Criteria

Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR) classification[12]

The American Psychiatric Association classification of mental disorders DSM-5-TR recognises the following as parasomnias:

  • Non-rapid eye movement (NREM) sleep arousal disorders

    • 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. When diagnosing it is necessary to specify if sleepwalking is accompanied by:

        • Sleep-related eating

        • Sleep-related sexual behaviour (sexomnia).

      • 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.

    • No or little (e.g., only a single visual scene) dream imagery is recalled

    • Amnesia for the episodes is present

    • The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

    • The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse or a medication)

    • Coexisting mental disorders and medical conditions do not explain the episodes of sleepwalking or sleep terrors.

  • Rapid eye movement sleep behaviour disorder (RBD)

    • Repeated episodes of arousal during sleep accompanied by vocalisation and/or complex motor behaviours.

    • Behaviours occur during rapid eye movement (REM) sleep. Typically 90 minutes after sleep onset and are more frequent during the later portions of the sleep. Uncommon during daytime naps.

    • Not confused or disorientated during awakening.

    • Either of the following:

      • REM sleep without atonia on polysomnographic recording

      • A history suggestive of REM sleep behaviour disorder and an established synucleinopathy diagnosis (e.g., Parkinson's disease, multiple system atrophy).

    • May cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (e.g., injury to self).

    • The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

  • Nightmare disorder

    • Repeated occurrences of long, dysphoric, and well-remembered dreams (these usually involve efforts to avoid threats to survival, security, or physical integrity).

    • On awakening the individual rapidly becomes oriented and alert.

    • The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

    • The nightmare symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).

    • Coexisting mental disorders and medical conditions do not explain the predominant complaint of dysphoric dreams.

    • When classifying it is necessary to specify:

      • If occuring during sleep onset

      • If it is with mental disorder or medical condition

      • If it is with another sleep disorder

      • Acute (≤1 month), subacute, (>1 month <6 months), persistent (≥6 months)

      • Severity (based on frequency): severity can be rated by the frequency (e.g., mild [< one episode per week], moderate [≥ one episode per week, but less than nightly], severe [nightly]).

International classification of sleep disorders, 3rd edition, text revision (ICSD-3-TR)[11]

The ICSD-3-TR defines parasomnias as undesirable physical events or experiences occurring during entry into sleep, within sleep, or during the transition from sleep to the awake state. It provides a classification of parasomnias and contains diagnostic criteria and severity criteria for each type of parasomnia. The conditions listed as other parasomnias are not addressed in this topic.

The ICSD-3-TR lists parasomnias as follows:

  • NREM-related parasomnias

    • Disorders of arousal (from NREM sleep)

      • Confusional arousals

      • Sleepwalking

      • Sleep terrors

      • Sleep-related eating disorder

  • Rapid eye movement (REM)-related parasomnias

    • REM sleep behaviour disorder

    • Recurrent isolated sleep paralysis

    • Nightmare disorder

  • Other parasomnias

    • Exploding head syndrome

    • Sleep-related hallucinations

    • Sleep-related urological dysfunction

    • Parasomnia due to a medical disorder

    • Parasomnia due to a medication or substance

    • Parasomnia, unspecified

Sleep-related movement disorders (e.g., restless legs syndrome, periodic limb movement disorder, sleep-related leg cramps, bruxism, and benign sleep myoclonus of infancy) are important in the consideration of paediatric parasomnias. The ICSD-3-TR classifies these events as movement disorders, as opposed to true parasomnias. It also classifies sleep-talking and sleep starts as isolated symptoms and normal variants.

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