Movement Disorders in Sleep
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Parasomnias Revisited New Mexico Thoracic Society Sapna Bhatia Md 02/25/17 Objectives
PARASOMNIAS REVISITED NEW MEXICO THORACIC SOCIETY SAPNA BHATIA MD 02/25/17 OBJECTIVES • Appreciate the clinical semiology to help differentiate between REM and NREM parasomnias • Appreciate the ICSD III Classification Scheme for the major parasomnias • Understand management modalities including behavioral and pharmacological for NREM and REM parasomnias • Understand the difference between parasomnias and seizures WHAT ARE PARASOMNIAS? Undesirable motor, or verbal phenomena that arise from sleep or sleep-wake transition PARASOMNIAS: OVERLAPPING STATES REM PARASOMNIAS WAKE NREM PARASOMNIAS REM NREM PARASOMNIAS: DIFFERENTIAL DIAGNOSIS RBD Confusional Arousals Recurrent Isolated Sleep Paralysis Sleepwalking Nightmare Disorder Sleep Terrors WAKE Sleep Related Eating Disorder REM NREM PYSCHOGENIC SEIZURES SPELLS NFLE Dissociative Disorder ICSD II ICSD III REM Parasomnias • RBD • RBD • Recurrent Isolated Sleep • Recurrent Isolated Sleep Paralysis ICSD II VS ICSDParalysis III CLASSIFICATION• Nightmare Disorder • Nightmare Disorder Disorders of arousal • Confusional Arousals • Confusional Arousals (NREM sleep) • Sleepwalking • Sleep Walking • Sleep Terrors • Sleep Terrors • SRED Other Parasomnias • SRED • Sleep Related Dissociative • Sleep Related Dissociative Disorders Disorders • Sleep Enuresis • Sleep Enuresis • Catathrenia SDB • Catathrenia • Exploding Head Syndrome • Exploding Head syndrome • Sleep Related Hallucinations • Sleep Related Hallucinations • Parasomnia, Unspecified • Parasomnia, Unspecified • Parasomnia due to Drug or • Parasomnia -
Sleep Disorders Preeti Devnani
SPECIAL ISSUE 1: INVITED ARTICLE Sleep Disorders Preeti Devnani ABSTRACT Sleep disorders are an increasingly important and relevant burden faced by society, impacting at the individual, community and global level. Varied presentations and lack of awareness can make accurate and timely diagnosis a challenge. Early recognition and appropriate intervention are a priority. The key characteristics, clinical presentations and management strategies of common sleep disorders such as circadian rhythm disorders, restless legs syndrome, REM behavior disorder, hypersomnia and insomnia are outlined in this review. Keywords: Hypersomnia, Insomnia, REM behavior International Journal of Head and Neck Surgery (2019): 10.5005/jp-journals-10001-1362 INTRODUCTION Department of Neurology and Sleep Disorder, Cleveland Clinic, Abu Sleep disorders are becoming increasingly common in this modern Dhabi, United Arab Emirates era, resulting from several lifestyle changes. These complaints may Corresponding Author: Preeti Devnani, Department of Neurology present excessive daytime sleepiness, lack of sleep or impaired and Sleep Disorder, Cleveland Clinic, Abu Dhabi, United Arab Emirates, quality, sleep related breathing disorders, circadian rhythm disorder e-mail: [email protected] misalignment and abnormal sleep-related movement disorders.1 How to cite this article: Devnani P. Sleep Disorders. Int J Head Neck They are associated with impaired daytime functioning, Surg 2019;10(1):4–8. increased risk of cardiovascular and cerebrovascular disease, poor Source of support: Nil glycemic control, risk of cognitive decline and impaired immunity Conflict of interest: None impacting overall morbidity and mortality. Diagnosis of sleep disorders is clinical in many scenarios, The following circadian rhythm sleep–wake disorders adapted polysomnography is a gold standard for further evaluation of from the ICSD-3: intrinsic sleep disorder such as obstructive sleep apnea (OSA) • Delayed sleep–wake phase disorder and periodic limb movement disorder (PLMD). -
