Parasomnias are sleep disorders caused by the activation of the autonomic nervous system or cognitive processes during inappropriate times of the sleep-wake cycle. Abnormal sleep cycles are common in children. These may include sleeping in odd positions, with their eyes open, with arched backs, and sometimes sleeping upside down are common in children. These sleep abnormalities tend to run in families, and become more prominent in children who are overtired, have a febrile illness, or are on certain medications.
These kinds of sleep disorders are less common in adults, and therefore appropriate medical evaluation should be considered. Some of the adult sleep disorders include obstructive sleep apnea, periodic limb movement, insomnia, and sometimes other medical conditions such as heartburn or chronic pain syndromes. Primary insomnia may be treated with behavioral management techniques to improve sleep habits and restrict time in bed, or with medications that aid in restful sleep. Restless leg syndrome and periodic limb movements may also respond to appropriate medications, after a complete medical evaluation has been performed to exclude more serious medical conditions.
Most patients on levodopa, for Parkinson's disease develop a side effect known as augmentation. Augmentation is when restless leg symptoms appear earlier during the day and involve new parts of the body with increasing severity.
Some of the more common, easily treatable causes of sleep disorders include stress, depression, medications such as caffeine and tricyclic antidepressants, heartburn, chronic pain, periodic limb movements, and obstructive sleep apnea. The common signs of sleeping disorders include headaches, difficulty with memory, heavy snoring, impaired motor coordination, irritability, and impaired social interaction.
Various medical therapies have been used depending on the specific kind of sleep disorder. Various benzodiazepines including diazepam, clonazepam, temazepam, and lorazepam have been effective. Parkinson's disease medications such as levodopa/carbidopa, bromocriptine, and pramipexole (Mirapex) have also been effective in selected patients. Clonazepam has been used in the treatment of REM sleep disorders. Opiates, including codeine, oxycodone, propoxyphene, and methadone have also been used, particularly in patients with chronic pain syndromes.
In addition to medical therapy, other treatments may include behavior modification through hypnosis or relaxation/mental imagery techniques. Stress reduction and biofeedback may also be helpful for selected patients. A positive pressure oxygen mask during sleep may be prescribed for patients with obstructive sleep apnea. Other simple techniques which may be helpful include locking doors and windows, and clearing a path in areas where a person may be sleepwalking. Avoidance of certain medications including the tricyclic antidepressants, caffeine, and alcohol are also recommended.
