00:00
Let's walk through some of the non-REM parasomnias and
understand the
typical presentation given the importance of the history in
making this diagnosis.
00:10
Let's start with sleep walking disorder. Typically, the
event will begin with simple to
complex movements. Patients may sit up in the bed. They may
walk and ambulate
around their room or other areas inside or outside the home.
There may be eating
associated with this. They may go outdoors and this presents
a concern for their
safety and we can also see violent behaviors but that is
rare. Typically, patients
are walking around as they typically would but during sleep.
This is a dissociation
between sleep and wakefulness. Patients wake up and are able
to move and
ambulate and move around in a coordinated fashion, but
they're asleep during
this event. They have no conscious recollection of what is
happening. This is a
non-REM parasomnia. So during the episode, patients are very
difficult to arouse.
01:01
Their eyes may be open but they have a blank stare. They're
not fully conscious
during this event. They're not lying down to new memories
and they're in that
deep slow wave period of sleep and as a result very
difficult to arouse out of the
episode. Trying to arouse the patient to wake them up and
get them out of it is
often unsuccessful and we want to move patients in to the
bed back in to sleep.
01:25
The end of the episode typically occurs as the patient
returns to bed or briefly
may wake up confused and disoriented in some of these
episodes. And the next
morning, the patients will usually have amnesia or lack of
recollection of the
event, failing to recall the episode that has occurred. What
about sleep terror
non-REM parasomnia? This is more common in children but we
can see in rare
episodes this extend into adulthood. These episodes tend to
start with sudden
arousals beginning with screaming or crying or yelling
loudly. There can be autonomic
changes, tachycardia, tachypnea, diaphoresis, mydriasis,
change in pupillary size
during the event. Again, this is a non-REM parasomnia so
patients often are very
difficult to arouse or wake up during the episode. They're
not responsive during
these episodes. Sleep terrors are often much shorter than
sleep walking
parasomnias but can occur for extended period in some cases.
As the event ends,
patients return to sleep and go back to bed and then the
following morning most
patients are amnestic to the event or may have partial
recollection. What about
sleep-related eating disorder? How does this present and
what do we hear from
patients. Well, to make a diagnosis of sleep-related eating
disorder, we tend to
see that episodes vary in frequency from once a week to more
than 5 times
in the same night, so this can become quite significant and
frequent. These
episodes tend to start with out-of- control or involuntary
eating during arousals
from sleep. Patients may be partially or completely
unconscious during this event.
03:16
Eating but unaware of what is happening around them.
Patients again are often
very difficult to arouse owing it that this is a non-REM
parasomnia and it ends
with the patient returning to sleep. Importantly, there is
some variation in the
patient's ability to recall these episodes. Many patients
will retain complete
amnesia, they will not remember the episodes that have
occurred, but some
may have partial recollection of the events. So what
differentiates just eating at
night someone who is hungry at night versus a sleep-related
eating disorder.
03:52
Well, in general, one or more of the following must be
present with recurrent
episodes to make a diagnosis of sleep-related eating
disorder. Number 1,
consumption of toxic foods, cigarette butts, preservatives,
patients are eating
things that they wouldn't normally eat if they were
conscious and aware of what
was going on. Two, engaging in potentially injurious
behaviors while obtaining food.
04:17
We see that patients may fall or burn themselves or sustain
cuts and not recall
that and that would be supportive of a diagnosis of
sleep-related eating disorder.
04:27
And then lastly, these patients need to have adverse health
consequences from
recurrent nocturnal eating either weight gain or daytime
fatigue or other indication
that this is negatively impacting their health. And then
let's talk about confusional
arousals. This is another non-REM parasomnia, a mental
confusion or disorientation
that occurs on awakening during slow wave sleep. Typically,
these episodes are
short lasting less than 15 minutes. Patients may awaken in a
semi-conscious
state with reduced responsiveness and typically there is not
recall of the event
the following morning. And then lastly, let's talk about
sleep-related abnormal
sexual behaviors. These can occur in patients with
obstructive sleep apnea
or as a result of a true non-REM parasomnia. We see abnormal
sexual behaviors
without awareness and typically without recall and this can
include masturbation,
sexual intercourse with a partner, or sexual assault in some
cases.