Non-rapid eye movement sleep arousal disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]

Synonyms and keywords: NREM sleep arousal disorder

Overview

Non-rapid eye movement sleep arousal disorder is characterized by incomplete awakening from the deep sleep stage. During an episode, it usually presents as either sleepwalking or sleep terrors. It also includes: amnesia and impairment in important areas of functioning. Moreover, this diagnosis excludes significant dream imagery and physiological effects of a substance.

Differential Diagnosis

• Alcohol-induced blackouts
• Breathing-related sleep disorders
• Dissociative amnesia, with dissociative fugue
• Sleep-related seizures
• Malingering or other voluntary behavior occurring during wakefulness
• Medication-induced complex behaviors
• REM sleep behavior disorder
• Night eating syndrome
• Nightmare disorder
• Panic disorder
• Parasomnia overlap syndrome

Epidemiology and Demographics

Prevalence

• Among children, the prevalence of non-rapid eye movement sleep arousal disorders is 10,000 to 30,000 per 100,000 (10% to 30%).
• Among adults, the lifetime prevalence of non-rapid eye movement sleep arousal disorder is 29,200 (29.2%) among adults.

Risk Factors

• Sedative use
• Sleep deprivation
• Sleep-wake schedule disruptions
• Fatigue
• Physical or emotional stress

Prognosis

Poor prognostic factors include:

• Emotional stress
• Males during adulthood
• Fatigue
• Females during childhood
• Physical stress
• Sleep-wake schedule disruptions

Diagnostic Criteria

DSM-V Diagnostic Criteria for Non-Rapid Eye Movement Sleep Arousal Disorder

“

A. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either one of the following: Sleepwalking: Repeated episodes of rising from bed during sleep and walking about. While sleepwalking, the individual has a blank, staring face; is relatively unresponsive to the efforts of others to communicate with him or her; and can be awakened only with great difficulty. Sleep terrors: Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream. There is intense fear and signs of autonomic arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode. There is relative unresponsiveness to efforts of others to comfort the individual during the episodes. AND B. No or little (e.g., only a single visual scene) dream imagery is recalled. AND C. Amnesia for the episodes is present. AND D. The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. AND E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). AND F. Coexisting mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors. Specify whether: Sleepwalking type Specify if: With sleep-related eating With sleep-related sexual behavior (sexsomnia) Sleep terror type

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