Parasomnias in adults

Nonrapid eye movement (NREM) sleep parasomnias

Patient prognosis is very good for NREM parasomnias (confusional arousals, sleepwalking, and sleep terrors), which are more common in childhood. The parasomnia decreases in severity as the child grows older. It usually resolves by adolescence. Remission rates are reported as between 50% and 65%.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.​ However, the adult variant form of confusional arousals may persist without remission and is associated with violent complications, including homicide.[2]American Academy of Sleep Medicine. The AASM international classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication]. https://aasm.org/clinical-resources/international-classification-sleep-disorders ​​

Sleep-related eating disorder is chronic and unremitting, but controllable.

Rapid eye movement (REM) sleep parasomnias

• Rapid eye movement sleep behavior disorder (RBD) responds very well to treatment with melatonin and/or clonazepam in most cases.

• Isolated RBD is associated with a high rate (up to 93%) of development of neurodegenerative disorders such as Parkinson disease and other synucleinopathies.[35]Boeve BF, Silber MH, Ferman TJ, et al. Clinicopathologic correlations in 172 cases of rapid eye movement sleep behavior disorder with or without a coexisting neurologic disorder. Sleep Med. 2013 Aug;14(8):754-62. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745815 http://www.ncbi.nlm.nih.gov/pubmed/23474058?tool=bestpractice.com Median time from diagnosis of RBD to diagnosis of neurodegenerative disease is 8 years. Neurodegenerative pathology can be seen in postmortem cases even if a clinical neurodegenerative diagnosis was not made.[95]Postuma RB, Iranzo A, Hu M, et al. Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study. Brain. 2019 Mar 1;142(3):744-59. https://academic.oup.com/brain/article/142/3/744/5353011 http://www.ncbi.nlm.nih.gov/pubmed/30789229?tool=bestpractice.com

• The prognosis for nightmare disorder is variable, with underlying psychopathology being a poor prognostic factor.

• There has been little research into the prognosis of people with recurrent-isolated sleep paralysis.

Other parasomnias

• Exploding head syndrome usually resolves spontaneously.

• Hallucinations related to sleep are very variable but tend to get better with time.

• Enuresis is usually self-limited in most cases with children and in adults who follow the recommended treatment.