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Fri 27 Jul 2007

Brief Overview and Common Questions About the Parasomnias

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Carlos H. Schenck, M.D.

1. What are Parasomnias?

The term iParasomniasi refers to all the abnormal things that can happen to people cheapest alprazolam they sleep, apart from sleep apnea. Parasomnias in particular involve abnormal behaviors, but also abnormal perceptions cheapest alprazolam experiences. Virtually all our instinctual behaviors can appear inappropriately with Parasomnias, as found with sleep related eating disorder, sexsomnia (sleepsex), locomotion (sleepwalking, REM sleep behavior disorder), and sleep aggression or sleep violence. Sleep itself is an instinctual behavior that can go wrong, as seen with severe morning sleep inertia (or sleep drunkenness), in which the person has great difficulty in shifting gears out of sleep and into wakeful mode, with altered behaviors and major consequences at Alprazolam half life, work and in school. Some other examples of Parasomnias include sleepwalking, sleep terrors, confusional arousals, sleep paralysis, nocturnal groaning, sleeptalking, and sleep related dissociative disorders. Parasomnias can have negative effects on people during the daytime, including daytime sleepiness.

2. When do Parasomnias occur Cheapest alprazolam - and how are they treated?

Parasomnias can occur Cheapest alprazolam : as cheapest alprazolam person is falling asleep Alprazolam half life : or at any point in the Cheapest alprazolam : sleep cycle, from very early to very late, and can affect children or adults as cheapest alprazolam enter sleep, or during any of the 5 stages of sleep, or when they exit sleep during an arousal or full awakening. All of sleep, therefore, is vulnerable to Parasomnias. Even other sleep disorders can trigger parasomnias. For example, at least 12 parasomnias can emerge with Obstructive Sleep Apnea and its therapy with CPAP. Fortunately, parasomnias can be diagnosed and successfully treated in most cases. And no matter how weird, bizarre or violent the behavior, parasomnias are rarely the manifestation of a psychiatric disorder. Weird or dangerous alprazolam cod at night during sleep does usually indicate weird or dangerous behavior during the day. However, people with parasomnias can be misunderstood, minimized or laughed at, which can be demoralizing. And the bedpartner can get upset with how the parasomnia disturbs his or her sleep or causes injury, which adds to the burden of having a parasomnia.

Parasomnias are also surprisingly common, with the behavioral Cheapest alprazolam, parasomnias affecting at least 10% of adults in America (not counting Restless Legs Syndrome), which cheapest alprazolam into millions of people. There is often a strong gender bias in the parasomnias, as will be described below. Referral to a physician at an accredited sleep cheapest alprazolam center should take place for people afflicted with persistent, disruptive, harmful, or intensifying parasomnia symptoms. cheapest alprazolam careful clinical interview of the patient and bedpartner should take place, and there should be serious consideration for requesting a sleep cheapest alprazolam study. Here is the breakdown of the most common parasomnias (excluding enuresisobedwetting), and their usual therapies:

Parasomnias while entering sleep: 1) cheapest alprazolam hallucinations (HH): visual or auditory, usually something disturbing or threatening, and rarely amusing or neutral-content. (Usual therapy: low-dose tricyclic antidepressants at bedtime). 2) Recurrent sleep paralysis: having your body be paralyzed, literally paralyzed, alprazolam cod seconds to minutes while falling asleep, which can be quite frightening, especially Cheapest alprazolam - if combined with hypnagogic hallucinations (Usual therapy: same as for HH).

Parasomnias during sleep: 1) REM sleep behavior disorder (RBD): typically involves vigorous and harmful dream-enacting behaviors in men over 50 years of age, but can affect Alprazolam half life - people of any age who are taking certain medications, such as antidepressants, and people with neurologic disorders, such as narcolepsy or stroke. RBD often heralds the future appearance of Parkinsonis disease or a cheapest alprazolam condition such as Lewy body dementia. Therefore, RBD is clearly a brain-based disorder. A sleep lab study is mandatory to diagnose RBD. (Usual therapy: clonazepam [Klonopin] or less frequently melatonin at bedtime, and periodic neurologic follow-up is needed in most cases). 2) Nightmare disorder: intense, disturbing dreams that often awaken the person. It Cheapest alprazolam : may or may not be Cheapest alprazolam, related to anxiety or other psychologic disturbances (Usual therapy: various cognitive-behavioral strategies; certain medications, such as prazocin and periactin). 3) Sleep related groaning: can be quite loud and disturbs the sleep of the bedpartner or roommate; not related to obstructive or central sleep apnea, but occurs during alprazolam cod expiration, mainly during REM sleep. (Usual therapy: none yet identified, although CPAP may be tried, since there has been occasional reported success).

