Arousal disorders, such as sleepwalking and sleep eating, present a significant challenge in the medical field due to the absence of established treatment protocols. A recent comprehensive analysis sheds light on potential therapeutic approaches while underscoring the urgent need for structured guidelines to address the potential hazards associated with these disorders.
While arousal disorders pose inherent dangers, the absence of a unanimous consensus on optimal treatment strategies is a pressing concern.
In contrast to conditions like sleep apnea and insomnia, where well-defined and extensively researched treatment guidelines exist, the landscape is notably different for arousal disorders. This category encompasses various conditions, including sexsomnia (engaging in sexual activities during sleep), sleep “walking” (performing activities like walking, running, or even complex tasks such as driving while asleep), sleep terrors (manifesting as intense screaming and fear during sleep), and sleep eating.
Jennifer Mundt, an assistant professor of neurology at Northwestern University Feinberg School of Medicine, highlights the critical issue that sets arousal disorders apart from almost all other sleep disorders: the absence of consensus treatment guidelines.
New Insights Unearthed by Recent Study
In a recently published study featured in the journal Sleep Medicine, Jennifer Mundt conducted the first systematic review focusing on the treatment of NREM (non-rapid eye movement) parasomnias. Many of the 72 publications analyzed, spanning from 1909 to 2023, consisted primarily of case reports or uncontrolled trials.
Mundt emphasizes the potential risks associated with these disorders, which can lead to injuries for the affected individuals or their loved ones. Thus, she underscores the importance of evaluating and treating symptoms promptly, while also advocating for the establishment of treatment guidelines that may not necessarily rely on medication as the sole solution.
According to Mundt, randomized, controlled trials are imperative to determine the efficacy of behavioral interventions for managing these parasomnias.
Promising Therapies and Patient Experiences
Mundt’s study reveals that among the treatments showing the most compelling evidence of effectiveness are cognitive behavioral therapy, hypnosis, sleep hygiene, and scheduled awakenings—strategies involving waking the individual shortly before the expected occurrence of a parasomnias episode.
Jennifer Mundt specializes in behavioral treatments for a range of sleep disorders, including insomnia, nightmares, NREM parasomnias, narcolepsy, and idiopathic hypersomnia.
It’s worth noting that patients often have limited or no recollection of their atypical nighttime behaviors. As Mundt explains, “Some people don’t know they have it or what’s going on with them at night.” This lack of awareness can lead to delayed diagnosis and treatment, with individuals sometimes seeking medical help only after sustaining injuries. Mundt also describes cases where individuals have resorted to recording themselves at night to confirm their activities, highlighting the unsettling nature of these disorders.
The repercussions of arousal disorders can be severe, ranging from self-inflicted injuries, such as cuts or lacerations resulting from punching objects like windows, mirrors, or walls, to unconscious consumption of medications or excessive food intake. The preference for indulging in unhealthy snacks during sleep is a common occurrence, often leading to discomfort or weight gain. Mundt even recounts a case where a patient consumed an entire block of cheese during sleep.
Prevalence and Onset of Arousal Disorders
The prevalence of parasomnias varies across different subtypes, with estimates indicating a lifetime prevalence of 6.9% for sleepwalking, 10% for sleep terrors, 18.5% for confusional arousals (a state of confusion while remaining in bed), 7.1% for sexsomnia, and 4.5% for sleep-related eating. Sleepwalking, sleep terrors, and confusional arousals are more commonly observed in childhood and tend to remit by adolescence. In contrast, sexsomnia and sleep-related eating typically manifest in adulthood.
While medical professionals sometimes reassure parents that their children will outgrow these disorders, Mundt cautions that not everyone does.
Reference: “Behavioral and psychological treatments for NREM parasomnias: A systematic review” by Jennifer M. Mundt et al., Sleep Medicine, 6 September 2023, DOI: 10.1016/j.sleep.2023.09.004
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Frequently Asked Questions (FAQs) about Parasomnia Treatment Guidelines
Q: What are arousal disorders, and why are they a concern?
A: Arousal disorders encompass conditions like sleepwalking, sleep eating, and sexsomnia. They are concerning because there are no established treatment guidelines, potentially leading to dangerous situations for individuals and their loved ones.
Q: Are there well-defined treatment guidelines for other sleep disorders?
A: Yes, conditions like sleep apnea and insomnia have established and extensively researched treatment guidelines, in stark contrast to arousal disorders.
Q: What was the focus of Jennifer Mundt’s recent study in Sleep Medicine?
A: Jennifer Mundt’s study concentrated on the treatment of NREM (non-rapid eye movement) parasomnias, examining 72 publications dating from 1909 to 2023. Many of these publications were case reports or uncontrolled trials.
Q: What are some of the promising treatments for arousal disorders?
A: Promising treatments include cognitive behavioral therapy, hypnosis, sleep hygiene, and scheduled awakenings, which involve waking the individual shortly before a parasomnias episode is expected.
Q: Why is prompt evaluation and treatment important for arousal disorders?
A: Arousal disorders can result in injuries to the individual or their loved ones, making it crucial to address symptoms promptly. Additionally, establishing treatment guidelines ensures that patients receive the most effective care.
Q: How common are arousal disorders, and when do they typically manifest?
A: The prevalence varies, with sleepwalking, sleep terrors, and confusional arousals being more common in childhood and often remitting by adolescence. In contrast, sexsomnia and sleep-related eating typically begin in adulthood. Prevalence estimates range from 4.5% to 18.5% for various subtypes.
More about Parasomnia Treatment Guidelines
- Sleep Medicine Journal
- Jennifer Mundt’s Profile at Northwestern University
- Study: “Behavioral and psychological treatments for NREM parasomnias: A systematic review”
- Northwestern University Feinberg School of Medicine
- More about Arousal Disorders
