51
|
Abstract
Sleep paralysis is the unusual experience of waking up in the night without the ability to move. Currently little is known about the experience, despite the fact that the vast majority of episodes are associated with extreme fear and in a minority of cases can lead to clinically significant levels of distress. The aim of this work was to review the existing literature pertaining to the relationship sleep paralysis has to sleep more generally, measured both with subjective questionnaires and objective laboratory recordings. In terms of subjective sleep variables, worse sleep quality has been found in multiple studies to be associated with increased odds of sleep paralysis occurrence. In addition, insomnia symptoms (but not a diagnosed insomnia disorder) have also been found to predict sleep paralysis. Associations between sleep paralysis and other unusual and/or threatening sleep experiences such as nightmares, exploding head syndrome, and lucid dreaming have been reported. In terms of objective measurements, the limited literature to date shows sleep paralysis to be a "mixed" state of consciousness, combining elements of rapid eye movement sleep with elements of wakefulness. Future research needs to focus on longitudinal designs to disentangle the direction of effects and more typically employ a broader assessment of sleep paralysis that better captures associated features such as hallucinations, fear, and distress.
Collapse
Affiliation(s)
- Dan Denis
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA, .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,
| |
Collapse
|
52
|
Nightmares and sleep paralysis among the general Japanese population: a nationwide representative survey. Sleep Biol Rhythms 2017. [DOI: 10.1007/s41105-017-0138-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
53
|
Abstract
PURPOSE OF REVIEW Little is known about the presence of parasomnias such as nightmare disorder, sleep paralysis, REM sleep behavior disorder (RBD), and sleep-related eating disorders (SRED) in people with mental illness. A predominant view suggests that psychotropic medications might be contributing to parasomnias. This article summarizes knowledge regarding the relationships between psychiatric disorders and parasomnias, and possible confounds. A systematic search of the literature in the past 10 years identified 19 articles. RECENT FINDINGS There were significantly elevated rates of parasomnias in psychiatric disorders (average prevalence of nightmares was 38.9%, sleep paralysis 22.3%, SRED 9.9%, sleepwalking 8.5%, and RBD 3.8%). Medication usage was only one of many risk factors (other sleep disorders, medical comorbidities, and substance abuse) which were associated with parasomnias. A strong association exists between mental illness and parasomnias which is not fully explained by medications. Prospective longitudinal studies are needed to develop a better understanding of the unique and shared variance from multiple risk factors.
Collapse
Affiliation(s)
- Flavie Waters
- School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia. .,Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service-Mental Health, Perth, Western Australia, Australia.
| | - Umberto Moretto
- Psychiatric Unit I Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, Italy.,Center for Studies in Behavioral Neurobiology & PERFORM Center, Department of Exercise Science, Concordia University, 7141 Sherbrooke St. West, SP 165.27, Montreal, H4B 1R6, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 chemin Queen-Mary, M5815, Montreal, H3W 1W5, Canada
| | - Thien Thanh Dang-Vu
- Center for Studies in Behavioral Neurobiology & PERFORM Center, Department of Exercise Science, Concordia University, 7141 Sherbrooke St. West, SP 165.27, Montreal, H4B 1R6, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 chemin Queen-Mary, M5815, Montreal, H3W 1W5, Canada
| |
Collapse
|
54
|
Abstract
PURPOSE OF REVIEW Review of the literature pertaining to clinical presentation, classification, epidemiology, pathophysiology, diagnosis, and treatment of sleep-related movement disorders and disturbances of motor control. RECENT FINDINGS Sleep-related movement disorders and disturbances of motor control are typically characterized by positive motor symptoms and are often associated with sleep disturbances and consequent daytime symptoms (e.g. fatigue, sleepiness). They often represent the first or main manifestation of underlying disorders of the central nervous system, which require specific work-up and treatment. Diverse and often combined cause factors have been identified. Although recent data provide some evidence regarding abnormal activation and/or disinhibition of motor circuits during sleep, for the majority of these disorders the pathogenetic mechanisms remain speculative. The differential diagnosis is sometimes difficult and misdiagnoses are not infrequent. The diagnosis is based on clinical and video-polysomnographic findings. Treatment of sleep-related motor disturbances with few exceptions (e.g. restless legs/limbs syndrome) are based mainly on anecdotal reports or small series. SUMMARY More state-of-the-art studies on the cause, pathophysiology, and treatment of sleep-related movement disorders and disturbances of motor control are needed.
Collapse
|
55
|
Abstract
Excessive daytime sleepiness is defined as the inability to maintain wakefulness during waking hours, resulting in unintended lapses into sleep. It is important to distinguish sleepiness from fatigue. The evaluation of a sleep patient begins with a careful clinical assessment that includes a detailed sleep history, medical and psychiatric history, a review of medications, as well as a social and family history. Physical examination should include a general medical examination with careful attention to the upper airway and the neurologic examination. Appropriate objective testing with a polysomnogram and a multiple sleep latency test if needed will help confirm the diagnosis and direct the appropriate treatment plan.
