Parasomnias

John A. Fleetham; Jonathan A.E. Fleming

doi:10.1503/cmaj.120808

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Table 1:

Characteristics of parasomnias

Characteristic	Nonrapid eye movement parasomnia				Rapid eye movement parasomnia

	Confusional arousal	Sleepwalking	Sleep terrors	Sleep-related eating disorder	REM sleep behaviour disorder	Sleep paralysis	Nightmare disorder
Emerges from	Stages II, III and IV^*	Stages III and IV	Stages III and IV	Stages II, III and IV	REM sleep	REM sleep	REM sleep

Time of night	Anytime during sleep	First third of sleep	First third of sleep	Anytime during sleep	Anytime but most frequently last third of sleep	Anytime	Anytime but most frequently last third of sleep

Vocalizations	Yes	Yes	Marked (screaming or crying)	Yes	Marked	Slight (moaning or groaning)	Sometimes

Getting out of bed	Rare	Usual	Sometimes	Always (food seeking)	Yes	No	No

Responsiveness on awakening	Decreased	Decreased	Decreased	Decreased	Responsive	Responsive	Responsive

Autonomic activity	Normal	Normal	Increased	Normal	No	No	Yes

Post-event confusion	Yes	Yes	Yes	Yes	No	No	No

Prevalence	4.2%10	1%–4% in adults, 80% of adults have sleep walked as children10	1%–2% in adults10	Unknown; estimated to be 1%–5% in general population but higher among patients with eating disorders; 2–4 times more common among women4	Unknown; estimated to be 0.38% in the general population and 0.5% among elderly people; about 33% of patients with newly diagnosed Parkinson Disease1; more common among men	Unknown. 15%–40% has been reported among students under 30 years for at least one episode1 and 1%–10% of the population for multiple episodes4	5%–8% of adults;4 more common among women

Amnesia of event	Yes	Yes	Yes	Variable	No	No	No

Injury risk	Low if undisturbed	Low if undisturbed; may strike out if disturbed or intoxicated	More common; may injure self trying to escape; may strike out if disturbed or intoxicated	Self-injury from food preparation (cuts, burns, poisoning)	May injure self or partner as part of dream enactment	None	None

Family history of parasomnias	Yes	Yes	Yes	Yes	Occasionally	Yes	Yes; twin studies suggest a genetic predisposition and co-occurrence with other parasomnias1

Note: REM = rapid eye movement.
↵* The scoring of sleep has changed recently with Stage II sleep being renamed N2, and stages III and IV being named N3. Because most clinicians are familiar with the old staging nomenclature, this is what we have used in this review.7