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Somnology-Jr-Book.Pdf
1 To Grace Zamudio and Zoe Lee-Chiong. 2 Preface Carpe noctem. Teofilo Lee-Chiong MD Professor of Medicine Division of Sleep Medicine National Jewish Health Denver, Colorado University of Colorado Denver School of Medicine Denver, Colorado Chief Medical Liaison Philips Respironics Murrysville, Pennsylvania 3 Abbreviations AHI Apnea-hypopnea index BPAP Bi-level positive airway pressure CPAP Continuous positive airway pressure CSA Central sleep apnea ECG Electrocardiography EEG Electroencephalography EMG Electromyography EOG Electro-oculography FEV1 Forced expiratory volume in 1 second GABA Gamma-aminobutyric acid N1 NREM stage 1 sleep N2 NREM stage 2 sleep N3 NREM stages 3 (and 4) sleep NREM Non-rapid eye movement O2 Oxygen OSA Obstructive sleep apnea PaCO2 Partial pressure of arterial carbon dioxide PaO2 Partial pressure of arterial oxygen REM Rapid eye movement sleep SaO2 Oxygen saturation SOREMP Sleep onset REM period 4 Table of contents Introduction 15 Neurobiology of sleep 16 Neural systems generating wakefulness 16 Neural systems generating NREM sleep 16 Neural systems generating REM sleep 16 Main neurotransmitters 17 Acetylcholine 17 Adenosine 17 Dopamine 17 Gamma-aminobutyric acid 17 Glutamate 17 Glycine 17 Histamine 18 Hypocretin 18 Melatonin 18 Norepinephrine 18 Serotonin 18 Physiology during sleep 19 Autonomic nervous system 19 Respiratory system 19 Respiratory patterns 19 Cardiovascular system 19 Gastrointestinal system 20 Renal and genito-urinary systems 20 Endocrine system 20 Growth hormone 20 Thyroid stimulating hormone -
Sleep Disorders As Outlined by Outlined As Disorders Sleep of Classification N the Ribe the Features and Symptoms of Each Disorder
CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 2NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORSleep SALE OR DISTRIBUTION Disorders NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Agsandrew/Shutterstock © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER OUTLINE EEG arousal alveolar hypoventilation paradoxical breathing idiopathic central alveolar History of Sleep Disorders© Jones & Bartlett Learning, LLCmicrognathia © Joneshypoventilation & Bartlett Learning, LLC Classification of Sleep DisordersNOT FOR SALE OR DISTRIBUTIONretrognathia NOTsnoring FOR SALE OR DISTRIBUTION Insomnia apnea–hypopnea primary snoring Sleep-Related Breathing Disorders index (AHI) sleep-related groaning Central Disorders of Hypersomnolence respiratory disturbance catathrenia Circadian Rhythm Sleep–Wake Disorders index (RDI) CPAP therapy Parasomnias respiratory effort–related positional therapy Sleep-Related© Jones Movement & Bartlett Disorders Learning, LLC arousal (RERA)© Jones & Bartletttonsillectomy Learning, LLC OtherNOT Sleep FOR Disorders SALE OR DISTRIBUTION upper-airwayNOT resistance FOR SALEadenoidectomy OR DISTRIBUTION Chapter Summary syndrome bi-level therapy excessive daytime multiple sleep latency LEARNING OBJECTIVES sleepiness (EDS) test (MSLT) sudden infant -
The Co-Occurrence of Sexsomnia, Sleep Bruxism and Other Sleep Disorders
Journal of Clinical Medicine Review The Co-Occurrence of Sexsomnia, Sleep Bruxism and Other Sleep Disorders Helena Martynowicz 1, Joanna Smardz 2, Tomasz Wieczorek 3, Grzegorz Mazur 1, Rafal Poreba 1, Robert Skomro 4, Marek Zietek 5, Anna Wojakowska 1, Monika Michalek 1 ID and Mieszko Wieckiewicz 2,* 1 Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, 50-367 Wroclaw, Poland; [email protected] (H.M.); [email protected] (G.M.); [email protected] (R.P.); [email protected] (A.W.); [email protected] (M.M.) 2 Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland; [email protected] 3 Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; [email protected] 4 Division of