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"Sleepwalking."
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Abnormal timing of slow wave synchronization processes in non-rapid eye movement sleep parasomnias
Abstract
Study Objectives
Sleepwalking, confusional arousals, and sleep terrors are parasomnias occurring out of non-rapid eye movement (NREM) sleep. Several previous studies have described EEG changes associated with NREM parasomnia episodes, but it remains unclear whether these changes are specific to parasomnia episodes or whether they are part of the normal awakening process. Here we directly compared regional brain activity, measured with high-density (hd-) EEG, between parasomnia episodes and normal awakenings (without behavioral manifestations of parasomnia).
Methods
Twenty adult patients with non-rapid eye movement parasomnias underwent a baseline hd-EEG recording (256 electrodes) followed by a recovery sleep recording after 25 h of total sleep deprivation, during which auditory stimuli were administered to provoke parasomnia episodes.
Results
Both normal awakenings (n = 25) and parasomnia episodes (n = 96) were preceded by large, steep, and “K-complex-like” slow waves in frontal and central brain regions, and by a concomitant increase in high-frequency EEG (beta) activity. Compared to normal awakenings, parasomnia episodes occurred on a less activated EEG background and displayed higher slow wave activity (SWA) and lower beta activity in frontal and central brain regions after movement onset.
Conclusions
Our results suggest that non-rapid eye movement awakenings, irrespective of behavioral manifestations of parasomnia episodes, involve an arousal-related slow wave synchronization process that predominantly recruits frontal and central brain areas. In parasomnia episodes, this synchronization process comes into play abnormally during periods of high SWA and is associated with higher SWA after movement onset. Thus, an abnormal timing of arousal-related slow wave synchronization processes could underlie the occurrence of NREM parasomnias.
Journal Article
Prevalence of Sleepwalking: A Systematic Review and Meta-Analysis
Sleepwalking is thought to be a common arousal disorder; however, the epidemiology of this disorder has not yet been systematically examined. A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, PubMed, and ScienceDirect was conducted for 'sleepwalking' OR 'somnambulism' in any field, to identify studies that reported the epidemiology of sleepwalking or sleepwalking disorders. Fifty-one studies assessed the prevalence rates of sleepwalking in a total sample of 100 490. The meta-analysis showed the estimated lifetime prevalence of sleepwalking was 6.9% (95% CI 4.6%-10.3%). The current prevalence rate of sleepwalking-within the last 12 months-was significantly higher in children 5.0% (95% CI 3.8%-6.5%) than adults 1.5% (95% CI 1.0%-2.3%). There was no evidence of developmental trends in sleepwalking across childhood. The significant risk of bias across all studies suggests these results should be used cautiously. Further epidemiological research that addresses methodological problems found in studies of sleepwalking to date is needed.
Journal Article
The day the sun died : a novel
\"Yan Lianke has secured his place as contemporary China's most essential and daring novelist, \"with his superlative gifts for storytelling and penetrating eye for truth\" (New York Times Book Review). His newest novel, The Day the Sun Died--winner of the Dream of the Red Chamber Award, one of the most prestigious honors for Chinese-language novels--is a haunting story of a town caught in a waking nightmare. In a little village nestled in the Balou mountains, fourteen-year-old Li Niannian and his parents run a funeral parlor. One evening, he notices a strange occurrence. Instead of preparing for bed, more and more neighbors appear in the streets and fields, carrying on with their daily business as if the sun hadn't already set. Li Niannian watches, mystified. As hundreds of residents are found dreamwalking, they act out the desires they've suppressed during waking hours. Before long, the community devolves into chaos, and it's up to Li Niannian and his parents to save the town before sunrise. Set over the course of one increasingly bizarre night, The Day the Sun Died is a propulsive, darkly sinister tale set against the national optimism of the Chinese dream\"-- Provided by publisher.
Book
Talking to sleepwalkers? Response to communication efforts in disorders of arousals
Abstract
Study Objectives
Disorders of arousal (DoA) are diagnosed on the basis of clinical criteria, including inappropriate or absent responsiveness to communication attempts. Surprisingly, the ability of patients to interact with others during DoA episodes has not been systematically investigated. To address this gap, we conducted three studies.
Methods
First, we used a retrospective questionnaire to assess verbal responsiveness during episodes in 61 adult patients with DoA (Study 1). Second, we used auditory stimulation during polysomnographically verified N3 sleep to trigger DoA episodes in 14 patients. We then asked questions to test the possibility of verbal interactions during the episodes (Study 2). Third, we assessed the presence and quality of conversations with a bed partner in 364 home video-recorded episodes from 19 patients (Study 3).
