While working at the Madigan Army Medical Center in Washington state, Vincent Mysliwiec, MD, FAASM, and his colleagues started to notice a unique phenomenon. Soldiers coming into the sleep lab were experiencing disruptive nocturnal behaviors and nightmares following traumatic experiences associated with their deployment. These symptoms which occurred frequently at home, would at times occur in the sleep lab where the patients would have REM without atonia (RWA) during polysomnography. It was odd — unlike other instances of PTSD-induced nightmares he had seen — and it made Mysliwiec think there was something more there. “It was definitely something distinct,” Mysliwiec said. “Everyone always goes, ‘That’s just PTSD.’ Yes, those with PTSD very frequently have nightmares, but nowhere in the PTSD criteria do they have disruptive nocturnal behaviors or dream reenactment.” Mysliwiec and his colleagues called the phenomenon “Trauma Associated Sleep Disorder” and classified it as a potential parasomnia. Their first paper on it was published in October 2014 in the Journal of Clinical Sleep Medicine. Since then, there are a growing number of clinicians and researchers finding evidence in their own labs that young soldiers, as well as veterans, might be experiencing something more intense than symptoms commonly associated with PTSD. Moreover, they believe further study of this proposed parasomnia could be a major preventative measure for long-term PTSD complications. “If you can actually say to a solider, veteran — or anyone suffering from traumatic exposure — that we have an established diagnostic criteria for the severe sleep disturbances you are experiencing, then you can begin to evaluate treatments for this disorder and prevent longterm adverse outcomes. We could potentially treat them for this potential parasomnia and improve their sleep and that of their bed partner.” he said. “It’s an important question — and we need researchers to develop the criteria.”
In 1934, French researcher Henri Roger coined the term parasomnie (in English, parasomnia; from the Greek para meaning “alongside” and Latin somnum meaning “sleep”) for phenomena that occur in the transition from sleep to wake or vice versa. A parasomnia can occur during the transition between nonrapid eye movement (NREM) sleep and wake (i.e., NREM parasomnias such as sleepwalking, sleep terrors, confusional arousal, sleep-related eating disorder) or during the transition between rapid eye movement (REM) sleep and wake (i.e., REM parasomnias such as REM sleep behavior disorder [RBD], recurrent isolated sleep paralysis, nightmare disorder). A parasomnia has the following features: recurrent episodes of incomplete awakening from sleep, an inappropriate or lack of response to intervention or redirection during an episode, limited or no cognition of dream imagery and partial or complete amnesia for the event. In addition, the nocturnal disturbance is not explained by another sleep, psychiatric or medical disorder or medication/substance use. Some people experience REM parasomnias and NREM parasomnias, a condition called parasomnia overlap disorder (POD). A person with POD has a disorder of arousal (e.g., sleepwalking confusional arousal, sleep terror) and rapid eye movement sleep behavior disorder (RBD; which involves vivid, often unpleasant dreams; vocalization during sleep and sudden, often violent, arm and leg movements during REM sleep [i.e., dream-enacting behavior]).
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In an informal conversation, you might bring the term "sleepwalking" up as a casual way of talking about a lack of focus or energy. But, for numerous adults and children, sleepwalking is a real problem with significant consequences. As a sleep professional, it is crucial you educate patients with parasomnias, like sleepwalking, as these sleep disorders can have physically destructive and lasting effects. What Is Sleep Walking (Somnambulism)? Sleepwalking (somnambulism), is a type of behavior disorder originating while you're in a deep sleep. It falls in the class of parasomnias. It leads to walking around or performing other behaviors while you're still mostly sleeping. It's more common in kids than it is in adults. There are more chances of it occurring in people:
This blog is based off of the AAST 2019 Annual Meeting Session "Parasomnias." For more information on this session and other session recordings click here. From nightmares to sleepwalking to REM sleep behavior disorder (RBD), parasomnias can occur in many forms without the patient even knowing they are experiencing an event. For sleep professionals, it is imperative they can educate patients with parasomnias as these sleep disorders can have lasting and physically damaging effects.