Collapse
Affiliation(s)
- Renee Monderer
- Sleep-Wake Disorders Center, Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, USA.
| | - Imran M Ahmed
- Sleep-Wake Disorders Center, Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, USA
| | - Michael Thorpy
- Sleep-Wake Disorders Center, Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, USA
| |
Collapse
|
56
|
Jiménez-Genchi A, Caraveo-Anduaga J. Crude and adjusted prevalence of sleep complaints in Mexico city. Sleep Sci 2017. [DOI: 10.1016/j.slsci.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
57
|
|
58
|
Jalal B, Ramachandran VS. Sleep Paralysis, "The Ghostly Bedroom Intruder" and Out-of-Body Experiences: The Role of Mirror Neurons. Front Hum Neurosci 2017; 11:92. [PMID: 28293186 PMCID: PMC5329044 DOI: 10.3389/fnhum.2017.00092] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/14/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Baland Jalal
- Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, University of CambridgeCambridge, UK; Center for Brain and Cognition, University of California at San DiegoLa Jolla, CA, USA
| | | |
Collapse
|
59
|
Zhang J, Wu Y. Automatic sleep stage classification of single-channel EEG by using complex-valued convolutional neural network. ACTA ACUST UNITED AC 2017; 63:177-190. [DOI: 10.1515/bmt-2016-0156] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Many systems are developed for automatic sleep stage classification. However, nearly all models are based on handcrafted features. Because of the large feature space, there are so many features that feature selection should be used. Meanwhile, designing handcrafted features is a difficult and time-consuming task because the feature designing needs domain knowledge of experienced experts. Results vary when different sets of features are chosen to identify sleep stages. Additionally, many features that we may be unaware of exist. However, these features may be important for sleep stage classification. Therefore, a new sleep stage classification system, which is based on the complex-valued convolutional neural network (CCNN), is proposed in this study. Unlike the existing sleep stage methods, our method can automatically extract features from raw electroencephalography data and then classify sleep stage based on the learned features. Additionally, we also prove that the decision boundaries for the real and imaginary parts of a complex-valued convolutional neuron intersect orthogonally. The classification performances of handcrafted features are compared with those of learned features via CCNN. Experimental results show that the proposed method is comparable to the existing methods. CCNN obtains a better classification performance and considerably faster convergence speed than convolutional neural network. Experimental results also show that the proposed method is a useful decision-support tool for automatic sleep stage classification.
Collapse
Affiliation(s)
- Junming Zhang
- College of Electronics and Information Engineering , Tongji University , Shanghai, 201804 , China
| | - Yan Wu
- College of Electronics and Information Engineering , Tongji University , Shanghai, 201804 , China
| |
Collapse
|
60
|
|
61
|
Molendijk ML, Montagne H, Bouachmir O, Alper Z, Bervoets JP, Blom JD. Prevalence Rates of the Incubus Phenomenon: A Systematic Review and Meta-Analysis. Front Psychiatry 2017; 8:253. [PMID: 29225584 PMCID: PMC5705555 DOI: 10.3389/fpsyt.2017.00253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/09/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The incubus phenomenon is a paroxysmal sleep-related disorder characterized by compound hallucinations experienced during brief phases of (apparent) wakefulness. The condition has an almost stereotypical presentation, characterized by a hallucinated being that exerts pressure on the thorax, meanwhile carrying out aggressive and/or sexual acts. It tends to be accompanied by sleep paralysis, anxiety, vegetative symptoms, and feelings of suffocation. Its prevalence rate is unknown since, in prior analyses, cases of recurrent isolated sleep paralysis with/without an incubus phenomenon have been pooled together. This is unfortunate, since the incubus phenomenon has a much greater clinical relevance than isolated sleep paralysis. METHODS PubMed, Embase, and PsycINFO were searched for prevalence studies of the incubus phenomenon, and a meta-analysis was performed. RESULTS Of the 1,437 unique records, 13 met the inclusion criteria, reporting on 14 (k) independent prevalence estimates (total N = 6,079). The pooled lifetime prevalence rate of the incubus phenomenon was 0.19 [95% confidence interval (CI) = 0.14-0.25, k = 14, N = 6,079] with heterogeneous estimates over different samples. In selected samples (e.g., patients with a psychiatric disorder, refugees, and students), prevalence rates were nearly four times higher (0.41, 95% CI = 0.25-0.56, k = 4, n = 1,275) than in the random samples (0.11, 95% CI = 0.08-0.14, k = 10, n = 4,804). This difference was significant (P < 0.001). CONCLUSION This review and meta-analysis yielded a lifetime prevalence of the incubus phenomenon in the general population of 0.11 and, in selected samples, of 0.41. This is slightly higher than the prevalence rates in previous analyses that included cases of recurrent isolated sleep paralysis without an incubus phenomenon. Based on the condition's robust clinical presentation and the relatively high prevalence rates, we advocate inclusion of the incubus phenomenon as a diagnostic category in major classifications such as the International Classification of Diseases and Related Health Problems and the Diagnostic and Statistical Manual of Mental Disorders. Recommendations are also made for clinical practice and future research.
Collapse
Affiliation(s)
- Marc L Molendijk
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Zeynep Alper
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Jan-Pieter Bervoets
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Jan Dirk Blom
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University of Groningen, Groningen, Netherlands
| |
Collapse
|
62
|
Jiménez-Genchi A, Caraveo-Anduaga J. Crude and Adjusted Prevalence of Sleep Complaints in Mexico City. ACTA ACUST UNITED AC 2017; 10:113-121. [PMID: 29410740 PMCID: PMC5699854 DOI: 10.5935/1984-0063.20170020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the crude prevalence rates of several sleep complaints and the
prevalence for each one adjusted for the coexistence of symptoms in other
sleep domains in a representative sample of adult individuals from Mexico
City. METHODS A probabilistic sample of 1933 adult individuals living in Mexico City was
surveyed using fourteen questions of the Sleep Disorders Questionnaire to
assess sleep-related symptoms and sleep complaints. Estimates of crude
prevalence rates for each sleep disturbance and adjusted for a score
≥ the 80th. percentile in the questionnaire were calculated. RESULTS The following prevalence rates were found: insomnia 39.7%; excessive diurnal
sleepiness (EDS) 20.9%; obstructive sleep apnea syndrome (EDS plus snoring)
7.7%; habitual snoring 9.9%; restless legs syndrome (RLS) 4.4%; narcolepsy
0.9%; sleep paralysis (SP) 13.2%; and hypnotic use 1.2%. When prevalence
rates were calculated accounting for symptoms in other sleep domains,
notable reductions were observed in complaints of insomnia (17.3%), EDS
(10.3%), and SP (8.7%), while minor decreases were observed for complaints
of snoring (7.4%), OSAS (5%), and RLS (3.8%); narcolepsy prevalence
practically did not change (0.9%). CONCLUSIONS Sleep complaints are highly prevalent in Mexican adult population. More than
a half of the individuals with a given sleep disturbance have a global sleep
deterioration associated to psychosocial and health impairments.
