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Sleep starts, also known as somnolescent starts, hypnic starts, hypnagogic jerk or hypnic jerks, cause sudden start or excitation of the motor centers at the moment of sleep onset. Sleep starts may be divided into the six subtypes: Motor sleep starts, Sensory-motor types, pure sensory sleep starts, intensified hypnic jerks, exploding head syndrome, and Blip syndrome. Sleep starts should be differentiated from a variety of conditions mimicking sleep starts based on the history and physical examination and appropriate laboratory tests. Sleep starts are common physiological phenomenon affecting up to 70% of the adult population and the course is benign, resolving without any neurological sequela. Therefore reassurance and counseling are all that is needed to calm the patient down. The patient should also be advised to follow a strict sleep-wake schedule, avoid sleep deprivation, follow commonsense sleep hygiene measures, and avoid stimulants and heavy exercise in the evening.
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