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Parasomnias are involuntary behaviors or subjective experiences during sleep. Our objective was to review existing information on the presence of parasomnias in patients with addictions or during treatment for addictions. Information about parasomnias related to rapid-eye-movement (REM) and non-REM sleep in patients with addictions, while using substances or in abstinence, was reviewed. A systematic search of published articles reporting parasomnias as a consequence of drug use or abuse was conducted in the PubMed and SciELO databases. The search for the studies was performed in three phases: (1) by title, (2) by abstract, and (3) by complete text. The search was performed independently by two researchers, who then compared their results from each screening phase. Seventeen articles were found. The consumption of alcohol was reported in association with arousal disorders, such as sexsomnia and sleep-related eating disorder; and REM sleep behavior disorder was reported during alcohol withdrawal. Cocaine abuse was associated with REM sleep behavior disorder with drug consumption dream content. Overall, we found that several types of parasomnias were very frequent in patients with addictions. To avoid accidents in bedroom, legal problems, and improve evolution and prognosis; must be mandatory to include security measures related to sleep period; avoid pharmacological therapy described as potential trigger factor; improve sleep hygiene; and give pharmacological and behavioral treatments for patients with these comorbid sleep disorders.
The bizarre and often dangerous parasomnias such as sleepwalking and sleep terrors have been historically regarded as symptoms of psychiatric illness. Parasomnias are undesirable physical, experiential, or behavioral phenomena that occur exclusively during sleep or are exacerbated by the sleeping state. The designation "disorders of arousal", first coined, has reappeared as a category of non-rapid eye movement (NREM) parasomnias and includes confusional arousals, sleepwalking, and sleep terrors. Dissociative disorders may also occur during the sleep period, typically in individuals suffering daytime syndromes such as dissociative identity disorder (DID), psychogenic amnesia, and dissociative disorder not otherwise specified (NOS). Sexsomnia has been classified in the ICSD-2 within the group of parasomnias named "disorders of arousal", with the designation of "sleep-related abnormal sexual behaviors" being a variant of confusional arousals. Some primary psychiatric disorders may include symptoms that occur prominently or exclusively in association with the sleep period.
This chapter discusses the case of a 46-year-old female with a 5-year history of distressing, unpleasant and bizarre dreams that occurred from a few times a week to once a month, depending on her stress level. It presents the clinical history, examination, diagnosis, follow-up, general remarks and the results of the procedures performed on the patient. Nocturnal polysomnography (PSG) was carried out, and the thyroid-stimulating hormone level in plasma was determined. The diagnosis was nightmare disorder with primary snoring. The relationship between daytime stress, anxiety and nightmares was emphasized. The treatment plan centered on addressing daily stress and anxiety. Recurrent nightmares are frequent in children (20-39%) and less frequent in adults (5-8%). Nightmares also occur in patients with psychiatric illnesses such as anxiety, depression and schizophrenia, as well as in individuals with poor coping mechanisms and creative tendencies.
This chapter discusses the case of a 17-year-old girl who was admitted for the evaluation of excessive daytime sleepiness (EDS). It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. She suffered developmental delay, and was later diagnosed with mild mental retardation. Nocturnal polysomnography (PSG) and a multiple sleep latency test (MSLT) were carried out. The diagnosis was childhood-onset narcolepsy with cataplexy. The parents declined CSF testing for hypocretin. The onset of narcolepsy may occur with any of the four cardinal symptoms (excessive sleepiness, sleep paralysis, hypnagogic hallucinations and cataplexy), the most frequent being EDS. Childhood onset of narcolepsy is uncommon, but has been reported. The usual age of onset is mid- to late teens up to mid-20s. Occasionally patients may become ill after the age of 40.
Violent behaviors during sleep may result in events which have forensic science implications. The apparent suicide (for example, leap to death from a second-storey window), assault or murder (for example, molestation, strangulation, stabbing, shooting) may be the unintentional, non-culpable but catastrophic result of disorders of arousal, sleep-related seizures, REM sleep behavior disorder (RBD), or psychogenic dissociative states. Violent sleep-related behaviors have been reviewed in the context of automatic behavior in general, with many well-documented cases resulting from a wide variety of disorders. Conditions associated with sleep-period-related violence fall into two major categories: neurologic and psychiatric. Psychogenic dissociative disorders may arise exclusively or predominantly from the sleep period. Recent interest in the forensic aspects of parasomnias provides sleep medicine professionals with an opportunity to educate and assist the legal profession in cases of sleep-related violence. One infrequently used tactic to improve scientific testimony is to use a court-appointed impartial expert.
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