REM Sleep Parasomnias
Parasomnias
Sleep, REM
Sleep Arousal Disorders
Sleep
Somnambulism
Sleep Disorders
Sleep Stages
Epilepsy, Frontal Lobe
Polysomnography
REM Sleep Behavior Disorder
Wakefulness
Sleep Apnea Syndromes
CSF hypocretin-1 levels in narcolepsy, Kleine-Levin syndrome, and other hypersomnias and neurological conditions. (1/4)
OBJECTIVE: To determine the role of CSF hypocretin-1 in narcolepsy with and without cataplexy, Kleine-Levin syndrome (KLS), idiopathic and other hypersomnias, and several neurological conditions. PATIENTS: 26 narcoleptic patients with cataplexy, 9 narcoleptic patients without cataplexy, 2 patients with abnormal REM-sleep-associated hypersomnia, 7 patients with idiopathic hypersomnia, 2 patients with post-traumatic hypersomnia, 4 patients with KLS, and 88 patients with other neurological disorders. RESULTS: 23 patients with narcolepsy-cataplexy had low CSF hypocretin-1 levels, while one patient had a normal hypocretin level (HLA-DQB1*0602 negative) and the other two had intermediate levels (familial forms). One narcoleptic patient without cataplexy had a low hypocretin level. One patient affected with post-traumatic hypersomnia had intermediate hypocretin levels. The KLS patients had normal hypocretin levels while asymptomatic, but one KLS patient (also affected with Prader-Willi syndrome) showed a twofold decrease in hypocretin levels during a symptomatic episode. Among the patients without hypersomnia, two patients with normal pressure hydrocephalus and one with unclear central vertigo had intermediate levels. CONCLUSION: Low CSF hypocretin-1 is highly specific (99.1%) and sensitive (88.5%) for narcolepsy with cataplexy. Hypocretin ligand deficiency appears not to be the major cause for other hypersomnias, with a possible continuum in the pathophysiology of narcolepsy without cataplexy and idiopathic hypersomnia. However, partial hypocretin lesions without low CSF hypocretin-1 consequences cannot be definitely excluded in those disorders. The existence of normal hypocretin levels in narcoleptic patients and intermediate levels in other rare aetiologies needs further investigation, especially for KLS, to establish the functional significance of hypocretin neurotransmission alterations. (+info)Prevalence and correlates of frequent nightmares: a community-based 2-phase study. (2/4)
STUDY OBJECTIVES: To determine the prevalence of frequent nightmares and their correlates in a large community-based cohort of middle-aged Hong Kong Chinese. DESIGN: A 2-phase design involving a cross-sectional survey of 8558 subjects (men, 47.6%) with a mean age of 40.9 years (SD 5.5, range 20-78) and subsequently followed by a detailed clinical evaluation of the psychopathology and personality profile of 252 subjects. SETTING: Community. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The prevalence of frequent nightmares, as defined by at least once per week, was 5.1%. Female sex, low monthly family income, insomnia symptoms, sleep-disordered breathing symptoms, and sleep-related daytime consequences were significantly associated with nightmare frequency. The risk of having a psychiatric disorder was 5.74 times greater for subjects with frequent nightmares (95% confidence interval 2.03-16.26), especially mood disorders (odds ratio = 15.57, 95% confidence interval 3.77-64.37). After exclusion of concomitant psychiatric morbidities, subjects with frequent nightmares still scored significantly higher on neuroticism in the personality scale (p < 0.05). CONCLUSIONS: Frequent nightmares were not uncommon in the general population and were associated with a constellation of factors, including sociodemographic characteristics and comorbid sleep and psychiatric disorders. Moreover, frequent nightmares were independently related to the neuroticism personality trait, irrespective of psychiatric diagnosis. Prospective studies should be conducted to investigate various predisposing, precipitating, and perpetuating factors and the associated repercussions of nightmares. (+info)Functional outcomes in patients with REM-related obstructive sleep apnea treated with positive airway pressure therapy. (3/4)
(+info)Treatment outcomes in REM sleep behavior disorder. (4/4)
(+info)REM sleep parasomnias are a category of disorders that involve abnormal behaviors, experiences, or physiological events occurring during REM (rapid eye movement) sleep, a stage of sleep characterized by rapid eye movements, low muscle tone, and vivid dreaming. These parasomnias include:
1. REM sleep behavior disorder (RBD): A condition where individuals act out their dreams during REM sleep, often resulting in complex motor behaviors, vocalizations, or even injuries to themselves or their bed partners.