Results
In Study 1, most patients (81%) reported occasional conversations during parasomnia episodes. Patients’ ongoing mental content influenced both their responses to questions during episodes and their perception of the outside world (including their surroundings and the identity of their interlocutor ). In Study 2, auditory stimulation had a limited effect in inducing episodes (7/157 trials). One patient indirectly responded to our verbal prompts in a DoA episode. In Study 3, we found 37 video instances of discussion between patients and their partner.
Conclusions
Overall, our findings suggest that DoA episodes are not a uniform state but may instead encompass varying states of consciousness, characterized by different levels of responsiveness and a complex interplay between internal and external information processing. These results highlight the limitations of current diagnostic criteria for DoA.
Graphical Abstract
Graphical Abstract
Journal Article
NonREM Disorders of Arousal and Related Parasomnias: an Updated Review
Parasomnias are abnormal behaviors and/or experiences emanating from or associated with sleep typically manifesting as motor movements of varying semiology. We discuss mainly nonrapid eye movement sleep and related parasomnias in this article. Sleepwalking (SW), sleep terrors (ST), confusional arousals, and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, and/or promote sleep inertia, lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after arousal from sleep. SRED is often associated with the use of sedative–hypnotic medications, in particular the widely prescribed benzodiazepine receptor agonists. Compelling evidence suggests that nocturnal eating may in some cases be another nonmotor manifestation of Restless Legs Syndrome (RLS). Initial management should focus upon decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders and eliminating incriminating drugs. Sexsomnia is a subtype of disorders of arousal, where sexual behavior emerges from partial arousal from nonREM sleep. Overlap parasomnia disorders consist of abnormal sleep-related behavior both in nonREM and REM sleep. Status dissociatus is referred to as a breakdown of the sleep architecture where an admixture of various sleep state markers is seen without any specific demarcation. Benzodiazepine therapy can be effective in controlling SW, ST, and sexsomnia, but not SRED. Paroxetine has been reported to provide benefit in some cases of ST. Topiramate, pramipexole, and sertraline can be effective in SRED. Pharmacotherapy for other parasomnias continues to be less certain, necessitating further investigation. NREM parasomnias may resolve spontaneously but require a review of priming and predisposing factors.
Journal Article
Wanderers : a novel
\"Shana wakes up one morning to discover her little sister in the grip of a strange malady. She appears to be sleepwalking. She cannot talk and cannot be woken up. And she is heading with inexorable determination to a destination that only she knows. But Shana and are sister are not alone. Soon they are joined by a flock of sleepwalkers from across America, on the same mysterious journey. And like Shana, there are other 'shepherds' who follow the flock to protect their friends and family on the long dark road ahead. For on their journey, they will discover an America convulsed with terror and violence, where this apocalyptic epidemic proves less dangerous than the fear of it. As the rest of society collapses all around them--and an ultraviolent militia threatens to exterminate them--the fate of the sleepwalkers depends on unraveling the mystery behind the epidemic. The terrifying secret will either tear the nation apart--or bring the survivors together to remake a shattered world.\"-- Provided by publisher.
Book
Sexsomnia: A Specialized Non-REM Parasomnia?
Abstract
Introduction:
To describe patients with sexsomnia and to contrast their clinical and sleep measures with those of healthy controls and sleepwalkers.
Aims and Methods:
Subjects referred for sexsomnia and for sleepwalking/night terror were interviewed, completed the Paris Arousal Disorder Severity Scale (PADSS), and were monitored 1–2 nights with video-polysomnography.
Results:
Seventeen patients (70.6% male, aged 17–76 years) had sexsomnia, with amnestic fondling of the bed partner (n = 11), complete sexual intercourse (n = 8), masturbation (n = 8), and spontaneous orgasm (n = 1). The sexual behaviors were more direct during sleep than during wakefulness (n = 12), leading to 6 sexual assaults, including intra-conjugal rape (n = 3), assault of a family member (n = 2), rape of a friend (n = 1), and forensic consequences (n = 2). In 47% of sexsomnia patients, there was a history or current occurrences of sleepwalking/night terrors. Patients with sexsomnia had more N3 awakenings than healthy matched controls and the same amount as regular sleepwalkers. Half of them presented evidence of cortico-cortical dissociation, including concomitant slow (mostly frontal) and rapid (mostly temporal and occipital) electroencephalography (EEG) rhythms, with concomitant N3 penile erection in 1 case. Of 89 sleepwalkers, 10% had previous episodes of amnestic sexual behaviors, with a higher PADSS-A score and a trend of a higher total PADSS score than the 80 sleepwalkers without sexsomnia.
Conclusion:
In this single-center series, we confirmed the male predominance of sexsomnias and its potential for severe clinical and forensic consequences. The results suggest a continuum of regular sleepwalking, sleepwalking with occasional sexsomnia, and quasi-exclusive sexsomnia.
Journal Article