Parasomnias
Sleep pathology in adults

Parasomnias in adults are sleep disorders characterized by abnormal and unwanted behaviors that occur during sleep. These behaviors may include dream talking, sleepwalking, night terrors, nightmares, eating or drinking during sleep, inappropriate sexual behaviors, as well as abnormal movements during REM sleep, such as REM sleep behavior disorder.

Parasomnias can affect sleep quality and cause daytime fatigue, as well as long-term mental and physical health problems if not treated properly.

It is characterized by a state of confusion and disorientation upon awakening, which can occur during the night or early in the morning. The person may be disoriented, disoriented in time or space, and have difficulty speaking or understanding the speech of others. They may also experience amnesia for the episode.

Sometimes the behavior can be inappropriate and violent. A subtype of confusional awakening is sexsomnia, which is characterized by the existence of sexual behaviors during sleep, carried out in bed or the place chosen to sleep, of which the subjects are not aware or remember having carried them out. when they wake up.

The duration in adults is longer than in children, up to an hour or more, and the behavior is more complex in adults than in children.

They consist of episodes of intense fear that begin with sudden crying or screaming, accompanied by an intense autonomic component with irregular heart rate, tachycardia, increased respiratory rate and excessive sweating. It can cause impulsive behavior, being able to get out of bed violently or agitatedly, affecting the level of consciousness and therefore without clear judgment in response to the dream images and with reactions that can harm the patient or third parties. The duration can be more than 5 minutes and the attempt to calm the episodes can cause greater agitation.

They are nocturnal episodes during which patients eat or drink compulsively and involuntarily, with variable alterations in the level of consciousness and subsequent memory. The eating episodes can be single or multiple each night (they can range from one to more than ten per night), and are characterized by being completely involuntary and uncontrolled in the absence of a true sensation of hunger.

Nocturnal sleep eating disorder is often associated with other sleep disorders, such as insomnia and restless legs syndrome, and can have negative consequences on the patient’s physical and mental health, such as weight gain, digestive disorders, daytime fatigue and mood disturbances. Treatment usually includes cognitive behavioral therapy.

It is characterized by the presence of vigorous movements, unpleasant or violent dreams, and the absence of muscle atonia during REM sleep. The behaviors may be accompanied by vocalizations, also related to the content of the dream, such as talking, shouting, crying, whistling, laughing or singing. The patient keeps his eyes closed and, if he is awakened, he is practically oriented immediately.

It can be an early symptom of neurodegenerative diseases, such as Parkinson’s disease and Alzheimer’s disease. Therefore, it is important that patients who present with this parasomnia are properly evaluated by a specialist to rule out possible underlying diseases.

It consists of the inability to move and speak for a short period of time, which can occur when falling asleep or waking up, and which in most cases is an extremely unpleasant experience for the patient. Consciousness is completely preserved and there is memory of the episode. The episodes last from seconds to minutes and the eyes are normally closed so people in the environment do not perceive what is happening.

Recurrent isolated sleep paralysis can also occur in adults and may be associated with sleep disorders such as narcolepsy. In addition, it has been observed that certain factors can increase the risk of sleep paralysis, such as sleep deprivation, stress, anxiety, the use of certain medications or substances, and psychiatric disorders. In general, sleep paralysis is not a serious medical problem, but it can be very uncomfortable and affect a patient’s quality of life.

It consists of speaking, from isolated words to complete speeches, and with varying degrees of understanding, during sleep. It is a harmless phenomenon, of which the subject does not remember anything the next day.

During sleep, a contraction of the masseter, internal pterygoid and temporal muscles frequently occurs, causing an energetic closure of the upper and lower jaw. If it is very intense, the tapping of the teeth can produce a noise or grinding, known as bruxism. This can cause wear of the tooth enamel, dental or jaw pain, alterations of the temporomandibular joint and headache. The prevalence decreases with age, in adults it is approximately 3%.

They are repeated episodes of sudden, rapid and involuntary movements of the extremities. They usually occur in sequences of 4 or more movements, separated by an interval of 20-40 seconds. They usually affect the lower extremities, and consist of an extension of the first toe, in combination with a partial flexion of the ankle, knee and, sometimes, also the hip. It can also affect the upper limbs.