2. Nightmare disorder: Recurrent episodes of extended, extremely vivid, and frightening dreams that cause significant distress and impairment upon awakening.
3. Sleep paralysis: A temporary inability to move or speak while falling asleep or waking up, often accompanied by hallucinations or a feeling of suffocation.
4. Catathrenia (nocturnal groaning): A rare parasomnia characterized by involuntary groaning or moaning during expiration (breathing out) in REM sleep.
5. Impaired sleep-related penile erections: The inability to achieve or maintain an erection during REM sleep, which can be a symptom of various medical conditions or medications.
6. Sleep-related painful erections: Spontaneous, often severe penile pain during REM sleep that can disrupt sleep and cause significant distress.
REM sleep parasomnias are thought to result from dysregulation in the brain mechanisms controlling REM sleep, leading to the intrusion of REM sleep phenomena into wakefulness or the intensification of REM-related physiological processes.
Parasomnias are a category of sleep disorders that involve unwanted physical events or experiences that occur while falling asleep, sleeping, or waking up. These behaviors can include abnormal movements, talk, emotions, perceptions, or dreams. Parasomnias can be caused by various factors such as stress, alcohol, certain medications, or underlying medical conditions. Some examples of parasomnias are sleepwalking, night terrors, sleep talking, and REM sleep behavior disorder. These disorders can disrupt sleep and cause distress to the individual and their bed partner.
REM sleep, or Rapid Eye Movement sleep, is a stage of sleep characterized by rapid eye movements, low muscle tone, and active brain activity. It is one of the two main types of sleep along with non-REM sleep and is marked by vivid dreaming, increased brain metabolism, and altered brain wave patterns. REM sleep is often referred to as "paradoxical sleep" because of the seemingly contradictory nature of its characteristics - an active brain in a state of relaxation. It is thought to play a role in memory consolidation, learning, and mood regulation. A typical night's sleep cycle includes several episodes of REM sleep, with each episode becoming longer as the night progresses.
Sleep arousal disorders are a category of sleep disorders that involve the partial or complete awakening from sleep, often accompanied by confusion and disorientation. These disorders are characterized by an abnormal arousal process during sleep, which can result in brief periods of wakefulness or full awakenings. The most common types of sleep arousal disorders include sleepwalking (somnambulism), sleep talking (somniloquy), and night terrors (pavor nocturnus).
In sleepwalking, the individual may get out of bed and walk around while still asleep, often with a blank stare and without any memory of the event. Sleep talking can occur in various levels of sleep and may range from simple sounds to complex conversations. Night terrors are episodes of intense fear and agitation during sleep, often accompanied by screams or cries for help, rapid heart rate, and sweating.
These disorders can be caused by a variety of factors, including stress, anxiety, fever, certain medications, alcohol consumption, and underlying medical conditions such as sleep apnea or restless leg syndrome. They can also occur as a result of genetic predisposition. Sleep arousal disorders can have significant impacts on an individual's quality of life, leading to fatigue, daytime sleepiness, impaired cognitive function, and decreased overall well-being. Treatment options may include behavioral therapy, medication, or addressing any underlying medical conditions.
Sleep is a complex physiological process characterized by altered consciousness, relatively inhibited sensory activity, reduced voluntary muscle activity, and decreased interaction with the environment. It's typically associated with specific stages that can be identified through electroencephalography (EEG) patterns. These stages include rapid eye movement (REM) sleep, associated with dreaming, and non-rapid eye movement (NREM) sleep, which is further divided into three stages.
Sleep serves a variety of functions, including restoration and strengthening of the immune system, support for growth and development in children and adolescents, consolidation of memory, learning, and emotional regulation. The lack of sufficient sleep or poor quality sleep can lead to significant health problems, such as obesity, diabetes, cardiovascular disease, and even cognitive decline.
The American Academy of Sleep Medicine (AASM) defines sleep as "a period of daily recurring natural rest during which consciousness is suspended and metabolic processes are reduced." However, it's important to note that the exact mechanisms and purposes of sleep are still being researched and debated among scientists.
