some of the same management approaches discussed in this article. These include getting seven to nine hours of sleep a night sticking with consistent bedtime and wakeup times, and limiting alcohol and recreational drug use. (See the treatment section for more tips.) Also, ask your healthcare provider to review your current medications. Many can disrupt sleep. If this is the case, perhaps different drugs can be prescribed.

Living With

When should I call the doctor about sleep problems?

You should talk to your doctor if you or your family member experiences any abnormal sleep-related behaviors, especially those associated with injuries or sleep disruption.

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Parasomnias: Causes, Symptoms, Types & Management

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A parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep. A parasomnia can occur before or during sleep or during arousal from sleep. If you have a parasomnia, you might have abnormal movements, talk, express emotions or do unusual things.

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Nightmare disorder must be differentiated from the following:
- sleep terror disorder
- REM sleep behavior disorder
- bereavement
- narcolepsy
- nocturnal seizures
- breathing-related sleep disorders
- panic disorder
- sleep-related dissociative disorders
- medication or substance use

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Nightmare Disorder Assessment Instrument audio

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See full article including psychometric information here:
https://insomnia.lab.arizona.edu/sites/insomnia.lab.arizona.edu/files/2021-01/Dietch%2C%20Taylor%2C%20Pruiksma%2C%20Wardle-Pinkston%2C%20Slavish%2C%20Mressman%2C%20Estevez%2C%20Ruggero%2C%20%26%20Kelly%202020%20%28Corrected%20Proofs%29.pdf

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In the comments, reply with a brief description of how you would use this VR technology to alter an image that would normally cause distress to you.

If you'd rather not share what would cause you distress, share ideas of how I could conquer my fear of someone attacking me while it is dark outside using this VR therapy. This has always been something that terrifies me! I used to run as fast as I could back into my house as a kid if my dad would make me take out the trash at night. Fun fact...I still do this as an adult. (insert laughing emoji)

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Virtual Reality Therapy for Nightmare Disorder

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Video by Dr. Jenn Lindsay, Documentarian for CMAC, www.jennlindsay.com and https://vimeopro.com/jennlindsay/portfolio

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Reply in the comments to 1 of the 2 prompts:
Based on what you've learned about REM Sleep Behavior Disorder, describe how this condition could impact your relationship with a sleep partner.

OR

Describe how you would need to alter your own sleep environment if you were diagnosed with this condition.

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link to article:
https://reader.elsevier.com/reader/sd/pii/S1389945716300831?token=3CC33CCB3B3BF1B5D96A4CBE1257F95FE5F453E802898E769629423A777F048B82632EEF473A3D54D3EA40C8E8E8DF6C&originRegion=us-east-1&originCreation=20220325182705

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- treating iron deficiencies (if applicable)
- medication
- home remedies such as: stretching, massage, exercise, cool or warm packs, taking warm baths

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This disorder must be distinguished from the following:
- substance intoxication or withdrawal
- delirium
- other sleep disorders
- sleep disorder due to another medical condition

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Central Sleep Apnea - Diagnostic Criteria

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Central Sleep Apnea - Diagnostic Criteria

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A. evidence by polysomnography of 5+ central apneas per hour of sleep
B. cannot be better explained by another sleep disorder

Specify whether:
- idiopathic central sleep apnea
- Cheyne-Stokes breathing
- central sleep apnea comorbid with opioid use

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Differential Diagnosis/Assessment Tool - p. 386

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Differential Diagnosis/Assessment Tool - p. 386

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Central sleep apnea must be distinguished from other sleeping disorders (especially breathing sleep-related disorders) by the use of polysomnography.

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Innovation treatment option for Central Sleep Apnea

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Innovation treatment option for Central Sleep Apnea

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According to the Mayo Clinic, treatment options for Central Sleep Apnea include:

Addressing associated medical problems. Possible causes of central sleep apnea include other disorders and treating those conditions might help your central sleep apnea. For example, therapy for heart failure might improve central sleep apnea.

Reduction of opioid medications. If opioid medications are causing your central sleep apnea, your doctor might gradually reduce your dose of those medications.

Continuous positive airway pressure (CPAP). This method, also used to treat obstructive sleep apnea, involves wearing a mask over your nose or your nose and mouth while asleep.

The mask is attached to a small pump that supplies a continuous amount of pressurized air to hold open your upper airway. CPAP may prevent the airway closure that can trigger central sleep apnea.

As with obstructive sleep apnea, it's important that you use the device only as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor. Several types of masks are available. Doctors can also adjust the air pressure.

Adaptive servo-ventilation (ASV). If CPAP doesn't effectively treat your condition, you might be given ASV. Like CPAP, ASV also delivers pressurized air.

Unlike CPAP, ASV adjusts the amount of pressure breath-by-breath during inhalation to smooth out your breathing pattern. The device might also automatically deliver a breath if you haven't taken a breath within a certain number of seconds.

ASV isn't recommended for people with symptomatic heart failure.

Bilevel positive airway pressure (BPAP). Like ASV, BPAP delivers pressure when you breathe in and a different amount of pressure when you breathe out. Unlike ASV, the amount of pressure during inspiration is fixed rather than variable. BPAP can also be set to deliver a breath if you haven't taken a breath within a certain number of seconds.

BPAP could worsen central sleep apnea in people with heart failure. Talk to your doctor about the potential risks of BPAP if you have heart failure.

Supplemental oxygen. Using supplemental oxygen while you sleep might help if you have central sleep apnea. Various devices are available to deliver oxygen to your lungs.

Medications. Medications such as acetazolamide have been used to stimulate breathing in people with central sleep apnea. These medications might be prescribed to help your breathing as you sleep if you can't tolerate positive airway pressure.

Source: https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/diagnosis-treatment/drc-20352114

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The remedē® System for Central Sleep Apnea

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Diagnostic Criteria:
A. polysomnography shows episodes of decreased breathing associated with elevated CO2 levels
B. the disturbance is not better explained by another sleep disorder

Specify whether: (along with severity)
- idiopathic hypoventilation
- congenital central alveolar hypoventilation
- comorbid sleep-related hypoventilation

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Sleep-related Hypoventilation must be differentiated from:

- other medical conditions affecting ventilation (lung diseases, skeletal malformations, neuromuscular disorders)
- other breathing-related sleep disorders