Mark W. Mahowald's research while affiliated with University of Minnesota Medical Center, Fairview and other places

Publications (223)

Article
Full-text available
This review of sleep-related violence reports the nature of the underlying sleep-suspected conditions enountered and helps establish the spectrum of sleep-related behaviors resulting in forensic consequences. This information may begin to bridge the gap between the differing medical and legal concepts of automatisms (complex motor behaviors occurri...
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N A RECENT publication, Ebrahim and colleagues state in their abstract that they have provided an assessment of “all known scientific studies of the effects of alcohol on the nocturnal sleep of healthy volunteers” (Ebrahim et al., 2013, p. 539). Our review of this article found it to be seriously flawed by research design and statistical problems....
Chapter
Human sleep alternates between periods of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Sleep and wakefulness are modulated by homeostatic and circadian regulatory mechanisms. Like most physiological systems, sleep and wakefulness are also governed by a circadian oscillator located in the suprachiasmatic nucleus (SCN) of the hyp...
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Objective: The objective of this study was to determine the extent that confusional arousals (CAs) are associated with mental disorders and psychotropic medications. Methods: Cross-sectional study conducted with a representative sample of 19,136 noninstitutionalized individuals of the US general population aged 18 years or older. The study was p...
Article
Objective: To determine the pathologic substrates in patients with rapid eye movement (REM) sleep behavior disorder (RBD) with or without a coexisting neurologic disorder. Methods: The clinical and neuropathologic findings were analyzed on all autopsied cases from one of the collaborating sites in North America and Europe, were evaluated from Ja...
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Sir, The recent Letter to the Editor by Drs Ebrahim and Fenwick (2012) challenges one sentence in a 2010 article published in Brain (Siclari et al. , 2010) stating that, because of the lack of reliable evidence, alcohol-induced sleepwalking should not be allowed as a defence to criminal acts. This, in turn, refers to an article published 22 years a...
Article
To assess the prevalence and comorbid conditions of nocturnal wandering with abnormal state of consciousness (NW) in the American general population. Cross-sectional study conducted with a representative sample of 19,136 noninstitutionalized individuals of the U.S. general population ≥18 years old. The Sleep-EVAL expert system administered question...
Article
Wakefulness and sleep and consciousness and unconsciousness are not all-or-none, mutually exclusive states but rather occur on a broad spectrum with fluid and rapidly changing boundaries, resulting in a wide variety of unusual and often complex and perplexing behaviors. The resulting behaviors may have forensic implications with varying degrees of...
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This resource provides information for the management of disorders occurring during sleep and brings greater awareness to the treatment of sleep disorders, as well as treatments of neurological, medical, and psychiatric disorders.
Chapter
Chapter 7 focuses on the emergent events in sleep triggered by the two most common forms of primary sleep parasomnias (disorders of arousal and REM sleep behavior disorder), followed by a discussion of the forensic issues engendered by these parasomnias.
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Sleep is clearly not only a whole-brain or global phenomenon, but can also be a local phenomenon. This accounts for the fact that the primary states of being (wakefulness, NREM sleep, and REM sleep) are not necessarily mutually exclusive, and components of these states may appear in various combinations, with fascinating clinical consequences. Exam...
Chapter
Rapid eye movement (REM) sleep behavior disorder (RBD) is a fascinating experiment in Nature predicted decades ago by animal studies. RBD is characterized by the absence of muscle atonia during REM sleep, resulting in the appearance of dream enactment, which may result in violent or injurious behaviors. RBD typically affects men over the age of 50,...
Article
Parasomnias are defined as unpleasant or undesirable behavioral or experiential phenomena that occur predominately or exclusively during the sleep period. Most parasomnias represent the simultaneous admixture of wakefulness and sleep. This chapter focuses on the clinical features, pathophysiology, diagnosis, and treatment of the two most common par...
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Although generally considered as mutually exclusive, violence and sleep can coexist. Violence related to the sleep period is probably more frequent than generally assumed and can be observed in various conditions including parasomnias (such as arousal disorders and rapid eye movement sleep behaviour disorder), epilepsy (in particular nocturnal fron...
Article
Parasomnias encompass the undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousals from sleep. Basic drive states emerge pathologically with the parasomnias, as seen with sleep-related aggression and locomotion, sleep-related eating disorder, and sleep-related abnormal sexual behaviors (sexsomn...
