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Mundt JM, Schuiling MD, Warlick C, Dietch JR, Wescott AB, Hagenaars M, Furst A, Khorramdel K, Baron KG. Behavioral and psychological treatments for NREM parasomnias: A systematic review. Sleep Med 2023; 111:36-53. [PMID: 37716336 PMCID: PMC10591847 DOI: 10.1016/j.sleep.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Non-rapid eye movement (NREM) parasomnias are often benign and transient, requiring no formal treatment. However, parasomnias can also be chronic, disrupt sleep quality, and pose a significant risk of harm to the patient or others. Numerous behavioral strategies have been described for the management of NREM parasomnias, but there have been no published comprehensive reviews. This systematic review was conducted to summarize the range of behavioral and psychological interventions and their efficacy. METHODS We conducted a systematic search of the literature to identify all reports of behavioral and psychological treatments for NREM parasomnias (confusional arousals, sexsomnia, sleepwalking, sleep terrors, sleep-related eating disorder, parasomnia overlap disorder). This review was conducted in line with PRISMA guidelines. The protocol was registered with PROSPERO (CRD42021230360). The search was conducted in the following databases (initially on March 10, 2021 and updated February 24, 2023): Ovid (MEDLINE), Cochrane Library databases (Wiley), CINAHL (EBSCO), PsycINFO (EBSCO), and Web of Science (Clarivate). Given a lack of standardized quantitative outcome measures, a narrative synthesis approach was used. Risk of bias assessment used tools from Joanna Briggs Institute. RESULTS A total of 72 publications in four languages were included, most of which were case reports (68%) or case series (21%). Children were included in 32 publications and adults in 44. The most common treatment was hypnosis (33 publications) followed by various types of psychotherapy (31), sleep hygiene (19), education/reassurance (15), relaxation (10), scheduled awakenings (9), sleep extension/scheduled naps (9), and mindfulness (5). Study designs and inconsistent outcome measures limited the evidence for specific treatments, but some evidence supports multicomponent CBT, sleep hygiene, scheduled awakenings, and hypnosis. CONCLUSIONS This review highlights the wide breadth of behavioral and psychological interventions for managing NREM parasomnias. Evidence for the efficacy of these treatments is limited by the retrospective and uncontrolled nature of most research as well as the infrequent use of validated quantitative outcome measures. Behavioral and psychological treatments have been studied alone and in various combinations, and recent publications suggest a trend toward preference for multicomponent cognitive behavioral therapies designed to specifically target priming and precipitating factors of NREM parasomnias.
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Affiliation(s)
- Jennifer M Mundt
- Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall 11th Floor, 710 N Lake Shore Drive, Chicago, IL, 60611, USA; Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, USA.
| | - Matthew D Schuiling
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 119, Indianapolis, IN, 46202, USA.
| | - Chloe Warlick
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL, 60611, USA.
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA.
| | - Annie B Wescott
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
| | - Muriel Hagenaars
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, Netherlands.
| | - Ansgar Furst
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Mailcode 151Y, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, USA; Polytrauma System of Care, VA Palo Alto Health Care System, USA.
| | - Kazem Khorramdel
- Department of Psychology and Education Science, Shiraz University, Shiraz, Fars, 71345, Iran.
| | - Kelly G Baron
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Suite A, Room 142, Salt Lake City, UT, 84108, USA.
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Idir Y, Oudiette D, Arnulf I. Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new. J Sleep Res 2022; 31:e13596. [PMID: 35388549 DOI: 10.1111/jsr.13596] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 01/03/2023]
Abstract
Disorders of arousal (DOA) is an umbrella term initially covering classical sleepwalking, sleep terrors, and confusional arousals, and now including a wider spectrum of specialised forms of non rapid eye movement (non REM) parasomnias such as sexsomnia, sleep-related eating disorder, and sleep-related choking syndrome. Growing evidence has shown that DOA are not restricted to children but are also prevalent in adults (2%-4% of the adult population). While DOA run in family, genetics studies remain scarce and inconclusive. In addition to the risk of injury on themselves and others (including sexual assaults in sexsomnia), adults with DOA frequently suffer from excessive daytime sleepiness, pain, and altered quality of life. The widespread view of DOA as automatic and amnesiac behaviours has now been challenged by subjective (dream reports) and objective (dream-enacting behaviours documented on video-polysomnography) observations, suggesting that sleepwalkers are 'dream walking' during their episodes. Behavioural, experiential, cognitive, and brain (scalp electroencephalography [EEG], stereo-EEG, high density-EEG, functional brain imaging) data converge in showing a dissociated pattern during the episodes. This dissociated pattern resembles the new concept of local arousal with a wake-like activation in motor and limbic regions and a preserved (or even increased) sleep intensity over a frontoparietal network. EEG and behavioural criteria supporting the DOA diagnosis with high sensitivity and specificity are now available. However, treatment is still based on controlling priming and precipitating factors, as well as on clinicians' personal experience with sedative drugs. Placebo-controlled trials are needed to improve patients' treatment. DOA deserve more attention from sleep researchers and clinicians.
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Affiliation(s)
- Yannis Idir
- Sorbonne University, Paris, France.,Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,APHP-Sorbonne, Pitie-Salpetriere University Hospital Sleep Disorders Unit, Paris, France
| | - Delphine Oudiette
- Sorbonne University, Paris, France.,Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,APHP-Sorbonne, Pitie-Salpetriere University Hospital Sleep Disorders Unit, Paris, France
| | - Isabelle Arnulf
- Sorbonne University, Paris, France.,Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,APHP-Sorbonne, Pitie-Salpetriere University Hospital Sleep Disorders Unit, Paris, France
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