Respiratory Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada; [email protected] 5 Department of Periodontology, Wroclaw Medical University, 50-367 Wroclaw, Poland; [email protected] * Correspondence: [email protected]; Tel.: +48-660-47-87-59 Received: 3 August 2018; Accepted: 19 August 2018; Published: 23 August 2018 Abstract: Background: Sleep sex also known as sexsomnia or somnambulistic sexual behavior is proposed to be classified as NREM (non-rapid eye movement) parasomnia (as a clinical subtype of disorders of arousal from NREM sleep—primarily confusional arousals or less commonly sleepwalking), but it has also been described in relation to REM (rapid eye movement) parasomnias. Methods: The authors searched the PubMed database to identify relevant publications and present the co-occurrence of sexsomnia and other sleep disorders as a non-systematic review with case series. -
Periodic Limb Movement Disorder: Characteristics
SLEEP SCIENCE : SLEEP , SLEEPINESS , AND SLEEPLESSNESS Kenneth Lichstein, Ph.D. Professor Emeritus Department of Psychology The University of Alabama sleeplessness II a lot can go wrong topics (among 70 sleep disorders) sleep apnea narcolepsy restless legs periodic limb movements disorders we won’t talk about exploding head syndrome sexsomnia sleep-related epilepsy catathrenia if left untreated, sleep apnea is a slow moving terminal illness Pickwickian syndrome (now called obesity-hypoventilation syndrome) obesity, daytime labored breathing, daytime sleepiness ̶ Burwell et al., 1956 10 years later sleep apnea “Nocturnal polygraphic registrations disclosed respiratory pauses…” ̶ Gastaut et al., 1966 invisible sleep apnea science advances by two processes ❑ steady, incremental, systematic research ❑ abrupt, accidental discovery o Between 1956 and 1966, 10s of thousands of PSGs had been performed world wide and no one noticed some people had quit breathing. o Bed partners were not complaining that their partner had quit breathing. when you don’t know what you are looking for, you don’t see the obvious benign snoring and sleep apnea moderate and severe snoring sleep apnea benign snoring I snoring without breath cessation ▪ occurs in 10-15% of population ▪ sleeping on back increases likelihood of snoring ▪ snorer usually has no knowledge of condition ▪ more troublesome to bed partner ▪ at 5-year follow-up, benign snoring (without weight gain) is not a risk factor for sleep apnea physiology ▪ partial airway obstruction ▪ on continuum -
The Effortless Sleep Method: Cure for Insomnia
Sleeping Pills: An Introduction 1 1 Sleeping Pills: An Introduction What Are Sleeping Pills? Most sleeping pills are “sedative hypnotics.” That’s a specific class of drugs used to induce and/or maintain sleep. Sedative hypnotics include benzodiazepines, barbiturates, and various hypnotics. SLEEPING PILL ABUSE: ITS SIGNS AND SYMPTOMS A number of people underestimate the powerful grip sleeping pills like Ambien or Sonata can have over someone’s life and the dangers of abusing these drugs. 2 The Effortless Sleep Method: Cure for Insomnia... Many people abusing sleeping pills experience memory and concentration problems. Some of the signs of sleeping pill abuse include: • Slurred speech • Uncoordinated movements • Unsteady gait • Inability to focus • Impaired memory • Unusual euphoria. SLEEPING PILLS: ITS MAIN DANGERS Both the immediate and long-term dangers of sleeping pill abuse are enough for most people to exercise caution when using them. However, many people aren’t aware of the dangers of these medications. The dangerous effects of sleep medications range from seizures to depressed breathing. Some people also experience allergic reactions from sleeping pills that can cause difficulty breathing, chest pain, nausea and swelling. Though rare, people who use sleeping pills may