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Parasomnias
Sleep pathology in adults

Definition

Parasomnias in adults are sleep disorders characterized by abnormal and unwanted behaviors that occur during sleep. These behaviors may include sleep 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.

Bruxism

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%.

Catathrenia

Catathrenia is a sleep disorder characterized by prolonged moaning or groaning sounds, only during exhalation, while the person is sleeping. Unlike other nocturnal sounds such as snoring, catathrenia is distinguished by a prolonged moaning or sighing sound that occurs during the REM phase of sleep, when the respiratory muscles are relaxed.

Some key aspects of catathrenia include:

  1. Distinctive and peculiar sound: The moans usually last several seconds and occur during exhalation. They may be intermittent and vary in intensity, often disrupting the sleep of the bed partner, although the person experiencing catathrenia usually does not wake up.
  2. It does not cause serious health problems: Unlike sleep apnea, catathrenia does not usually cause significant interruption in breathing or a reduction in oxygen in the blood. However, it can be bothersome for those sleeping near the affected person.
  3. Diagnosis and treatment: Catathrenia is a rare disorder and is often diagnosed by a sleep study (polysomnography). Treatment is not always necessary unless the sound is causing significant problems. In some cases, strategies such as changing the sleeping position or continuous positive airway pressure (CPAP) therapy may be recommended if associated with apnea.

Confusional awakening

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 in time or space, and may have difficulty speaking or understanding the speech of others. They may also experience amnesia for the episode.

Sometimes 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 awaken.

Rhythmic movements during sleep

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.

Recurrent isolated sleep paralysis

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.

Sexsomnias

Sexsomnias are a type of parasomnia in which a person engages in sexual behavior while asleep, without being aware of them or remembering what happened upon awakening. It is a relatively rare condition and is part of the group of non-REM parasomnias, which include physical or verbal activities during deep sleep, such as sleepwalking or night terrors.

Characteristics of Sexomnias:

  • Involuntary sexual activities: People with sexsomnia may experience behaviors such as masturbation, sexual fondling, moaning, sexual intercourse, or even sexual comments or advances while asleep.
  • Lack of awareness and amnesia: The person is not aware of his or her actions and, upon awakening, often does not remember what happened. This can lead to confusion, discomfort, or even problems in the relationship if the other individual is affected by these behaviors.
  • Triggers: Sexsomnias can be aggravated by factors such as stress, lack of sleep, alcohol or drug use, and some mental health conditions or sleep disorders such as obstructive sleep apnea.

Diagnosis and Treatment:
Sexsomnia is usually diagnosed through a sleep study, or polysomnography, which looks at brain activity and behavior throughout the night. Treatment may include techniques to improve sleep quality, reduce triggers, avoid alcohol or drug use before bed, and, in some cases, the use of medications.

Psychological and Legal Considerations:
Because these behaviors are involuntary and occur during sleep, sexomnia can present both emotional and legal challenges. Affected individuals may experience feelings of shame or anxiety, and in certain legal contexts, sexomnia has been raised as a possible defense in cases of inappropriate or abusive sexual conduct, although these cases are often very complex.

Somnambulism

These are episodes of wandering that are described as routine but inappropriate both at the time they occur and because of their condition, with potential danger, violence and agitation. The eyes are usually open during the episode. There is persistence of impaired consciousness and impaired judgment, making it difficult to awaken the patient during the episode. They generally end up returning to bed or may continue sleeping anywhere.

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.

Somniloquy

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

Night terrors

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. This can cause impulsive behavior, getting 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.

REM sleep behavior disorder

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´s eyes are closed and, if awakened, he is oriented almost 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 suffer from this parasomnia are properly evaluated by a specialist to rule out possible underlying diseases.

Nocturnal eating disorder during sleep

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.

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