Dyssomnias and parasomnias

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1. Overview

Sleep disorders are common in patients presenting to the doctor. Sleep is a periodical and reversible physiological state, characterized by loss of consciousness, associated with decreased perception of auditory and visual stimuli, vital functions (breathing, heart rate) slowing, muscle relaxation, decreased body temperature by 0.5 degrees Celsius, decreased secretory function .

There are two types of sleep: rapid eye movement sleep (REM) or paradoxical sleep and non-rapid eye movement sleep (NREM). The duration of these two phases of sleep varies with age, depends of previous deprivation of sleep, but also of the night period when the person sleep.

On awakening from REM sleep, dreams can be evoked in detail, vivid. NREM sleep dreams can also be evoked, but their lack of details and vividness is way to accentuated compared to REM sleep dreams. Circadian rhythm is regulated by the hypothalamus, which acts as a pacemaker in managing sleep-wake rhythm.

Sleep disorders are divided into:

- Dyssomnias;
- Parasomnias;
- Sleep disorders associated with medical or psychiatric disorders.


1. Overview
2. Dyssomnias
3. Parasomnias
4. Sleep disorders associated with medical or psychiatric disorders

2. Dyssomnias

Dyssomnias category include:

Insomnia (unsatisfying sleep) – it may be perceived as falling asleep difficulty or frequent awakenings, early morning awakenings, persistent sleepiness.

Psychophysiological insomnia is a behavioral disorder in which patients are concerned about the perceived inability to sleep well at night. They easily fall asleep at any unscheduled hour or outside the ambient used for sleep.

Altitude insomnia occurs when exposure to high altitude. It is believed that both hypoxia and hypocapnia cause periodic breathing, which leads to poor sleep and frequent awakenings.

Transient situational insomnia occurs when sleeping environment is changed.

Sleep disorders that are addicted to alcohol and drugs.

Caffeine is the most common pharmacological cause of insomnia. Also, alcohol and nicotine can cause insomnia, though some patients use to induce sleep.

Narcolepsy. It is characterized by daytime sleepiness, sleep disorders during night (terrifying hallucinations at sleep onset or upon awakening, paralysis sleep), cataplexy (sudden loss of muscle tone without loss of consciousness caused by emotions), memory loss.

Sleep apnea syndromes. Are a common cause of daytime sleepiness and nocturnal sleep disturbances.

Apnea or cessation of breathing occurs due to upper airway obstruction or the main cause may be the central brain (absence of respiratory effort). Sleep apnea is common in overweight men, elderly and hypertension.

Dyssomnias associated with limb movement: restless legs syndrome and periodic limb movements (nocturnal myoclonus). If restless legs syndrome, the patient is desperate to move his feet in before sleep or during awakening. On the other hand they cannot sleep because of this movement.

Nocturnal myoclonus occurs with stereotyped extension of thumbs and dorsal flexion of the legs during the first part of the night and can last from 10 minutes to several hours. Nocturnal myoclonus associated with frequent awakenings.

3. Parasomnias

Parasomnias are behavior disorders associated with short partial awakenings during sleep, but without total interruption of sleep.

Parasomnias include:

Somnambulism (sleep walking) – usually occurs during slow wave sleep (SWS normally occurs in the first 2 hypnic cycles), being common in children and adolescents, in which they leave the bed and perform automatic motor activities (walking, leave the house, urinating in inappropriate places). Waking up is hard, while activities performed can be fatal.

Terrifying dreams or pavor nocturnus occurs mainly in young children in the early hours of the onset of sleep (during slow sleep NREM): child suddenly screams, sweats, his heart starts beating fast, breathing too often, it is hard to wake up and settles in presence of parents. Terrifying dreams and sleepwalking are abnormalities of waking up. Nightmares occur in REM sleep, waking up is complete, remembering the bad dream in detail.

REM sleep behavior disorder is a rare parasomnia, affecting middle-aged men with a history of neurological disease. Symptoms are the violent behavior in sleep, confirmed by the sleep partner, resulting in serious injury to the latter.

Sleep bruxism is an involuntary clenching of the teeth during sleep, resulting in destruction of enamel and dentin.

Nocturnal enuresis or bed urination occurs during slow-wave sleep NREM. Enuresis treatment is done after the age of 5-6 years, by then being considered a normal feature in the evolution of the child.

Other parasomnias are the balancing head in sleep, sleep talking and leg cramps during sleep.

4. Sleep disorders associated with medical or psychiatric disorders

Sleep disorders associated with psychiatric disorders

In schizophrenia, the sleep- wakefulness rhythm is reversed, sleep is fragmented and insomnia occurs. Patients with anxiety, affective disorders, obsessive compulsive disease, chronic alcoholism sleep less than the normal people.

If mental depression, insomnia occurs when sleep onsets or very early in the morning, which are important and early signs of depression. In mania and hypomania sleep duration is reduced.

Chronic alcoholics do not have slow sleep NREM; they have only REM sleep and, paradoxically, often wake up at night, are sleepy during the day and persists for years after cessation of alcohol consumption.

Sleep disorders associated with neurological disorders

Various neurological pain can cause sleep disruption. Dementia is associated with sleep – wakefulness rhythm synchronization disorders “nocturnal wanderings.”

In epilepsy, during sleep, seizures may occur.

Sleep disorders associated with medical conditions

Among the most important problems associated with sleep disorders include asthma, cardiac ischemia, chronic obstructive pulmonary disease, menopause, hyperthyroidism, gastroesophageal reflux, chronic renal failure, liver failure.

To diagnose sleep disorders the doctor will need to know patient’s medical history (patient interview), but also to perform a clinical examination, study of sleep stages using electroencephalogram (EEG), electrooculogram (EOG) and surface electromyogram (EMG), and other specific investigations coexisting medical conditions.

So if you have trouble sleeping, do not hesitate to go to the doctor! Our life quality depends on a good night sleep!



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