Collapse
Affiliation(s)
| | - Jorge Caraveo-Anduaga
- División de Investigaciones Epidemiológicas y Sociales, Instituto Nacional de Psiquiatría Ramón de la Fuente
| |
Collapse
|
63
|
de Sá JFR, Mota-Rolim SA. Sleep Paralysis in Brazilian Folklore and Other Cultures: A Brief Review. Front Psychol 2016; 7:1294. [PMID: 27656151 PMCID: PMC5013036 DOI: 10.3389/fpsyg.2016.01294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/12/2016] [Indexed: 11/13/2022] Open
Abstract
Sleep paralysis (SP) is a dissociative state that occurs mainly during awakening. SP is characterized by altered motor, perceptual, emotional and cognitive functions, such as inability to perform voluntary movements, visual hallucinations, feelings of chest pressure, delusions about a frightening presence and, in some cases, fear of impending death. Most people experience SP rarely, but typically when sleeping in supine position; however, SP is considered a disease (parasomnia) when recurrent and/or associated to emotional burden. Interestingly, throughout human history, different peoples interpreted SP under a supernatural view. For example, Canadian Eskimos attribute SP to spells of shamans, who hinder the ability to move, and provoke hallucinations of a shapeless presence. In the Japanese tradition, SP is due to a vengeful spirit who suffocates his enemies while sleeping. In Nigerian culture, a female demon attacks during dreaming and provokes paralysis. A modern manifestation of SP is the report of "alien abductions", experienced as inability to move during awakening associated with visual hallucinations of aliens. In all, SP is a significant example of how a specific biological phenomenon can be interpreted and shaped by different cultural contexts. In order to further explore the ethnopsychology of SP, in this review we present the "Pisadeira", a character of Brazilian folklore originated in the country's Southeast, but also found in other regions with variant names. Pisadeira is described as a crone with long fingernails who lurks on roofs at night and tramples on the chest of those who sleep on a full stomach with the belly up. This legend is mentioned in many anthropological accounts; however, we found no comprehensive reference on the Pisadeira from the perspective of sleep science. Here, we aim to fill this gap. We first review the neuropsychological aspects of SP, and then present the folk tale of the Pisadeira. Finally, we summarize the many historical and artistic manifestations of SP in different cultures, emphasizing the similarities and differences with the Pisadeira.
Collapse
Affiliation(s)
| | - Sérgio A. Mota-Rolim
- Brain Institute, Federal University of Rio Grande do NorteNatal, Brazil
- Department of Physiology, Federal University of Rio Grande do NorteNatal, Brazil
- Onofre Lopes University Hospital, Federal University of Rio Grande do NorteNatal, Brazil
| |
Collapse
|
64
|
Waters F, Blom JD, Dang-Vu TT, Cheyne AJ, Alderson-Day B, Woodruff P, Collerton D. What Is the Link Between Hallucinations, Dreams, and Hypnagogic-Hypnopompic Experiences? Schizophr Bull 2016; 42:1098-109. [PMID: 27358492 PMCID: PMC4988750 DOI: 10.1093/schbul/sbw076] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
By definition, hallucinations occur only in the full waking state. Yet similarities to sleep-related experiences such as hypnagogic and hypnopompic hallucinations, dreams and parasomnias, have been noted since antiquity. These observations have prompted researchers to suggest a common aetiology for these phenomena based on the neurobiology of rapid eye movement (REM) sleep. With our recent understanding of hallucinations in different population groups and at the neurobiological, cognitive and interpersonal levels, it is now possible to draw comparisons between the 2 sets of experiences as never before. In the current article, we make detailed comparisons between sleep-related experiences and hallucinations in Parkinson's disease, schizophrenia and eye disease, at the levels of phenomenology (content, sensory modalities involved, perceptual attributes) and of brain function (brain activations, resting-state networks, neurotransmitter action). Findings show that sleep-related experiences share considerable overlap with hallucinations at the level of subjective descriptions and underlying brain mechanisms. Key differences remain however: (1) Sleep-related perceptions are immersive and largely cut off from reality, whereas hallucinations are discrete and overlaid on veridical perceptions; and (2) Sleep-related perceptions involve only a subset of neural networks implicated in hallucinations, reflecting perceptual signals processed in a functionally and cognitively closed-loop circuit. In summary, both phenomena are non-veridical perceptions that share some phenomenological and neural similarities, but insufficient evidence exists to fully support the notion that the majority of hallucinations depend on REM processes or REM intrusions into waking consciousness.
Collapse
Affiliation(s)
- Flavie Waters
- Clinical Research Centre, Graylands Hospital, North Metro Health Service Mental Health, Perth, Australia; School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Australia;
| | | | - Thien Thanh Dang-Vu
- Center for Studies in Behavioral Neurobiology, PERFORM Center and Department of Exercise Science, Concordia University; and Centre de Recherches de l’Institut Universitaire de Gériatrie de Montréal and Department of Neurosciences, University of Montreal, Montreal, QC, Canada
| | - Allan J. Cheyne
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | | | - Peter Woodruff
- University of Sheffield, UK, Hamad Medical Corporation, Doha, Qatar
| | - Daniel Collerton
- Clinical Psychology, Northumberland, Tyne and Wear NHS Foundation Trust, and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
65
|
Tachibana N. Sleep related movement and behavior disorders. Rinsho Shinkeigaku 2016; 56:541-9. [PMID: 27477578 DOI: 10.5692/clinicalneurol.cn-000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Movement and behavior disorders developing during sleep or in the transitional state from sleep to wakefulness are mostly unfamiliar to Japanese neurologists, primarily because these disorders are objects of basic research. In addition, the patients with sleep related movement and behavior disorders (SRMBD) show no signs and symptoms in our consulting rooms, and cannot be identified without polysomnography (PSG) attended by trained sleep technologists. Although attended PSG is not widely available in Japan, some kinds of SRMBD ought to be clinical targets for neurologists, and they are the scope of this review.