Article
As mentioned in the preceding two chapters, parasomnias may conveniently be divided into two major categories: Primary parasomnias are those due to disorders of sleep per se, and the secondary parasomnias are those that result from dysfunction of other organ systems and that take advantage of the sleeping state to declare themselves. By far, the pr...
Article
Parasomnias are defined as unpleasant or undesirable behavioral or experiential phenomena that occur predominantly or exclusively during the sleep period. These were initially thought to represent a unitary phenomenon, often attributed to psychiatric disease. As more parasomnias are being carefully studied both polygraphically and clinically, it is...
Article
This chapter discusses the case of a 32-year-old married man presented with a chief complaint of fondling his wife during sleep. He was an alert, healthy-looking, white male in no distress. The oropharynx was clear, without redundant tissue, and he had a normal neck circumference. A psychiatric interview was unremarkable, apart from some dysphoria...
Article
Restless legs syndrome (RLS) is thought to be due to abnormalities of iron metabolism in the central nervous system; however, occasional cases are associated with lesions of the spinal cord, spinal rootlets, and peripheral nervous system. This is a case report of RLS exacerbated by shingles with a review of the literature of extra-cerebral lesions...
Article
This review provides a historical background on sleep-related eating disorders, summarizes findings from a series of 38 adults, and presents a current classification. The "night-eating syndrome" was first reported in 1955; only nine reports on this syndrome appeared during the next 36 years, seven being single-case studies and two containing the ob...
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The aim of this study was to investigate the potential of mindfulness-based stress reduction (MBSR) as a treatment for chronic primary insomnia. A randomized controlled trial was conducted. The study was conducted at a university health center. Thirty adults with primary chronic insomnia based on criteria of the Diagnostic and Statistical Manual of...
Article
This chapter provides an overview of circadian rhythm disorders. Chronobiology is the study of biologic rhythms, both normal and abnormal. Disorders of these rhythms affect alertness, concentration, and performance that can be crucial for safety in occupations such as transportation and manufacturing. The biologic clock is a powerful physiologic fo...
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To propose criteria for diagnosis of the night eating syndrome (NES). An international research meeting was held in April 2008, and consensus criteria for NES diagnosis were determined. The core criterion is an abnormally increased food intake in the evening and nighttime, manifested by (1) consumption of at least 25% of intake after the evening me...
Article
Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by loss of the muscle atonia of REM sleep, with release of complex and violent behaviors that are often attempted dream-enactments. This study reviewed the literature on RBD with regard to potentially lethal behavior. A total of 39-41 clinical cases of RBD associated with poten...
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SUMMARY  REM sleep behaviour disorder (RBD) is an injurious clinical disorder of attempted dream-enactment (‘oneirism’) in humans which has a corresponding experimental animal model involving dorsolateral pontine tegmental lesions in cats. To date, our sleep disorders centre has collected data on 96 chronic RBD cases which can be compared with pool...
Article
The recent report by Miyamoto et al.1 on comparably reduced cardiac 123I-MIBG accumulation in idiopathic REM sleep behavior disorder (iRBD), Parkinson's disease (PD), and Dementia with Lewy bodies, which implicates parkinsonian pathology (Lewy bodies; α-synuclein) in cardiac postganglionic sympathetic and intrinsic neurons, contains the following c...
Article
Actus non facit reum nisi mens sit rea - the deed does not make a man guilty unless his mind is guilty Edward Coke (1552-1634) Introduction Increasingly, parasomnias are invoked as an explanation for a wide variety of illegal and/or violent behaviors ostensibly arising from the sleep period, with the hope that if such behavior is deemed sleep-relat...
Article
Parasomnias are defined in the International Classification of Sleep Disorders-2nd Edition (ICSD-2) as undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousals from sleep. Instinctual behaviors can inappropriately emerge with the parasomnias, including appetite behaviors (feeding, sex), locomot...
Chapter
Rapid eye movement (REM) sleep behavior disorder (RBD) is a multifaceted motor, behavioral, and experiential disorder of REM sleep in which the affected person typically enacts in his sleep the stereotypically altered dreams that have intruded on him, featuring confrontation, aggression, and violence, but lacks any daytime tendency for increased ag...
