A report on Parasomnia

Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep.

- Parasomnia

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Pediatric polysomnography

Sleep disorder

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Medical disorder of an individual's sleep patterns.

Medical disorder of an individual's sleep patterns.

Pediatric polysomnography
Sign with text: Sömnförsök pågår (Sleep study in progress), room for sleep studies in NÄL hospital, Sweden.

Sleep disorders are broadly classified into dyssomnias, parasomnias, circadian rhythm sleep disorders involving the timing of sleep, and other disorders including ones caused by medical or psychological conditions.

John Everett Millais, The Somnambulist, 1871

Sleepwalking

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Phenomenon of combined sleep and wakefulness.

Phenomenon of combined sleep and wakefulness.

John Everett Millais, The Somnambulist, 1871
Amina, the somnabuliste, at the mill.
Mary Hoare's painting Lady Macbeth, Sleepwalking
"The Boston Tragedy," the murder of Maria Bickford, 1846; Tirrell was acquitted because of sleepwalking. National Police Gazette, 1846

It is classified as a sleep disorder belonging to the parasomnia family.

Stage N1 Sleep. EEG highlighted by red box.

Non-rapid eye movement sleep

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Non-rapid eye movement sleep (NREM), also known as quiescent sleep, is, collectively, sleep stages 1–3, previously known as stages 1–4.

Non-rapid eye movement sleep (NREM), also known as quiescent sleep, is, collectively, sleep stages 1–3, previously known as stages 1–4.

Stage N1 Sleep. EEG highlighted by red box.
Stage N2 Sleep. EEG highlighted by red box. Sleep spindles highlighted by red line.
Stage 3 Sleep. EEG highlighted by red box.

Stage 3 – previously divided into stages 3 and 4, is deep sleep, slow-wave sleep (SWS). Stage 3 was formerly the transition between stage 2 and stage 4 where delta waves, associated with "deep" sleep, began to occur, while delta waves dominated in stage 4. In 2007, these were combined into just stage 3 for all of deep sleep. Dreaming is more common in this stage than in other stages of NREM sleep though not as common as in REM sleep. The content of SWS dreams tends to be disconnected, less vivid, and less memorable than those that occur during REM sleep. This is also the stage during which parasomnias most commonly occur. Various education systems e.g. the VCAA of Australian Victorian education practice still practice the stages 3 & 4 separation.

Night terror

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Sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement sleep and lasting for 1 to 10 minutes.

Sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement sleep and lasting for 1 to 10 minutes.

Frans Verhas, Inconsolable, 1878 (Royal Museum of Fine Arts Antwerp)

Sleep terror is classified in the category of NREM-related parasomnias in the International Classification of Sleep Disorders.

Sleep-talking

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Somniloquy, commonly referred to as sleep-talking, is a parasomnia that refers to talking aloud while asleep.

Rapid eye movement sleep behavior disorder

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Sleep disorder in which people act out their dreams.

Sleep disorder in which people act out their dreams.

RBD is a parasomnia.

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Sleep sex

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The image above depicts an individual undergoing a sleep study.
Pictured above is an individual wearing a CPAP device.

Sexsomnia, also known as sleep sex, is a distinct form of parasomnia, or an abnormal activity that occurs while an individual is asleep.

Attrition (tooth wear caused by tooth-to-tooth contact) can be a manifestation of bruxism.

Bruxism

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Excessive teeth grinding or jaw clenching.

Excessive teeth grinding or jaw clenching.

Attrition (tooth wear caused by tooth-to-tooth contact) can be a manifestation of bruxism.
View from above of an anterior (front) tooth showing severe tooth wear which has exposed the dentin layer (normally covered by enamel). The pulp chamber is visible through the overlying dentin. Tertiary dentin will have been laid down by the pulp in response to the loss of tooth substance. Multiple fracture lines are also visible.
The left temporalis muscle
The left medial pterygoid muscle, and the left lateral pterygoid muscle above it, shown on the medial surface of the mandbilar ramus, which has been partially removed along with a section of the zygomatic arch
The left masseter muscle (red highlight), shown partially covered by superficial muscles

There is evidence that sleep bruxism is caused by mechanisms related to the central nervous system, involving sleep arousal and neurotransmitter abnormalities.

Microscopic image of a Lewy body (arrowhead) in a neuron of the substantia nigra; scale bar=20 microns (0.02mm)

Dementia with Lewy bodies

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Type of dementia characterized by changes in sleep, behavior, cognition, movement, and regulation of automatic bodily functions.

Type of dementia characterized by changes in sleep, behavior, cognition, movement, and regulation of automatic bodily functions.

Microscopic image of a Lewy body (arrowhead) in a neuron of the substantia nigra; scale bar=20 microns (0.02mm)
People with DLB are very sensitive to antipsychotic medications like haloperidol, which carry an increased risk of morbidity and mortality in DLB.
A ribbon diagram of apolipoprotein E. Variants of this protein influence the risk of developing DLB.
This photomicrograph shows brown-immunostained alpha-synuclein in Lewy bodies (large clumps) and Lewy neurites (thread-like structures) in the neocortical tissue of a person who died with Lewy body disease.
Positron emission tomography, for example, using PiB is helpful in the diagnosis of DLB.
Adult connected to wires from sensors for polysomnography
According to his widow, Robin Williams (pictured in 2011) was diagnosed during autopsy as having diffuse Lewy bodies.

REM sleep behavior disorder (RBD) is a parasomnia in which individuals lose the paralysis of muscles (atonia) that is normal during rapid eye movement (REM) sleep, and consequently act out their dreams or make other abnormal movements or vocalizations.

Polysomnographic record of REM sleep. Eye movements highlighted by red rectangle.

Polysomnography

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Multi-parameter study of sleep and a diagnostic tool in sleep medicine.

Multi-parameter study of sleep and a diagnostic tool in sleep medicine.

Polysomnographic record of REM sleep. Eye movements highlighted by red rectangle.
Connections of polysomnography wires on an adult patient
Use of equipment for overnight diagnosis in hospitalization records
Pediatric polysomnography patient
Adult patient, equipped for ambulatory diagnosis
Electrophysiological recordings of stage 3 sleep

Video-EEG polysomnography which combines polysomnography with video recording has been described as more effective than only polysomnography for the evaluation of sleep troubles such as parasomnias, because it allows easier correlation of EEG and polysomnography with bodily motion.