Collapse
Affiliation(s)
- Naoko Tachibana
- Division of Sleep Medicine, Kansai Electric Power Medical Research Institute
| |
Collapse
|
66
|
Erratum: How to Make the Ghosts in my Bedroom Disappear? Focused-Attention Meditation Combined with Muscle Relaxation (MR Therapy)—A Direct Treatment Intervention for Sleep Paralysis. Front Psychol 2016; 7:1194. [PMID: 27493640 PMCID: PMC4971565 DOI: 10.3389/fpsyg.2016.01194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 12/02/2022] Open
|
67
|
Abstract
OBJECTIVES Relatively little is known about isolated sleep paralysis (ISP), and no empirically supported treatments are available. This study aims to determine: the clinical impact of ISP, the techniques used to prevent or disrupt ISP, and the effectiveness of these techniques. METHOD 156 undergraduates were assessed with lifetime ISP using a clinical interview. RESULTS 75.64% experienced fear during ISP, and 15.38% experienced clinically significant distress/interference, while 19.23% attempted to prevent ISP, and 79.31% of these believed their methods were successful. Regarding disruption, 69.29% made attempts, but only 54.12% reported them effective. CONCLUSIONS Disruption was more common than prevention, but several techniques were useful. Encouraging individuals to utilize these techniques and better monitor their symptoms may be an effective way to manage problematic ISP.
Collapse
|
68
|
|
69
|
Jalal B. How to Make the Ghosts in my Bedroom Disappear? Focused-Attention Meditation Combined with Muscle Relaxation (MR Therapy)-A Direct Treatment Intervention for Sleep Paralysis. Front Psychol 2016; 7:28. [PMID: 26858675 PMCID: PMC4731518 DOI: 10.3389/fpsyg.2016.00028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/07/2016] [Indexed: 11/24/2022] Open
Abstract
Sleep paralysis (SP) is a common state of involuntary immobility occurring at sleep onset or offset. It can include terrifying hypnogogic or hypnopompic hallucinations of menacing bedroom intruders. Unsurprisingly, the experience is associated with great fear and horror worldwide. To date, there exist no direct treatment intervention for SP. In this article, I propose for the first time a type of focused inward-attention meditation combined with muscle relaxation as a direct intervention to be applied during the attack, to ameliorate and possibly eliminate it (what could be called, meditation-relaxation or MR therapy for SP). The intervention includes four steps: (1) reappraisal of the meaning of the attack; (2) psychological and emotional distancing; (3) inward focused-attention meditation; (4) muscle relaxation. The intervention promotes attentional shift away from unpleasant external and internal stimuli (i.e., terrifying hallucinations and bodily paralysis sensations) unto an emotionally pleasant internal object (e.g., a positive memory). It may facilitate a relaxed meditative state characterized by a shift from sympathetic to parasympathetic dominance, associated with greater levels of alpha activity (which may lead to drowsiness and potentially sleep). The procedure may also reduce the initial panic and arousal that occur when realizing one is paralyzed. In addition, I present a novel Panic-Hallucination (PH) Model of Sleep Paralysis; describing how through escalating cycles of fear and panic-like autonomic arousal, a positive feedback loop is created that worsens the attack (e.g., leading to longer and more fearful episodes), drives content of hallucinations, and causes future episodes of SP. Case examples are presented to illustrate the feasibility of MR therapy for SP.
Collapse
Affiliation(s)
- Baland Jalal
- Behavioural and Clinical Neuroscience Institute, Department of Psychiatry, University of CambridgeCambridge, UK
| |
Collapse
|
70
|
Lišková M, Janečková D, Klůzová Kráčmarová L, Mladá K, Bušková J. The occurrence and predictive factors of sleep paralysis in university students. Neuropsychiatr Dis Treat 2016; 12:2957-2962. [PMID: 27881921 PMCID: PMC5115681 DOI: 10.2147/ndt.s115629] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of the present study was to assess the occurrence and predictive factors of sleep paralysis (SP) in Czech university students. Our sample included 606 students who had experienced at least one episode of SP. The participants completed an online battery of questionnaires involving questionnaires focused on describing their sleep habits and SP episodes, the 18-item Boundary Questionnaire (BQ-18), the Modified Tellegen Absorption Scale (MODTAS), the Dissociative Experience Scale Taxon, the Beck Depression Inventory II and the State-Trait Anxiety Inventory. The strongest predictive factor for the frequency of SP episodes was nightmares. The strongest predictive factor for the intensity of fear was dream occurrences. In our study sample, SP was more common in women than in men. Those who scored higher in BQ-18 experienced more often pleasant episodes of SP and those who scored higher in MODTAS were more likely to experience SP accompanied with hallucinations. While 62% of respondents answered that their SP was accompanied by intense fear, 16% reported that they experienced pleasant feelings during SP episodes. We suggest that not only the known rapid eye movement sleep dysregulation but also some personality variables may contribute to the characteristics of SP.