Somnambulism is defined as a parasomnia, which is a type of sleep disorder, that involves walking or performing other complex behaviors while asleep. It's more commonly known as sleepwalking. During a sleepwalking episode, a person will have their eyes open and may appear to be awake and aware of their surroundings, but they are actually in a state of low consciousness.
Sleepwalking can range from simply sitting up in bed and looking around, to walking around the house, dressing or undressing, or even leaving the house. Episodes usually occur during deep non-REM sleep early in the night and can last from several minutes to an hour.
Although it is more common in children, especially those between the ages of 3 and 7, somnambulism can also affect adults. Factors that may contribute to sleepwalking include stress, fatigue, fever, certain medications, alcohol consumption, and underlying medical or psychiatric conditions such as sleep apnea, restless leg syndrome, gastroesophageal reflux disease (GERD), post-traumatic stress disorder (PTSD), or dissociative states.
Most of the time, somnambulism is not a cause for concern and does not require treatment. However, if sleepwalking leads to potential harm or injury, or if it frequently disrupts sleep, medical advice should be sought to address any underlying conditions and ensure safety measures are in place during sleep.
Sleep disorders are a group of conditions that affect the ability to sleep well on a regular basis. They can include problems with falling asleep, staying asleep, or waking up too early in the morning. These disorders can be caused by various factors such as stress, anxiety, depression, medical conditions, or substance abuse.
The American Academy of Sleep Medicine (AASM) recognizes over 80 distinct sleep disorders, which are categorized into the following major groups:
1. Insomnia - difficulty falling asleep or staying asleep.
2. Sleep-related breathing disorders - abnormal breathing during sleep such as obstructive sleep apnea.
3. Central disorders of hypersomnolence - excessive daytime sleepiness, including narcolepsy.
4. Circadian rhythm sleep-wake disorders - disruption of the internal body clock that regulates the sleep-wake cycle.
5. Parasomnias - abnormal behaviors during sleep such as sleepwalking or night terrors.
6. Sleep-related movement disorders - repetitive movements during sleep such as restless legs syndrome.
7. Isolated symptoms and normal variants - brief and occasional symptoms that do not warrant a specific diagnosis.
Sleep disorders can have significant impacts on an individual's quality of life, productivity, and overall health. If you suspect that you may have a sleep disorder, it is recommended to consult with a healthcare professional or a sleep specialist for proper evaluation and treatment.
Sleep stages are distinct patterns of brain activity that occur during sleep, as measured by an electroencephalogram (EEG). They are part of the sleep cycle and are used to describe the different types of sleep that humans go through during a normal night's rest. The sleep cycle includes several repeating stages:
1. Stage 1 (N1): This is the lightest stage of sleep, where you transition from wakefulness to sleep. During this stage, muscle activity and brain waves begin to slow down.
2. Stage 2 (N2): In this stage, your heart rate slows, body temperature decreases, and eye movements stop. Brain wave activity becomes slower, with occasional bursts of electrical activity called sleep spindles.
3. Stage 3 (N3): Also known as deep non-REM sleep, this stage is characterized by slow delta waves. It is during this stage that the body undergoes restorative processes such as tissue repair, growth, and immune function enhancement.
4. REM (Rapid Eye Movement) sleep: This is the stage where dreaming typically occurs. Your eyes move rapidly beneath closed eyelids, heart rate and respiration become irregular, and brain wave activity increases to levels similar to wakefulness. REM sleep is important for memory consolidation and learning.
The sleep cycle progresses through these stages multiple times during the night, with REM sleep periods becoming longer towards morning. Understanding sleep stages is crucial in diagnosing and treating various sleep disorders.
Frontal lobe epilepsy is a type of focal epilepsy, which means that the seizures originate from a specific area in the brain called the frontal lobe. The frontal lobe is located at the front part of the brain and is responsible for various functions such as motor function, problem-solving, decision making, emotional expression, and social behavior.