even develop parasomnias. Parasomnias are defined as sleep disorders that include behaviors like sleep-walking, sleep-eating, sleep-sex, sleep- driving and other potentially dangerous sleep-related activities. The immediate dangers of sleeping pills range from minor fatigue to coma. Some of these side effects can even lead to deadly overdoses, casting light on the true dangers of sleeping pills. Common symptoms of sleeping pill abuse are: • Dizziness • Dry mouth • Difficulty with coordination • Daytime drowsiness • Memory loss • Unusual dreams • Itching and swelling Sleeping Pills: An Introduction 3 • Lightheadedness • Depressed breathing rate. -
Indeling Der Slaap
Classification of sleep disorders Prof. Dr. J. Verbraecken Multidisciplinary Sleep Disorders Centre Antwerp University Hospital University of Antwerp Prevalence Sleep disorders occur in 10% of the population impacting daily live. Most frequent: Insomnia (use of hypnotics !), Sleep related breathing disorders, Restless legs syndrome Classification sleep disorders The old classification systems (1979, 1990, 1997): according to cardinal symptom Insomnia: poor sleep Hypersomnia: too much sleep and/or EDS Parasomnia: abnormal behaviour during sleep International Classification of Sleep Disorders (2005; 2014): according to pathophysiology DSM-V (Diagnostic and Statistical Manual of Mental Disorders) ICD-10 (International Classification of Diseases - WHO) ICSD 3 (AASM): 7 categories 1. Insomnia 2. Sleep Related Breathing Disorders 3. Central Disorders of Hypersomnolence 4. Circadian Rhythm Sleep-Wake Disorders 5. Parasomnias 6. Sleep Related Movement Disorders 7. Other Sleep Disorder Appendix: Sleep Related Medical and Neurological Disorders ICSD 3 (AASM): 7 categories 1. Insomnia 10% 2. Sleep Related Breathing Disorders 3-7% or ↑ 3. Central Disorders of Hypersomnolence 0,02- 0,18% 4. Circadian Sleep-Wake Rhythm Disorders 7-16% 5. Parasomnias (children/adults) 3-17% 6. Sleep Related Movement Disorders 5-10% 7. Other Sleep Disorders Appendix: Sleep Related Medical and Neurological Disorders Insomnia Subjective: Patients suffer from poor sleep Different dimensions: Problem of initiating sleep Problem of maintaining sleep Problem of awakening too -
Exploding Head Syndrome – the Early Steps Síndrome Da Cabeça Explodindo – Os Primeiros Passos
CASE REPORT Exploding head syndrome – the early steps Síndrome da cabeça explodindo – os primeiros passos Elcio Juliato Piovesan1,2, Pedro André Kowacs1, Helder Granhold Campos3, Lucas Pires Augusto3, Lucas Coluni3, Lineu Cesar Werneck1,2 1Neurology Service, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná (UFPR), PR, Brazil 2Experimental Laboratory, Health Sciences Sector (LESCS), Universidade Federal do Paraná (UFPR), PR, Brazil 3Faculdade de Medicina, Universidade Federal do Paraná, PR, Brazil. Sponsored by a grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Piovesan EJ, Kowacs PA, Campos HG, Augusto LP, Coluni L, Werneck LC Exploding head syndrome – the early steps. Headache Medicine. 2011;2(4):209-11 ABSTRACT INTRODUCTION Exploding head syndrome is a rare entity associated with migraine that occurs during sleep onset. A male migraine Exploding head syndrome (EHS) is a rare with aura patient presented with episodes of abrupt awakening phenomenon characterized by a painless loud noise at following perceptions of sounds resembling a speeding up the onset of sleep.(1) Armstrong-Jones described it for the motorcycle engine interspersed with bursts of exhaust explosions like noises, accompanied by an exploding sensation in the first time in 1920 and referred to it as "snapping of the head. The patient presented in the evolution of self-limited brain".(2) Pearce coined the name "exploding head period of headache chronicity. This syndrome has been syndrome in 1989.(3) This is a rare benign sleep-wake associated with an atypical form of acoustic aura that often transition disorder of unknown aetiology.(4) The attacks are leads to migraine chronification. -