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Full-text available
REM sleep behaviour disorder (RBD) is a parasomnia characterized by the loss of normal skeletal muscle atonia during REM sleep with prominent motor activity accompanying dreaming. The terminology relating to RBD, and mechanisms underlying REM sleep without atonia and RBD based on data in cat and rat are presented. Neuroimaging data from the few pub...
Article
Difficulty sleeping is a frequent complaint of elderly patients. But poor sleep is not a normal part of aging. This article discusses the most common sleep problem among older adults-insomnia, its causes, and potential treatments including over-the-counter and prescription medications and behavioral treatments such as relaxation therapy, sleep hygi...
Article
An increasing number of criminal cases have claimed the defendant to be in a state of sleepwalking or related disorders induced by high quantities of alcohol. Sleepwalkers who commit violent acts, sexual assaults and other criminal acts are thought to be in a state of automatism, lacking conscious awareness and criminal intent. They may be acquitte...
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Full-text available
To formulate the first classification of sleep related disorders and abnormal sexual behaviors and experiences. A computerized literature search was conducted, and other sources, such as textbooks, were searched. Many categories of sleep related disorders were represented in the classification: parasomnias (confusional arousals/sleepwalking, with o...
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Full-text available
Evidence suggests that, to maintain treatment effects, nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) needs to be used every night. What remains unknown is the nightly duration of use required to normalize functioning. This study, employing probit analyses and piecewise regression to estimate dose-respons...
Article
REM sleep behavior disorder (RBD) is a fascinating experiment in nature predicted by animal studies in 1964. A defining feature of REM sleep is active paralysis of all somatic musculature (sparing the diaphragm to permit respiration). RBD is characterized by the absence of REM atonia, permitting the appearance of dream-enacting behaviors. These one...
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Full-text available
The International Classification of Sleep Disorders (ICSD-2) has separated sleep-related movement disorders into simple, repetitive movement disorders (such as periodic limb movements in sleep [PLMS], sleep bruxism, and rhythmic movement disorder) and parasomnias (such as REM sleep behavior disorder and disorders of partial arousal, e.g., sleep wal...
Article
Comprehensive review of factors participating in the appearance of disorders of arousal due to sleepwalking or polysomnography of an accused is discussed. The expert witness in these cases can inform all parties that there is absolutely no after-the-fact polysomnographic finding that could have any relevance as to whether the accused was sleepwalki...
Article
To determine the prevalence of restless legs syndrome (RLS) in native South Americans and identify the impact of geographic location. An epidemiological telephone survey of RLS symptoms involving natives from coastal and mountainous areas was performed during July 2, 2004, through September 28, 2004. The process consisted of 2 phases: the creation...
Article
Parasomnias are undesirable behavioral or experiential phenomena arising from the sleep period. Once felt to be a unitary phenomenon, it is now clear that a wide variety of sleep disorders are capable of resulting in complex behaviors arising during sleep. The most common are disorders of arousal and rapid eye movement sleep disorder. Less common c...
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This article reviews nine case studies of patients presenting with sleep complaints.
Article
To determine the frequency of subjective sleep problems in spinocerebellar ataxia type 6 (SCA6), the authors surveyed 25 patients and 25 age-matched controls with the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). The ESS was higher in patients with SCA6 (9.12 +/- 5.80; CI: 2.28) than in controls (4.96 +/- 3.01; CI: 1.18)...
Article
This is a qualitative analysis of data from a multisite study of 156 participants with Obstructive Sleep Apnea (OSA). Participants completed a battery of tests, including the Functional Outcomes of Sleep Questionnaire (FOSQ) that contains an item assessing the impact of OSA on relationships. Approximately one third of participants wrote comments; t...
Article
This chapter discusses the rapid eye movement (REM) sleep behavior disorder. Parasomnias are undesirable experiential or motor phenomena arising from the sleep period, and can conveniently be divided into two major categories: those representing abnormalities of sleep states per se, and those because of abnormalities of various organ systems taking...
Chapter
Epilepsy is the third most common neurologic disorder after stroke and Alzheimer's disease in the United States. Sleep, sleep disorders, and epilepsy are commonly associated. It is well known that sleep and sleep deprivation increase the incidence of parasomnias and seizure activity. Conversely, seizure disorders can affect the wake-sleep cycle. Sl...
Article
The recognition of RBD has shed additional scientific light on the "bumps in the night"; expanded knowledge of states of being and state dissociation; opened up new areas of research on brain and mind dysfunction during sleep; expanded knowledge of various neurologic disorders, particularly narcolepsy and parkinsonism; and reaffirmed the vital link...
