eMedicine Specialties > Psychiatry > Adult

Parasomnias: Follow-up

Author: Sat Sharma, MD, FRCPC, FACP, FCCP, DABSM, Program Director, Associate Professor, Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Manitoba; Site Director of Respiratory Medicine, St Boniface General Hospital
Contributor Information and Disclosures

Updated: Apr 4, 2007

Follow-up

Further Inpatient Care

  • Inpatient care is not indicated for parasomnias.
  • If the patient is violent during these episodes, consider hospitalization.

Further Outpatient Care

  • Frequent contact and encouragement is critical for patients undergoing treatment for one of the parasomnias. When these disorders occur in children, parents must be encouraging and comforting.

Inpatient & Outpatient Medications

  • Should the patient need inpatient treatment for any other reason, outpatient medications should be continued unless contraindicated by the condition for which the patient is hospitalized.

Deterrence/Prevention

  • No Information is available regarding deterrence and prevention.

Complications

  • Accidental injury to self or others can occur, particularly in patients with sleepwalking disorder (to self), sleep terror disorder (self or others because the patient sometimes moves violently while trying to escape the terror), and REM sleep behavior disorder (patient may act out a complex series of dream-related violent behaviors).
  • Reports exist of patients eating during episodes of sleepwalking, with partial or complete amnesia for the event. Excessive intake of food can be considered a complication of this disorder.

Prognosis

  • Nightmare disorder
    • Most children outgrow this disorder.
    • A small number (percentage unknown) of patients report this disorder persisting into adulthood and becoming a lifelong problem.
    • Some patients may experience an attenuation of the symptoms later in life.
  • Sleep terror disorder
    • If the onset is in childhood, the prognosis is excellent.
    • If the onset is in adulthood, the prognosis is poorer because the disorder tends to be chronic, with a waxing and waning course.
  • Sleepwalking disorder
    • If the onset is in childhood, the prognosis is excellent.
    • If the onset is in adulthood and no evidence of an underlying neurological or substance abuse problem is present, the prognosis is poorer because the disorder tends to be chronic, following a waxing and waning course.
  • Restless legs syndrome and periodic limb movement disorder
    • The prognosis of these disorders is quite variable.
    • Many patients develop long-term remissions, whereas others continue to experience the symptoms throughout life.
    • Generally, the severity increases as patients become older.

Patient Education

  • When these disorders present during childhood, the most important aspect of patient education is support of the parents and providing tips on how to respond to episodes of the disorder.
  • When these disorders present during adulthood, educating the patient regarding the chronicity and recurrence of these episodes is important.
  • Advising patients and/or caretakers about the risks of injury to self and others during sleepwalking, and emphasizing avoiding such damage, is critical. Sleepwalkers' homes should be redesigned to avoid injuries.
  • The following good sleep hygiene measures should be used in all these disorders:
    • Patients should go to bed at the same time each night, use the bed only for sleeping and intimacy, and avoid napping.
    • Patients should avoid stress, fatigue, and sleep deprivation. Vigorous activity prior to bedtime should also be avoided, though a brief period of aerobic activity 4 hours before bedtime may be helpful.
    • Patients should avoid cigarettes, alcohol, and excessive caffeine.
  • For excellent patient education resources, visit eMedicine's Sleep Disorders Center. Also, see eMedicine's patient education articles Disorders That Disrupt Sleep (Parasomnias), REM Sleep Behavior Disorder, Sleepwalking, Periodic Limb Movement Disorder, Night Terrors, and Sleep Disorders and Aging.

Miscellaneous

Medicolegal Pitfalls

  • Parasomnias cover a wide variety of peculiar, distressing, and potentially dangerous sleep behaviors. These bizarre and frightening nocturnal experiences are not a manifestation of psychologic or psychiatric disorders and are scientifically explainable
  • Wakefulness, REM sleep, and NREM sleep may occur simultaneously or in dissociated or incomplete forms to produce primary sleep parasomnias. Dysfunction of other organ systems may manifest during the sleep state, resulting in secondary parasomnias.
  • Parasomnias often are misdiagnosed and inappropriately treated as psychiatric disorders.
  • Experienced sleep professionals should evaluate patients with these disorders.
  • Parasomnias also may have forensic implications. Accidents, homicides, and suicides have occurred during these bizarre nocturnal experiences.
  • Parasomnias can adversely affect obstructive sleep apnea by interfering with nasal continuous positive-pressure therapy.
  • Failing to advise patients and/or their caretakers about the risks of injury to self or others could be construed as actionable, depending on the extent of the damage sustained.
  • Failure to look for an underlying cause for one of the parasomnias, especially when the onset is in adulthood, also could be actionable.
  • RLS had been misunderstood for several hundred years until the twentieth century. It is a neurologic disorder caused by dopaminergic dysfunction and is strongly associated with iron insufficiency.

Special Concerns

  • Pediatric - Consequences of falls and other injuries to self or others
  • Geriatric - Consequences of sleep deprivation, falls, and other injuries to self or others
 


More on Parasomnias

Overview: Parasomnias
Differential Diagnoses & Workup: Parasomnias
Treatment & Medication: Parasomnias
Follow-up: Parasomnias
Multimedia: Parasomnias
References
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Further Reading

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Keywords

nightmare disorder, sleep terror disorder, sleepwalking disorder, rapid eye movement sleep behavior disorder, REM sleep behavior disorder, non–rapid eye movement, NREM, restless legs syndrome, RLS, periodic limb movement disorder, PLMD, dyssomnias, sleep drunkenness, microsleeps

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Contributor Information and Disclosures

Author

Sat Sharma, MD, FRCPC, FACP, FCCP, DABSM, Program Director, Associate Professor, Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Manitoba; Site Director of Respiratory Medicine, St Boniface General Hospital
Sat Sharma, MD, FRCPC, FACP, FCCP, DABSM is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Mohammed Memon, MD, Medical Director of Geriatric Psychiatry, Department of Psychiatry, Spartanburg Regional Hospital System
Mohammed Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Iqbal Ahmed, MD, Program Director, General and Geriatric Psychiatry Residency Programs, Department of Psychiatry, Vice Chair for Education, Professor, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry, Assistant Professor, Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration
Disclosure: Nothing to disclose.

 
 
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