Parasomnias

Parasomnias are common sleep disorders, especially in children. Most of the time, when there is no evidence of the existence of underlying medical conditions, treatment with drugs is not required.

Restless Legs Syndrome (RLS) is a common condition in which the urge of leg movement during sleep is a result of an uncomfortable sensation. These jerky leg movements, more common in individuals over 50 years old, usually happen before falling asleep, but may also interrupt sleep.

RLS may be exacerbated by pregnancy, fatigue, environmental temperature extremes, the intake of caffeinated beverages and some antidepressants, and drug withdrawal states.

Sometimes RLS may be associated with medical conditions such as kidney failure, rheumatoid arthritis, fibromyalgia, anemia. In about 1/3 of patients Restless Legs Syndrome is inherited.

Recently the Food and Drug Administration has approved Requip (ropinirole) to treat moderate to severe Restless Legs Syndrome.

Nightmares occur during REM sleep. These mostly affect children, but are not uncommon in adults. Some situations may act as a precipitating or exacerbating factor, for example use of certain drugs or alcohol, fever, or extreme fatigue.

Night terrors are sudden awakenings with sweating, rapid heart rate, and fear. They are more prevalent in children than adults, and may be accompanied by sleepwalking. They occur in NREM stages 3 and 4. Night terrors may be associated with psychological problems or alcoholism.

Somnambulism refers to specific behaviors or activities such as walking, sitting or talking during sleep. Even though individuals may have their eyes opened, they are still unconscious, and usually don't remember the episode after they wake up.
This is most common in older children or young adults. It is important to protect walking individuals, who may be in danger of injuring themselves if something is in their way - stairs or other obstacles.

There are many other forms of parasomnias, such as nocturnal enuresis, bruxism (teeth grinding), aggression during sleep, or head banging.

• difficulty falling asleep
  
• frequent awakening in the night
  
• daytime drowsiness
  
• snoring
  
• depression
  
• anxiety
  
• difficulty concentrating
  
• irritability
  
• leg movements during sleep

Treatment for Parasomnias has to be individualized based on the type of condition, severity and other personal factors, such as patient's age and coexistence of medical conditions (pregnancy, renal failure). Because of the complexity of these sleeping problems, the patient and physician have to work as a team, discussing every aspect of the condition to come up with the best resolution. In many cases simple solutions, like better sleep hygiene , will significantly improve the condition. Hypnosis is used sometimes to treat night terrors.

Physical activity during the day is always helpful for any sleep problem including parasomnias and of course is good for healthy life in general. If pharmacologic treatment is necessary, anticonvulsant or anxiety drugs may be considered.




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