Article
Parasomnias are unpleasant or undesirable behavioral or experiential phenomena that occur during sleep. Once believed unitary phenomena related to psychiatric disorders, it is now clear that parasomnias result from several different phenomena and usually are not related to psychiatric conditions. Parasomnias are categorized as primary (disorders of...

Citations

... 8 Transient insomnia is defined as insomnia that resolves after removal of the stressor or adaptation of the individual to the nuisance. 24 Such dramatic rates of resolution therefore support the notion that sudden cases of new-onset in-hospital insomnia are closely tied to factors related to the hospital environment. ...
... Sleep-related violence associated with dissociative psychopathology 19,41 could also carry forensic consequences and be included among the disorders represented in sleep-related medical-legal cases. 42 ...
... In patients with idiopathic REM-sleep behavior disorder (RBD), which is a strong predictor of neurodegeneration (Mahowald and Schenck, 2018), mean SAI was found to be significantly reduced (Figorilli et al., 2021). SAI also correlated with episodic verbal memory and executive functions, supporting the hypothesis of cholinergic dysfunction and risk of cognitive impairment in some RBD patients (Nardone et al., 2012). ...
... Conversely throughout NREM sleep, muscle atonia is not there, and contemplates not present. Rapid eye movement sleep behavior disorder (RBD) is signalizing by divergent behaviors, typically dream decreeing, and an overabundance of muscle tone or phasic muscle twitching throughout REM sleep (Frauscher, et al., 2012, Schenck, et al., 2018. ...
... It is also important to note that different symptomatic profiles have been described in human RBD, characterized by either PS without atonia (also known as REM without atonia, or RWA) alone or in combination with abnormal motor behaviors 42 . In our pre-clinical models (as shown here and in Valencia Garcia et al. 12 ), rats with a subtotal genetic inactivation of either glutamatergic SLD or GABA/glycinergic vmM neurons present both types of profiles, although the vast majority of PS bouts depict a combination of RWA and high actimetry levels. ...
... Other case reports featuring polysomnography methods in three adults each suggest sleep-isolated nocturnal scratching (not associated with dermatological or other conditions) may represent a parasomnia (Nigam, Riaz, Hershner, Goldstein, & Chervin, 2016) or NREM sleep-related parasomnia more specifically. (Schenck and Mahowald, 2007). These case summaries highlight the contributions of sleep architecture to BFRB expression occurring during sleep. ...
... In addition to melatonin acting as an important sleep-regulating hormone, several regulatory neurotransmitters, such as acetylcholine, serotonin and norepinephrine, control our sleep cycles and daily activities. [42] The changes in the neural activation of sympathetic tone disrupt the daytime and nighttime activity and thus increase the occurrence of various types of injury, as shown in Table S3, http://links.lww.com/MD/F809. In addition, NASD may also be responsible for the dysregulation of mood and even suicide, homicide or abuse, as both mood and sleep cycles are derived from the same monoamine neurotransmitters in brain. ...
... Krieger dan Caples 16 mengutip dari Sin, menyatakan dari 450 penderita gagal jantung kongesti (CHF), 32% memiliki OSA. Menurut Chan seperti yang dikutip oleh Cramer et al. 11 menyatakan 50% penderita gagal jantung diastolik memiliki nilai AHI yang abnormal. Beberapa penelitian mengindikasikan bahwa OSA merupakan predisposisi gagal jantung yang mungkin disebabkan oleh mekanisme edema pada saluran napas atas. ...
... Scientists initially believed that motor activity relied on the cerebrum, and Blower brain structures^only sustained Bvegetative^activities like breathing [25]. However, new discoveries have found that Bextremely complex emotional and motor behaviors can originate from [the brain stem and cerebellum] without involvement of 'higher' neural structures^ [25]. ...
... Although SW have more frequent arousals from SWS than normal sleepers, 9 this sleep instability had been observed in patients with other diagnoses such as obstructive sleep apnea (OSA). 10 Therefore, once the many other possible diagnoses that might account for an alleged non-conscious episode of a defendant had been ruled out, 11 sleep experts pre-2000 had to decide for themselves is this case likely to be one of sleepwalking or not. Most often the cases that came to trial were those involving aggressive behaviors infl icted on another person. ...