Parasomnias: Common and rare types, diagnosis, prevention, and management of nrem parasomnias

Parasomnias are described as undesirable motor activity displayed during sleep. Parasomnias are generally characterized by abrupt talking, screaming, walking, confusional arousals, bruxism (ie, teeth grinding), or other complex activity arising from nonrapid eye movement (NREM) stages, rapid eye movement (REM) stages, or transitions between sleep stages and sleep-wake states. Parasomnias are associated with a poor recall of events by the patient, making information from a bed partner valuable. The use of attended polysomnography (PSG) with continuous audio and video recording and the inclusion of extended electroencephalographic (EEG) montage is required to diagnose REM parasomnias. PSG is not required for the diagnosis of NREM parasomnias, as these are diag nosed by clinical history. Nonpharmacologic interventions that are effective for NREM parasomnias include relaxation, hypnosis, anticipatory awakenings, and ensuring environmental safety to reduce the risk of injury to the patient, bed partners, and family members. Pharmaceuticals shown to have significant effectiveness in NREM parasomnias include melatonin, benzodiazepines, tricyclic antidepressants, and medications that reduce arousals.