Collapse
Affiliation(s)
- Monika Lišková
- Institute of Sleep Medicine, National Institute of Mental Health, Klecany; Third Faculty of Medicine, Charles University, Prague
| | - Denisa Janečková
- Institute of Sleep Medicine, National Institute of Mental Health, Klecany
| | | | - Karolína Mladá
- Institute of Sleep Medicine, National Institute of Mental Health, Klecany
| | - Jitka Bušková
- Institute of Sleep Medicine, National Institute of Mental Health, Klecany; Third Faculty of Medicine, Charles University, Prague
| |
Collapse
|
71
|
Abstract
This review summarizes the empirical and clinical literature on sleep paralysis most relevant to practitioners. During episodes of sleep paralysis, the sufferer awakens to rapid eye movement sleep-based atonia combined with conscious awareness. This is usually a frightening event often accompanied by vivid, waking dreams (ie, hallucinations). When sleep paralysis occurs independently of narcolepsy and other medical conditions, it is termed "isolated" sleep paralysis. Although the more specific diagnostic syndrome of "recurrent isolated sleep paralysis" is a recognized sleep-wake disorder, it is not widely known to nonsleep specialists. This is likely due to the unusual nature of the condition, patient reluctance to disclose episodes for fear of embarrassment, and a lack of training during medical residencies and graduate education. In fact, a growing literature base has accrued on the prevalence, risk factors, and clinical impact of this condition, and a number of assessment instruments are currently available in both self-report and interview formats. After discussing these and providing suggestions for accurate diagnosis, differential diagnosis, and patient selection, the available treatment options are discussed. These consist of both pharmacological and psychotherapeutic interventions which, although promising, require more empirical support and larger, well-controlled trials.
Collapse
Affiliation(s)
- Brian A Sharpless
- Clinical Psychology Program, American School of Professional Psychology at Argosy University, Washington DC, Arlington, VA, USA
| |
Collapse
|
72
|
Jalal B, Romanelli A, Hinton DE. Cultural Explanations of Sleep Paralysis in Italy: The Pandafeche Attack and Associated Supernatural Beliefs. Cult Med Psychiatry 2015; 39:651-64. [PMID: 25802016 DOI: 10.1007/s11013-015-9442-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current study examines cultural explanations regarding sleep paralysis (SP) in Italy. The study explores (1) whether the phenomenology of SP generates culturally specific interpretations and causal explanations and (2) what are the beliefs and local traditions associated with such cultural explanations. The participants were Italian nationals from the general population (n = 68) recruited in the region of Abruzzo, Italy. All participants had experienced at least one lifetime episode of SP. The sleep paralysis experiences and phenomenology questionnaire were orally administered to participants. We found a multilayered cultural interpretation of SP, namely the Pandafeche attack, associated with various supernatural beliefs. Thirty-eight percent of participants believed that this supernatural being, the Pandafeche-often referred to as an evil witch, sometimes as a ghost-like spirit or a terrifying humanoid cat-might have caused their SP. Twenty-four percent of all participants sensed the Pandafeche was present during their SP. Strategies to prevent Pandafeche attack included sleeping in supine position, placing a broom by the bedroom door, or putting a pile of sand by the bed. Case studies are presented to illustrate the study findings. The Pandafeche attack thus constitutes a culturally specific, supernatural interpretation of the phenomenology of SP in the Abruzzo region of Italy.
Collapse
Affiliation(s)
- Baland Jalal
- Center for Brain and Cognition, University of California at San Diego, San Diego, CA, USA.
| | - Andrea Romanelli
- Department of General Psychology, University of Padua, Padua, Italy
| | - Devon E Hinton
- Massechustest General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
73
|
Sutton EL. Profile of suvorexant in the management of insomnia. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:6035-42. [PMID: 26648692 PMCID: PMC4651361 DOI: 10.2147/dddt.s73224] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Suvorexant, approved in late 2014 in the United States and Japan for the treatment of insomnia characterized by difficulty achieving and/or maintaining sleep, is a dual orexin receptor antagonist and the first drug in its class to reach the market. Its development followed from the 1998 discovery of orexins (also called hypocretins), excitatory neuropeptides originating from neurons in the hypothalamus involved in regulation of sleep and wake, feeding behavior and energy regulation, motor activity, and reward-seeking behavior. Suvorexant objectively improves sleep, shortening the time to achieve persistent sleep and reducing wake after sleep onset, although at approved doses (≤20 mg) the benefit was subjectively assessed as modest. Its half-life of 12 hours is relatively long for a modern hypnotic; however, at approved doses (≤20 mg) next-day sedation and driving impairment were much less apparent than at higher doses. Suvorexant is metabolized by the hepatic CYP3A system and should be avoided in combination with strong CYP3A inhibitors. Drug levels are higher in women and obese people; hence, dosing should be conservative in obese women. Administration with food delays drug absorption and is not advised. No dose adjustment is needed for advanced age, renal impairment, or mild-to-moderate hepatic impairment. Suvorexant in contraindicated in narcolepsy and has not been studied in children. In alignment with the changes begun in 2013 in the labeling of other hypnotics, the United States Food and Drug Administration advises that the lowest dose effective to treat symptoms be used and that patients be advised of the possibility of next-day impairment in function, including driving. Infrequent but notable side effects included abnormal dreams, sleep paralysis, and suicidal ideation that were dose-related and reported to be mild. Given its mechanism of action, cataplexy and rapid eye movement (REM) sleep behavior disorder could potentially occur in some patients taking this medication.
Collapse
Affiliation(s)
- Eliza L Sutton
- Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
74
|
Sleep Paralysis Among Egyptian College Students: Association With Anxiety Symptoms (PTSD, Trait Anxiety, Pathological Worry). J Nerv Ment Dis 2015; 203:871-5. [PMID: 26488914 DOI: 10.1097/nmd.0000000000000382] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Among Egyptian college students in Cairo (n = 100), this study examined the relationship between sleep paralysis (SP) and anxiety symptoms, viz., posttraumatic stress disorder (PTSD), trait anxiety, and pathological worry. SP rates were high; 43% of participants reported at least one lifetime episode of SP, and 24% of those who reported at least one lifetime episode had experienced four or more episodes during the previous year. Fourteen percent of men had experienced SP as compared to 86% of women. As hypothesized, relative to non-SP experiencers, participants who had SP reported higher symptoms of PTSD, trait anxiety, and pathological worry. Also, as hypothesized, the experiencing of hypnogogic/hypnopompic hallucinations during SP, even after controlling for negative affect, was highly correlated with symptoms of PTSD and trait anxiety. The study also investigated possible mechanisms by examining the relationship of hallucinations to anxiety variables.
