Diagnosing parasomnias

Abstract

People with epilepsy are frequently referred to sleep specialists to evaluate their sleep/wake complaints, sometimes to determine whether their paroxysmal nocturnal behaviors are epileptic or not. Many patients with epilepsy have at least one parasomnia (some more than one), and we are often asked to differentiate and treat these. New onset or a late recurrence of sleep terrors or sleepwalking in adults warrant consideration of other primary sleep disorders (obstructive sleep apnea (OSA), restless legs syndrome (RLS), REM sleep behavior disorder (RBD), or shift work but stressful life events (changes in sleep environment, family or workplace conflicts) precede sleepwalking in the majority of the adult subjects. NFLE predisposes patients and their relatives to the particular parasomnias (DoA and bruxism). An individual with NFLE has a six-fold greater lifetime risk for DoA and fivefold for sleep-related bruxism compared to controls. The lifetime prevalence of a DoA in relatives of patients with NFLE was 4.7 times greater and nightmares 2.6 times greater than compared to relatives of control subjects. Sleep is more likely to be fragmented by frequent nocturnal awakenings in patients with NFLE who complain of EDS.