LA Night Moves

Abstract

Two cases of non–rapid-eye-movement (NREM) arousal parasomnias in adults are discussed in this chapter. NREM arousal parasomnias occur in 2% of adults and are often triggered by sleep deprivation, emotional stress, circadian rhythm disorders, and sleep fragmentation. Disorders of arousal include confusional arousal, sleepwalking, and sleep terrors. Research into the pathogenesis of arousal disorders in adults suggests that they reflect aberrant slow-wave sleep regulation, impaired arousal specifically from NREM 3 sleep, and/or sleep/wake state dissociations. Treatment of DoA includes avoidance of sleep deprivation/restriction, irregular sleep/wake schedules, and predisposing/precipitating factors. Pharmacotherapy can be considered when events pose a danger and/or sleep disturbance to the patient and/or others; involve potentially violent, dangerous, or sexual behavior; are frequent, chronic, and refractory to initial therapies; and/or have secondary consequences such as excessive daytime sleepiness, impaired quality of life, excessive weight gain, and injuries.