Collapse
|
75
|
Denis D, French CC, Rowe R, Zavos HMS, Nolan PM, Parsons MJ, Gregory AM. A twin and molecular genetics study of sleep paralysis and associated factors. J Sleep Res 2015; 24:438-46. [PMID: 25659590 PMCID: PMC4950339 DOI: 10.1111/jsr.12282] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022]
Abstract
Sleep paralysis is a relatively common but under-researched phenomenon. In this paper we examine prevalence in a UK sample and associations with candidate risk factors. This is the first study to investigate the heritability of sleep paralysis in a twin sample and to explore genetic associations between sleep paralysis and a number of circadian expressed single nucleotide polymorphisms. Analyses are based on data from the Genesis1219 twin/sibling study, a community sample of twins/siblings from England and Wales. In total, data from 862 participants aged 22-32 years (34% male) were used in the study. This sample consisted of monozygotic and dizygotic twins and siblings. It was found that self-reports of general sleep quality, anxiety symptoms and exposure to threatening events were all associated independently with sleep paralysis. There was moderate genetic influence on sleep paralysis (53%). Polymorphisms in the PER2 gene were associated with sleep paralysis in additive and dominant models of inheritance-although significance was not reached once a Bonferroni correction was applied. It is concluded that factors associated with disrupted sleep cycles appear to be associated with sleep paralysis. In this sample of young adults, sleep paralysis was moderately heritable. Future work should examine specific polymorphisms associated with differences in circadian rhythms and sleep homeostasis further in association with sleep paralysis.
Collapse
Affiliation(s)
- Dan Denis
- Department of Psychology, Goldsmiths, University of London, London, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
| | | | - Richard Rowe
- Department of Psychology, University of Sheffield, Sheffield, UK
| | | | | | | | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
| |
Collapse
|
76
|
Exploding head syndrome. Sleep Med Rev 2014; 18:489-93. [DOI: 10.1016/j.smrv.2014.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/17/2014] [Accepted: 03/04/2014] [Indexed: 11/22/2022]
|
77
|
Trastornos del sueño-vigilia en alumnos de 5.° año de Medicina de la Universidad Nacional de Córdoba y su impacto sobre el rendimiento académico. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.neuarg.2014.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
78
|
Abstract
Sleep issues are common in people with psychiatric disorders, and the interaction is complex. Sleep disorders, particularly insomnia, can precede and predispose to psychiatric disorders, can be comorbid with and exacerbate psychiatric disorders, and can occur as part of psychiatric disorders. Sleep disorders can mimic psychiatric disorders or result from medication given for psychiatric disorders. Impairment of sleep and of mental health may be different manifestations of the same underlying neurobiological processes. For the primary care physician, key tools include recognition of potential sleep effects of psychiatric medications and familiarity with treatment approaches for insomnia in depression and anxiety.
Collapse
Affiliation(s)
- Eliza L Sutton
- Department of Medicine, University of Washington, 4245 Roosevelt Way Northeast, Box 354765, Seattle, WA 98105, USA.
| |
Collapse
|
79
|
Cruz HG, Hay JL, Hoever P, Alessi F, te Beek ET, van Gerven JMA, Dingemanse J. Pharmacokinetic and pharmacodynamic interactions between almorexant, a dual orexin receptor antagonist, and desipramine. Eur Neuropsychopharmacol 2014; 24:1257-68. [PMID: 24880753 DOI: 10.1016/j.euroneuro.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 04/03/2014] [Accepted: 05/01/2014] [Indexed: 01/18/2023]
Abstract
Almorexant is a dual orexin receptor antagonist (DORA) with sleep-enabling effects in humans. Insomnia is often associated with mental health problems, including depression. Hence, potential interactions with antidepressants deserve attention. Desipramine was selected as a model drug because it is mainly metabolized by CYP2D6, which is inhibited by almorexant in vitro. A single-center, randomized, placebo-controlled, two-way crossover study in 20 healthy male subjects was conducted to evaluate the pharmacokinetic and pharmacodynamic interactions between almorexant and desipramine. Almorexant 200mg or matching placebo (double-blind) was administered orally once daily in the morning for 10 days, and a single oral dose of 50mg desipramine (open-label) was administered on Day 5. Almorexant increased the exposure to desipramine 3.7-fold, suggesting that almorexant is a moderate inhibitor of desipramine metabolism through inhibition of CYP2D6. Conversely, desipramine showed no relevant effects on the pharmacokinetics of almorexant. Pharmacodynamic evaluations indicated that almorexant alone reduced visuomotor coordination, postural stability, and alertness, and slightly increased calmness. Desipramine induced a reduction in subjective alertness and an increase in pupil/iris ratio. Despite the increase in exposure to desipramine, almorexant and desipramine in combination showed the same pharmacodynamic profile as almorexant alone, except for prolonging reduced alertness and preventing the miotic effect of almorexant. Co-administration also prolonged the mydriatic effect of desipramine. Overall, repeated administration of almorexant alone or with single-dose desipramine was well tolerated. The lack of a relevant interaction with antidepressants, if confirmed for other DORAs, would be a key feature for a safer class of hypnotics.
