Factors that predispose, prime and precipitate NREM parasomnias in adults: Clinical and forensic implications

Sleep Medicine Services, Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Lankenau Hospital, Wynnewood, Pennsylvania and Paoli Hospital, Paoli, PA 19096, USA.
Sleep Medicine Reviews (Impact Factor: 8.51). 03/2007; 11(1):5-30; discussion 31-3. DOI: 10.1016/j.smrv.2006.06.003
Source: PubMed


Sleepwalking and related disorders are the result of factors that predispose, prime and precipitate episodes. In the absence of one or more of these factors sleepwalking is unlikely to occur. Predisposition to sleepwalking is based on genetic susceptibility and has a familial pattern. Priming factors include conditions and substances that increase slow wave sleep (SWS) or make arousal from sleep more difficult. These factors include sleep deprivation, alcohol, medications, situational stress and fever among others. The patient with a genetic predisposition to sleepwalking and with priming factors still requires a precipitating factor or trigger to set the sleepwalking episode in motion.

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    • "Somnambulism, confusional arousals, and sleep terrors may occur when the transition from slow wave sleep to wakefulness is disrupted. Research has described several factors that may contribute to the development of a NREM parasomnia, including genetic susceptibility, sleep deprivation, situational stress, psychiatric conditions, medication, and substance use (Pressman, 2007). NREM sleep abnormalities have been studied in depressed subjects, with an early study by Buysse et al. (1997) finding a shift in slow wave delta activity to the initial part of the sleep period in depressed subjects following treatment with interpersonal psychotherapy. "
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    ABSTRACT: There exists a varying level of evidence linking the use of antidepressant medication to the parasomnias, ranging from larger, more comprehensive studies in the area of REM sleep behavior disorder to primarily case reports in the NREM parasomnias. As such, practice guidelines are lacking regarding specific direction to the clinician who may be faced with a patient who has developed a parasomnia that appears to be temporally related to use of an antidepressant. In general, knowledge of the mechanisms of action of the medications, particularly with regard to the impact on sleep architecture, can provide some guidance. There is a potential for selective serotonin reuptake inhibitors, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors to suppress REM, as well as the anticholinergic properties of the individual drugs to further disturb normal sleep architecture.
    Frontiers in Psychiatry 12/2011; 2:71. DOI:10.3389/fpsyt.2011.00071
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    • "The behaviour is most commonly walking around, but can include other behaviours which are highly familiar to the subject such as dressing, washing, making tea, arranging objects in the house, etc. Some cases of sleepwalking seem related to use of certain drugs, for example alcohol and hypnotics, especially zolpidem and triazolam (Pressman, 2007). It is rare for affected individuals to present for treatment, except if they have injured themselves or a partner, have put themselves into potential danger, or have excessive daytime fatigue because of nighttime disturbance. "
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    ABSTRACT: Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners. These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. Those invited to attend included BAP members, representative clinicians with a strong interest in sleep disorders and recognized experts and advocates in the field, including a representative from mainland Europe and the USA. Presenters were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomized controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aimed to reach consensus where the evidence and/or clinical experience was considered adequate or otherwise to flag the area as a direction for future research. A draft of the proceedings was then circulated to all participants for comment. Key subsequent publications were added by the writer and speakers at draft stage. All comments were incorporated as far as possible in the final document, which represents the views of all participants although the authors take final responsibility for the document.
    Journal of Psychopharmacology 11/2010; 24(11):1577-601. DOI:10.1177/0269881110379307 · 3.59 Impact Factor
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    • "Their comments suggest they are unfamiliar with the extensive research that supports the role of increased SWS in sleepwalking. The role of increased SWS in sleepwalking is very well established and supported by numerous published empirical studies in the sleep laboratory that address this question directly and have highly significant statistical results (Pressman, 2007a; Zadra et al., 2008; Joncas et al., 2002; Pilon et al., 2006). On the other hand, there is no generally accepted alternate theory of sleepwalking. "
    Journal of Sleep Research 01/2009; 17(4):473-4. DOI:10.1111/j.1365-2869.2008.00694.x · 3.35 Impact Factor
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