Therapeutic Symptomatic Strategies in the Parasomnias

Sertraline-Induced Sleep Paralysis: A Case Report

Major depressive disorder (MDD) is associated with both insomnia and hypersomnia, but it predominantly decreases sleep continuity and leads to a decrease in rapid eye movement (REM) latency, an increase in REM sleep duration, and an increase in REM density. Some of these changes persist even when MDD is treated and can be associated with a recurrence of MDD. Antidepressants can potentially complicate the relationship between REM sleep and depression, as a majority of patients report improved sleep when prescribed selective serotonin reuptake inhibitors (SSRIs) but some case reports mention that SSRIs have been associated with REM inhibition, resulting in decreased REM sleep. We present a case report of a young patient with MDD who started experiencing multiple episodes of distressing sleep paralysis after he started taking sertraline and resolved as he was tapered off the medication. Through references from the literature indicating a potential link between parasomnias and SSRIs, we were able to discuss that SSRIs can potentially lead to isolated sleep paralysis and should be considered as an uncommon yet distressing side effect although not listed in the package insert. Isolated sleep paralysis has been defined in the literature as the inability to perform voluntary movements of the trunk and all limbs for a period of seconds to minutes at the beginning of sleep or upon waking up. Further research is needed to clarify the impact of SSRIs on sleep and practice guidelines should be clarified in regard to their role.

Kambakutaisoto Treatment for Children With Night Crying and Arousal Parasomnias Developed During Prolonged Hospitalization for Hematological and Oncological Diseases

OBJECTIVE

The lack of an established treatment standard prompted an examination of whether kambakutaisoto, an herbal formula, is effective for non-rapid eye movement (NREM)-related parasomnias and night crying (provisionally defined as an infantile form of arousal parasomnia).

METHODS

This study included 137 children aged median 4.1 years (range, 0.02-18.5) who were admitted for hematological and oncological diseases.

RESULTS

Of 137, 3 children developed recurrent episodes of NREM-related parasomnias, and 3 developed night crying. The proportion of children with night-crying/parasomnia receiving invasive procedures was significantly higher than those without (100% vs. 47%, P = .013). All 6 children with night crying/parasomnia received kambakutaisoto at a dose of 0.13-0.22 g/kg per os and responded from the start of administration with a significant reduction in the number of episodes. No adverse effects were observed.

CONCLUSION

Kambakutaisoto may be a safe and promising therapy for night crying and NREM-related parasomnias in children.

Efficacy of yokukansan compared with clonazepam for rapid eye movement sleep behaviour disorder: a preliminary retrospective study

AIM

Rapid eye movement sleep behaviour disorder (RBD) is characterized by abnormal behaviours accordant with nightmares during rapid eye movement sleep and is considered a prodromal marker of dementia with Lewy body. Most common in the elderly population, RBD is generally treated with clonazepam (CZP), a long-term acting benzodiazepine antiepileptic. As such, alternative drugs for RBD are urgently needed to minimize the adverse effects peculiar to benzodiazepines. The efficacy of yokukansan (YKS), a traditional Japanese herbal medicine, on RBD was initially reported by Shinno et al. in 2008. However, no study has compared YKS with CZP. Therefore, this study aimed to clarify the possibility of using YKS as an alternative to CZP.

METHODS

This was a retrospective cohort study conducted at Jikei University Affiliated Hospital. The subjects were selected from 36 outpatients who had been diagnosed with RBD based on the International Classification of Sleep Disorders, third edition. Of the 23 who met the inclusion criteria but not the exclusion criteria, 11 were treated with YKS monotherapy, and 12 were treated with CZP monotherapy. The primary outcome was the total score on the Japanese version of the Rapid Eye Movement Sleep Behaviour Disorder Questionnaire (RBDQ-JP), and the secondary outcomes were the scores from the eight-item Short-Form Health Survey and factors 1 and 2 of the RBDQ-JP.

RESULTS

The mean total RBDQ-JP score significantly improved from 52.5 to 21.7 (P = 0.002) after treatment with YKS (mean dosage: 3.0 g/day), which was similar to the change after CZP treatment (from 43.8 to 21.3). On RBDQ-JP factor 1 (dream content), the mean score on five of six items significantly improved after treatment with YKS. There was no significant change in Short-Form Health Survey scores after treatment with either drug. Potassium concentrations were within the normal range in patients treated with YKS.

CONCLUSIONS

The present results suggest that a small amount of YKS may be an alternative to CZP for RBD, without remarkable adverse events. Further study is needed to prospectively clarify the efficacy and safety of YKS in more detail.