Collapse
Affiliation(s)
- Hans G Cruz
- Actelion Pharmaceuticals Ltd, Clinical Pharmacology, Gewerbestrasse 16, CH-4123 Allschwil, Switzerland
| | - Justin L Hay
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Petra Hoever
- Actelion Pharmaceuticals Ltd, Clinical Pharmacology, Gewerbestrasse 16, CH-4123 Allschwil, Switzerland
| | - Federica Alessi
- Actelion Pharmaceuticals Ltd, Biostatistics, Allschwil, Switzerland
| | | | | | - Jasper Dingemanse
- Actelion Pharmaceuticals Ltd, Clinical Pharmacology, Gewerbestrasse 16, CH-4123 Allschwil, Switzerland.
| |
Collapse
|
80
|
Baumann CR, Mignot E, Lammers GJ, Overeem S, Arnulf I, Rye D, Dauvilliers Y, Honda M, Owens JA, Plazzi G, Scammell TE. Challenges in diagnosing narcolepsy without cataplexy: a consensus statement. Sleep 2014; 37:1035-42. [PMID: 24882898 DOI: 10.5665/sleep.3756] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Diagnosing narcolepsy without cataplexy is often a challenge as the symptoms are nonspecific, current diagnostic tests are limited, and there are no useful biomarkers. In this report, we review the clinical and physiological aspects of narcolepsy without cataplexy, the limitations of available diagnostic procedures, and the differential diagnoses, and we propose an approach for more accurate diagnosis of narcolepsy without cataplexy. METHODS A group of clinician-scientists experienced in narcolepsy reviewed the literature and convened to discuss current diagnostic tools, and to map out directions for research that should lead to a better understanding and more accurate diagnosis of narcolepsy without cataplexy. RECOMMENDATIONS To aid in the identification of narcolepsy without cataplexy, we review key indicators of narcolepsy and present a diagnostic algorithm. A detailed clinical history is mainly helpful to rule out other possible causes of chronic sleepiness. The multiple sleep latency test remains the most important measure, and prior sleep deprivation, shift work, or circadian disorders should be excluded by actigraphy or sleep logs. A short REM sleep latency (≤ 15 minutes) on polysomnography can aid in the diagnosis of narcolepsy without cataplexy, although sensitivity is low. Finally, measurement of hypocretin levels can helpful, as levels are low to intermediate in 10% to 30% of narcolepsy without cataplexy patients.
Collapse
Affiliation(s)
- Christian R Baumann
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland ; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences, Stanford University, Stanford, CA
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan Overeem
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Isabelle Arnulf
- Hôpital Pitié-Salpêtrière, Pierre and Marie Curie University, Paris, France
| | - David Rye
- Department of Neurology and Program in Sleep, Emory University School of Medicine, Atlanta
| | - Yves Dauvilliers
- National Reference Network for Orphan Diseases (Narcolepsy), Department of Neurology, Hôpital Gui de Chauliac, CHU Montpellier, INSERM U1061, France
| | - Makoto Honda
- Tokyo Metropolitan Institute of Sleep Science, Tokyo, Japan
| | - Judith A Owens
- Sleep Medicine Children's National Med Center, Washington, DC
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Neurological Sciences, University of Bologna, and IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| |
Collapse
|
81
|
Abstract
In the current research we report data from two studies that examined rates and characteristics of sleep paralysis (SP) in the general population of Denmark and Egypt. In Study I, individuals from Denmark and Egypt did not differ in age whereas there were more males in the Egyptian sample (47 vs. 64 %); in Study II, individuals from Denmark and Egypt were comparable in terms of age and gender distribution. In Study I we found that significantly fewer individuals had experienced SP in Denmark [25 % (56/223)] than in Egypt [44 % (207/470)] p < .001. In Study II we found that individuals who had experienced at least one lifetime episode of SP from Denmark (n = 58) as compared to those from Egypt (n = 143) reported significantly fewer SP episodes in a lifetime relative to SP experiencers from Egypt (M = 6.0 vs. M = 19.4, p < .001). SP in the Egyptian sample was characterized by high rates of SP (as compared to in Denmark), frequent occurrences (three times that in the Denmark sample), prolonged immobility during SP, and great fear of dying from the experience. In addition, in Egypt, believing SP to be precipitated by the supernatural was associated with fear of the experience and longer SP immobility. Findings are discussed in the context of cultural elaboration and salience theories of SP.