A Rare Case Report: Abdominal Muscle Myoclonic Jerks Adrienne Hong
CASE REPORT A Rare Case Report: Abdominal Muscle Myoclonic Jerks Adrienne Hong Department of Neurology, California Northstate University, College of Medicine, California 95757, USA ABSTRACT Propriospinal myoclonus (PSM) is a rare disorder that is characterized by hyperkinetic movements of flexion or extension in the axial muscles. It can be idiopathic, secondary, or psychogenic. The psychogenic form, or functional movement disorder, has been increasingly recognized in patients previously diagnosed with idiopathic spinal myoclonus. This case report introduces a patient who presented with isolated abdominal muscle contractions that occur usually when a patient lies down, is about to fall asleep, or has just woken up. We discuss the possible differential diagnosis for this rare presentation as well as current knowledge regarding PSM. Key words: Myoclonic jerk, truncal myoclonus, propriospinal myoclonus, functional movement disorder INTRODUCTION presented to clinic with myoclonic jerks. 3 weeks ago, he began experiencing sudden jerks in the body, usually when yoclonus is produced by muscular contraction, he lies down, about to fall asleep, or has just woken up to characterized by brief, shock-like movements. initiate the first movements of the day; however, it does not Patients use descriptions such as “jerks,” “shakes,” occur every single time with the activities described above. Mor “spasms” for myoclonus. There are multiple ways to The jerks had woken him up from sleep twice since onset but classify myoclonus, including by clinical presentation, had not decreased his sleep quality as he does not feel tired anatomical location of signal origin, neurophysiology testing, throughout the day. He described the jerks to be a sudden and etiology. -
Hypnic Jerks Associated with Insomnia Kathy Sexton-Radek* Affiliation: Elmhurst College, Elmhurst, Il/Suburban Pulmonary and Sleep Associates, Westmont, IL, USA
https://doi.org/10.33805/2638-8073.114 Volume 2 Issue 1 | PDF 114 | Pages 1 Volume 1 . Issue 1 | PDF 101 | Page 1 of x Edelweiss: Psychiatry Open Access Case Report ISSN: 2638-8073 Hypnic Jerks Associated with Insomnia Kathy Sexton-Radek* Affiliation: Elmhurst College, Elmhurst, Il/Suburban Pulmonary and Sleep Associates, Westmont, IL, USA. *Corresponding author: Kathy Sexton-Radek, Elmhurst College, Elmhurst, Il/Suburban Pulmonary and Sleep Associates, Westmont, IL, USA, E-mail: [email protected] Citation: Sexton-Radek K. Hypnic jerks associated with insomnia (2018) Edelweiss Psyi Open Access 2: 28 Received: Dec 21, 2018 Accepted: Dec 22, 2018 Published: Dec 28, 2018 Copyright: © 2018 Sexton-Radek K., This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. A 38-year female fulltime working Optometrist presented to the The patient experiences of the hypnic jerks were reported to vary to Insomnia clinic with a history of six years of sleep onset insomnia. A some degree (i.e., feeling a warm sensation, tightness in limbs, no complete history revealed medical conditions of hypertension, sensations). And, in all cases the occurrence of the hypnic jerks were hypothyroidism controlled by prescribed medications. The patient had unrelated to external events. Oswald (2016) concluded that the hypnic a good appetite and BMI of 28. She exercised by walking three jerks occur as a result of poorly developed EEG K complexes. afternoons per week. Her work shift varied in terms of start times: 9- Additionally, the frequency and magnitude of the hypnic jerks preclude 5pm, 11-7pm or 1-9pm of which she had no control over.