A nightmare disorder can produce emotional manifestations of fear, anger, and sadness. Here are 7 reasons parasomnias can challenge even the smartest diagnostician.
Parasomnias are undesirable physical, experiential, or behavioral phenomena that occur only while falling asleep, while sleeping, or waking up from sleep. In DSM-5, the parasomnias are non-rapid eye movement (NREM) sleep arousal disorders (sleepwalking, sleep terrors), nightmare disorders (formerly known as dream anxiety disorder), and rapid eye movement (REM) sleep behavior disorder (RBD.). ). Interested readers may refer to Parasomnias: What Psychiatrists Need to Know, which this slideshow is based on. © MarcosMesaSamWordley / Shutterstock
1. NREM sleep arousal disorders. Although unspecified in DSM-5, the simplest arousal disorder is confusion, that is, disturbed arousal that is a partial awakening with periods of apparent confusion and inadequate or unresponsive to others in bed. There is typically amnesia for the event and minimal or no memory of the dream mentation. This can develop into spells, including intense autonomic activation with vocalization, tachycardia, tachypnea, mydriasis, sweating, and sleep horror or sleepwalking. © Ollyy / Shutterstock
2. Substance / drug induced sleep disorder. Parasomnias that resemble arousal disorders can be associated with the use of many psychotropic drugs, especially sedative-hypnotics. Sleepwalking and other amnesia-complex sleep-related behaviors have been reported in psychiatric patients taking benzodiazepines. The behavior can be prolonged and includes amnesia nightly eating, sexual activity, and even sleeping-driving. © RinSeiko / Shutterstock
3. Nightmare disorder. Formerly known as “dream anxiety attacks,” the nightmare disorder is now recognized as a REM sleep phenomenon, which is different from NREM sleep scares. As defined in DSM-5, this includes repetitive, extended, extremely dysphoric, and well-remembered dreams that involve threats to survival, safety, or physical integrity; Episodes usually occur during the second half of the sleep period. Typically, the person quickly becomes alert and oriented. Emotional manifestations of fear, anger, and sadness can be predominant. © LukiyanovaNataliaFrenta / Shutterstock
4. REM sleep behavior disorder. RBD patients – most often older men with a longer, chronic course – typically dream of themselves as defenders, rarely as aggressors. A violent dream staging can lead to an injury to the patient and / or bed partner, the presence of which is often included in the dream content. RBD spells likely occur in the second half of the night when REM sleep tends to be longer and more intense. In about 25% of patients, there is a prodromal phase with increased action-packed dream content, combined with vocalizations and twitching of the limbs, which can last for several years. When RBD becomes established, there is a tendency towards abrupt, often violent, movements that are consistent with remembered dream contents. © Makieni / Shutterstock
5. Recurrent isolated sleep paralysis. Sleep paralysis is essentially the atony of REM sleep that has been dissociated and occurs at times other than typical REM sleep phases during the night. It can either penetrate at the beginning of falling asleep or persist until waking if there is a delay in falling asleep and is often perceived as uncomfortable or frightening. It’s classically found in association with narcolepsy, but not exclusively. © IrynaGyrych / Shutterstock
6. Sleep-related events not specified in DSM-5. The clinical features of nocturnal seizures may be similar to panic disorder, but diagnostic caution is advised. Other disorders that may masquerade as nocturnal panic, such as sleepwalking / sleep horror, RBD, seizures, gastroesophageal reflux, obstructive sleep apnea, bruxism, nocturnal asthma, and nocturnal arrhythmias. Sleep disorders have played a prominent role in descriptions of dissociative identity disorder, dissociative amnesia, PTSD, and other disorders. © Namning / Shutterstock
7. Other rare but relevant disorders with sleep-related manifestations. Sleep-related epilepsy should be considered for any sleep-related behavior that is repetitive, inappropriate, and most importantly, stereotypical. Head exploding syndrome is a sudden sensation of a loud noise or a violent but painless “explosion” in the head that occurs when the person falls asleep or wakes up during the night. It is a rare, benign, but frightening event during the transition between waking and sleeping. Sleep-related hallucinations can be related to narcolepsy, drugs to block α-adrenergic receptors, Lewy body dementia, vision loss (Charles Bonnet hallucinations), and other brain disorders (stem hallucinosis). © Namning / Shutterstock
This article was published on August 17, 2017 and has been updated since then.