Collapse
|
82
|
Luca G, Haba-Rubio J, Dauvilliers Y, Lammers GJ, Overeem S, Donjacour CE, Mayer G, Javidi S, Iranzo A, Santamaria J, Peraita-Adrados R, Hor H, Kutalik Z, Plazzi G, Poli F, Pizza F, Arnulf I, Lecendreux M, Bassetti C, Mathis J, Heinzer R, Jennum P, Knudsen S, Geisler P, Wierzbicka A, Feketeova E, Pfister C, Khatami R, Baumann C, Tafti M. Clinical, polysomnographic and genome-wide association analyses of narcolepsy with cataplexy: a European Narcolepsy Network study. J Sleep Res 2013; 22:482-95. [PMID: 23496005 DOI: 10.1111/jsr.12044] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Gianina Luca
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS); Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
| | - Yves Dauvilliers
- INSERM-1061; Montpellier France
- Department of Neurology; National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia); Gui-de-Chauliac Hospital; Montpellier France
| | - Gert-Jan Lammers
- Department of Neurology and Clinical Neurophysiology; Leiden University Medical Centre; Leiden the Netherlands
| | | | - Claire E. Donjacour
- Department of Neurology and Clinical Neurophysiology; Leiden University Medical Centre; Leiden the Netherlands
| | - Geert Mayer
- Hephata-Clinic for Neurology; Schwalmstadt-Treysa Germany
| | - Sirous Javidi
- Hephata-Clinic for Neurology; Schwalmstadt-Treysa Germany
| | - Alex Iranzo
- Neurology Service; Hospital Clinic; Barcelona Spain
| | | | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit - Clinical Neurophysiology Department; Gregorio Marañón University Hospital; Madrid Spain
| | - Hyun Hor
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
| | - Zoltan Kutalik
- Department of Medical Genetics; University of Lausanne; Lausanne Switzerland
- Swiss Institute of Bioinformatics; Lausanne Switzerland
| | - Giuseppe Plazzi
- Department of Neurological Sciences; University of Bologna/IRCCS; Istituto delle Scienze Neurologiche di; Bologna Italy
| | - Francesca Poli
- Department of Neurological Sciences; University of Bologna/IRCCS; Istituto delle Scienze Neurologiche di; Bologna Italy
| | - Fabio Pizza
- Department of Neurological Sciences; University of Bologna/IRCCS; Istituto delle Scienze Neurologiche di; Bologna Italy
| | - Isabelle Arnulf
- National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia); Sleep Disorders Unit; Pitié-Salpêtrière Hospital; Paris France
| | - Michel Lecendreux
- Pediatric Sleep Center; National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia); Robert-Debré Hospital; Paris France
| | - Claudio Bassetti
- Department of Neurology; Inselspital, Bern University Hospital and University of Bern; Bern Switzerland
| | - Johannes Mathis
- Department of Neurology; Inselspital, Bern University Hospital and University of Bern; Bern Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS); Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
| | - Poul Jennum
- Department of Clinical Neurophysiology; University of Copenhagen; Glostrup Denmark
| | - Stine Knudsen
- Department of Clinical Neurophysiology; University of Copenhagen; Glostrup Denmark
| | - Peter Geisler
- Department of Psychiatry and Psychotherapy; Sleep Disorders and Research Center; University Hospital Regensburg; Regensburg Germany
| | - Aleksandra Wierzbicka
- Third Department of Psychiatry; Institute of Psychiatry and Neurology; Warsaw Poland
| | - Eva Feketeova
- Department of Neurology; Faculty of Medicine; Safarikiensis University and Louis Pasteur Faculty Hospital Kosice; Kosice Slovakia
| | - Corinne Pfister
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
| | - Ramin Khatami
- Sleep Medicine; Barmelweid Clinic; Barmelweid Switzerland
| | - Christian Baumann
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
| | - Mehdi Tafti
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
- Center for Investigation and Research in Sleep (CIRS); Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
| | | |
Collapse
|
83
|
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.
Collapse
Affiliation(s)
- Michael J Howell
- Department of Neurology, University of Minnesota Medical Center, Sleep Disorders Center, University of Minnesota, Minnesota, MN, USA.
| |
Collapse
|
84
|
Abstract
The classification of sleep disorders is necessary to discriminate between disorders and to facilitate an understanding of symptoms, etiology, and pathophysiology that allows for appropriate treatment. The earliest classification systems, largely organized according to major symptoms (insomnia, excessive sleepiness, and abnormal events that occur during sleep), were unable to be based on pathophysiology because the cause of most sleep disorders was unknown. These 3 symptom-based categories are easily understood by physicians and are therefore useful for developing a differential diagnosis. The International Classification of Sleep Disorders, version 2, published in 2005 and currently undergoing revision, combines a symptomatic presentation (e.g., insomnia) with 1 organized in part on pathophysiology (e.g., circadian rhythms) and in part on body systems (e.g., breathing disorders). This organization of sleep disorders is necessary because of the varied nature and because the pathophysiology for many of the disorders is still unknown. The International Classification of Sleep Disorders, version 2 provides relevant diagnostic and epidemiological information on sleep disorders to more easily differentiate between the disorders.
Collapse
Affiliation(s)
- Michael J Thorpy
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, NY, USA.
| |
Collapse
|
85
|
Comorbidities of Central Nervous System Hypersomnia. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
86
|
Weisberg RB, Beard C, Dyck I, Keller MB. The Harvard/Brown Anxiety Research Project-Phase II (HARP-II): rationale, methods, and features of the sample at intake. J Anxiety Disord 2012; 26:532-43. [PMID: 22410095 PMCID: PMC3319242 DOI: 10.1016/j.janxdis.2012.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We describe the rationale, method, and intake demographic and clinical findings of the Harvard/Brown Anxiety Research Project-Phase II (HARP-II). HARP-II is the first prospective, observational, longitudinal study to describe the characteristics and course of anxiety in African American, Latino, and Non-Latino White individuals. Participants met criteria for at least one of the following disorders: Generalized Anxiety Disorder, Social Phobia, Panic Disorder with or without Agoraphobia, Agoraphobia without history of Panic Disorder, Post-traumatic Stress Disorder. Initial intake data, collected between 2004 and 2011, are presented for 165 African American, 150 Latino, and 172 Non-Latino White participants. Participants evidenced substantial psychiatric comorbidity (mean number of Axis I disorders=3.4), and moderate to severe symptoms and functional impairment. HARP-II will examine clinical course, in the context of potential socio-cultural and individual moderators (e.g., discrimination, acculturation, negative affect). Results should lead to improved understanding, prognostics, and treatment of anxiety in diverse populations.
Collapse
Affiliation(s)
- Risa B. Weisberg
- Alpert Medical School of Brown University Department of Psychiatry and Human Behavior,Alpert Medical School of Brown University Department of Family Medicine,Corresponding Author (and address for all authors) Brown University Box G-BH, Duncan Building Providence, RI 02912 401.444.1945 Fax: 401.444.1911
| | - Courtney Beard
- Alpert Medical School of Brown University Department of Psychiatry and Human Behavior
| | - Ingrid Dyck
- Alpert Medical School of Brown University Department of Psychiatry and Human Behavior
| | - Martin B. Keller
- Alpert Medical School of Brown University Department of Psychiatry and Human Behavior
| |
Collapse
|