Parasomnias: An Updated Review

Howell, Michael J.

doi:10.1007/s13311-012-0143-8

Cited by 165Sleep and related disordersSleep and Wakefulness ResearchRestless Legs Syndrome Research

Parasomnias: An Updated Review

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Howell, Michael J.·2012·Neurotherapeutics

DOI 10.1007/s13311-012-0143-8PMC PMC3480572

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Abstract

Parasomnias are abnormal behaviors emanating from or associated with sleep. Sleepwalking and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, 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 an arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications; in particular, the widely prescribed benzodiazepine receptor agonists. Recently, compelling evidence suggests that nocturnal eating may in some cases be a nonmotor manifestation of Restless Legs Syndrome (RLS). rapid eye movement (REM) Sleep Behavior Disorder (RBD) is characterized by a loss of REM paralysis leading to potentially injurious dream enactment. The loss of atonia in RBD often predates the development of Parkinson's disease and other disorders of synuclein pathology. Parasomnia behaviors are related to an activation (in NREM parasomnias) or a disinhibition (in RBD) of central pattern generators (CPGs). Initial management should focus on decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders. Clonazepam and melatonin appear to be effective therapies in RBD, whereas paroxetine has been reported effective in some cases of sleep terrors. At this point, pharmacotherapy for other parasomnias is less certain, and further investigations are necessary.

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Tricyclic antidepressants, selective serotonin reuptake inhibitors, mirtazapine, and ramelteon have been used for the treatment of sleep terrors with varying success.
“Tricyclic antidepressants (such as imipramine, amitriptyline), selective serotonin reuptake inhibitors (such as paroxetine, fluoxetine), mirtazapine, and ramelteon have also been used for the treatment of sleep terrors with varying success [25, 57, 65, 83-88].”
From Sleep Terrors: An Updated Review (2020) · cites this paper as [65]
The Antidepressant Medication section (page unavailable) reports that imipramine, a tricyclic antidepressant, helped two patients with sleep terrors and that paroxetine, an SSRI, reduced sleep terrors in six patients. It does not report amitriptyline, fluoxetine, mirtazapine, or ramelteon as sleep-terror treatments; the Clinical Presentation section instead associates amitriptyline and mirtazapine with sleepwalking. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors.
“Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors [9, 22, 42, 57, 65, 76].”
From Sleep Terrors: An Updated Review (2020) · cites this paper as [65]
The Nonpharmacological Therapy section (page unavailable) describes anticipatory awakening as commonly used for childhood NREM parasomnias, performed just before a typical episode, and reports sustained positive results in four children. It does not specify awakening half an hour beforehand or establish that it is often effective specifically for frequently occurring sleep terrors; the cited studies listed in the References concern sleepwalking. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Prolonged confusional arousal episodes usually occur in the setting of poly-neuropharmacy, particularly sedative hypnotics.
“Prolonged episodes usually occur in the setting of poly-neuropharmacy, particularly sedative hypnotics [65].”
From Sleep Terrors: An Updated Review (2020) · cites this paper as [65]

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Authors: Howell, M. J.
Affiliations: University of Minnesota (US)
Corresponding author: Howell, Michael J.
ORCID: Howell, Michael J.
Venue: Neurotherapeutics
Publisher: Elsevier BV
Published: 2012-10
Volume: 9
Issue: 4
Pages: 753-775
ISSN: 1878-7479 (ISSN-L)
DOI: 10.1007/s13311-012-0143-8
PMC: PMC3480572
OpenAlex: W2078251421
Cited by: 165
References: 258
Citations by year: 2026: 17 · 2025: 4 · 2024: 8 · 2023: 15 · 2022: 17 · 2021: 14 · 2020: 15 · 2019: 13 · 2018: 12 · 2017: 10 · 2016: 18 · 2015: 6 · 2014: 6 · 2013: 5 · 2012: 3
FWCI: 0.94
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 3977 d)
Locations: Neurotherapeutics (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Health Sciences › Medicine › Epidemiology › Restless Legs Syndrome Research
Keywords: parasomnias, sleepwalking, sleep-related eating disorder, REM sleep behavior disorder, restless legs syndrome, sleep inertia, cyclic alternating pattern, benzodiazepine receptor agonists, clonazepam, melatonin, paroxetine, central pattern generator, synucleinopathies, Parkinson's disease, sleep disorders comorbidity
MeSH terms: Humans, Parasomnias

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Parasomnias: An Updated Review

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