In frontal lobe epilepsy, seizures can be quite varied in their presentation, but they often occur during sleep or wakefulness and may include symptoms such as:
* Brief staring spells or automatisms (such as lip smacking, chewing, or fumbling movements)
* Sudden and frequent falls or drops
* Vocalizations or sounds
* Complex behaviors, such as agitation, aggression, or sexual arousal
* Auras or warning sensations before the seizure
Frontal lobe epilepsy can be difficult to diagnose due to the varied nature of the seizures and their occurrence during sleep. Diagnostic tests such as electroencephalogram (EEG) and imaging studies like magnetic resonance imaging (MRI) may be used to help confirm the diagnosis. Treatment typically involves medication, but in some cases, surgery may be recommended if medications are not effective or cause significant side effects.
Polysomnography (PSG) is a comprehensive sleep study that monitors various body functions during sleep, including brain activity, eye movement, muscle tone, heart rate, respirations, and oxygen levels. It is typically conducted in a sleep laboratory under the supervision of a trained technologist. The data collected during PSG is used to diagnose and manage various sleep disorders such as sleep-related breathing disorders (e.g., sleep apnea), movement disorders (e.g., periodic limb movement disorder), parasomnias, and narcolepsy.
The study usually involves the attachment of electrodes to different parts of the body, such as the scalp, face, chest, and legs, to record electrical signals from the brain, eye movements, muscle activity, and heartbeats. Additionally, sensors may be placed on or near the nose and mouth to measure airflow, and a belt may be worn around the chest and abdomen to monitor breathing efforts. Oxygen levels are also monitored through a sensor attached to the finger or ear.
Polysomnography is often recommended when a sleep disorder is suspected based on symptoms or medical history, and other diagnostic tests have been inconclusive. The results of the study can help guide treatment decisions and improve overall sleep health.
REM Sleep Behavior Disorder (RBD) is a parasomnia, which is a disorder that involves undesirable experiences or abnormal behaviors during sleep. Specifically, RBD is a type of rapid eye movement (REM) sleep parasomnia where the muscle atonia (lack of muscle tone) that normally occurs during REM sleep is absent or incomplete, allowing for the emergence of motor behaviors and vivid dreaming. These dreams can be quite intense and may result in the individual physically acting out their dreams, leading to potential harm for themselves or their bed partner. RBD can occur in isolation or as a symptom of another neurological condition.
Wakefulness is a state of consciousness in which an individual is alert and aware of their surroundings. It is characterized by the ability to perceive, process, and respond to stimuli in a purposeful manner. In a medical context, wakefulness is often assessed using measures such as the electroencephalogram (EEG) to evaluate brain activity patterns associated with consciousness.
Wakefulness is regulated by several interconnected neural networks that promote arousal and attention. These networks include the ascending reticular activating system (ARAS), which consists of a group of neurons located in the brainstem that project to the thalamus and cerebral cortex, as well as other regions involved in regulating arousal and attention, such as the basal forebrain and hypothalamus.
Disorders of wakefulness can result from various underlying conditions, including neurological disorders, sleep disorders, medication side effects, or other medical conditions that affect brain function. Examples of such disorders include narcolepsy, insomnia, hypersomnia, and various forms of encephalopathy or brain injury.
Sleep apnea syndromes refer to a group of disorders characterized by abnormal breathing patterns during sleep. These patterns can result in repeated pauses in breathing (apneas) or shallow breaths (hypopneas), causing interruptions in sleep and decreased oxygen supply to the body. There are three main types of sleep apnea syndromes:
1. Obstructive Sleep Apnea (OSA): This is the most common form, caused by the collapse or obstruction of the upper airway during sleep, often due to relaxation of the muscles in the throat and tongue.
2. Central Sleep Apnea (CSA): This type is less common and results from the brain's failure to send proper signals to the breathing muscles. It can be associated with conditions such as heart failure, stroke, or certain medications.
3. Complex/Mixed Sleep Apnea: In some cases, a person may experience both obstructive and central sleep apnea symptoms, known as complex or mixed sleep apnea.
Symptoms of sleep apnea syndromes can include loud snoring, excessive daytime sleepiness, fatigue, morning headaches, difficulty concentrating, and mood changes. Diagnosis typically involves a sleep study (polysomnography) to monitor breathing patterns, heart rate, brain activity, and other physiological factors during sleep. Treatment options may include lifestyle modifications, oral appliances, positive airway pressure therapy, or even surgery in severe cases.