Parasomnias during arousals or awakenings from sleep: I) Disorders of Arousal from Non-REM sleep: 1) Confusional arousals: spontaneous, partial awakenings (arousals) from delta sleep with poor mental tracking, and confused behaviors that can be irritable, aggressive, cheapest alprazolam or sexual (with oneself or bedpartner, in aggressive or non-aggressive fashion). 2) Sleepwalking: from delta sleep, sudden cheapest alprazolam up and walking out of bed, out of the cheapest alprazolam and even out of the cheapest alprazolam with some instances of driving a car, or becoming violent. 3) cheapest alprazolam terrors: a sudden terror state coming out of delta sleep with screaming and heart pounding, and sometimes bolting from the bed and bedroom. (Usual therapy of the Disorders of Arousal: improved sleep hygiene, regular sleep Alprazolam half life : hours, sufficient sleep, stress reduction, relaxation methods, and at times--such as high-frequency or dangerous cases--medications, such as a benzodiazepine Alprazolam half life : taken at bedtime). II) Other disorders: 4) Sleep related eating disorder: abnormal, excessive eating during arousals from sleep, often with alprazolam cod gain. A sleep laboratory study is strongly recommended to identify any associated sleep disorder. alprazolam cod therapy: treat any associated sleep disorder, such as Restless alprazolam cod syndrome or sleep apnea; otherwise, the anti-convulsant topiramate taken at bedtime can be quite effective). 5) Sleep related hallucinations: hypnogogic hallucinations are identical in form to the hypnagogic hallucinations during entry into sleep (and same therapy).

3. What causes a parasomnia?

Parasomnias Cheapest alprazolam, often run in families, and so there is probably a genetic factor in many cases. Other sleep disorders, such as obstructive sleep apnea or restless legs syndrome can trigger parasomnias. Brain disorders are responsible for some parasomnias, such as many cases of REM sleep behavior disorder. Various medications can also release Parasomnias. What triggers the parasomnia events are typically ibrain misfiringsi causing the release of abnormal behaviors during sleep or during sleep-wake transitional states.

4. Why do parasomnias occur more often in children?

Brain immaturity predisposes children to have parasomnias Cheapest alprazolam : more often than adults. Once the brain matures sufficiently, cheapest alprazolam the rate of parasomnias goes down. For most children, parasomnias are not associated with clinical consequences, although a watchful eye on the part of parents, and certain precautions, such as removing sharp objects from the bedside area, is always advisable.

5. Should a person be awakened during a parasomnia episode?

Trying to awaken a iparasomniac in actioni (especially by shaking or shouting) can sometimes Cheapest alprazolam - trigger an irritable, aggressive or violent response. Therefore, gently redirect the person back to bed, such as by guiding him or her by the elbow, and speaking softly.

6. How can a parasomnia sufferer be protected?

Door alarms Cheapest alprazolam, can be helpful in fully awakening a person during an episode. Also, do not sleep on a top bunk, or next to a window. Remove sharp objects from the bedside area. Make the sleeping environment as safe as possible. Having vigilant roommates and household members helps too.

7. At what point should someone with a parasomnia seek cheapest alprazolam and possible treatment?

Whenever there is injury or the risk for injury to oneself or another person from the parasomnia, or if the parasomnia disrupts oneis own cheapest alprazolam or the sleep of the bedpartner or roommate, of if there is sufficient distress from the symptoms (e.g. nightmares), or if the frequency is quite high or escalating, then those would Alprazolam half life, be good reasons to seek help.

The first step is to make sure that you are following the proper sleep habits, such as keeping cheapest alprazolam regular sleep schedule, managing stress, having a relaxing bedtime routine, and getting a sufficient amount of sleep to feel rested in the morning. If you still have a problem despite ifollowing the rules,i then see your physician to be checked out to make sure that there isnit any medical problem, or a medication, that could be causing or playing a role with your Parasomnia. If nothing is identified, then your doctor should refer you to an accredited sleep disorders center for a clinical interview, preferably with your spouse, family members, and roommates in attendance to provide invaluable input. Afterwards, an overnight sleep lab study (ipolysomnographyi) may be needed. Cheapest alprazolam : The final step is to review all the findings, which should lead to rational and effective treatment.

Finally, consider checking out, cheapest alprazolam a source of useful information, the DVD documentary film on the Parasomnias Cheapest alprazolam, that I co-produced and participated in, iSleep Runners: The Stories Behind Everyday Parasomnias.i This website has a Cheapest alprazolam - link to the www.sleeprunners.com website.

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