Non-rapid eye movement sleep arousal disorders are conditions characterized by disturbed patterns of sleep. There are different types, with confusional arousal being one of them. Listed below are some of the symptoms and causes of non-rapid eye movement sleep arousal disorders. For more information, please visit the website of the American Academy of Sleep Medicine.
Symptoms of non-rapid eye movement sleep aroused include sleepwalking, night terrors, and confusional arousals. Though these disorders may be different from one another, they are related and are thought to exist on a continuum. The symptoms of non-rapid eye movement sleep arousal disorders typically begin during the first third or half of sleep. Children are more likely to experience these disorders than adults, and the most common arousal episodes are about 10 minutes long. However, they may last for an hour or more.
These symptoms may indicate a number of conditions, including seizures or delirium associated with medical disorders. They can also be indicative of RBD. Overnight polysomnography may be performed to confirm the diagnosis of non-rapid eye movement sleep arousal disorders. However, a thorough history of a patient’s sleep quality and symptom history is necessary to properly diagnose this condition.
Some sleep arousal disorders occur at irregular intervals, resulting in confusional arousals. While occasional sleepwalking is a common symptom, the frequency and duration of these episodes vary from person to person. Ten per cent to 30 per cent of children may experience an episode during their lifetime. In adults, the rate is a little higher, between 1 per cent and seven per cent, but fewer than one per cent experience sleepwalking episodes on a monthly basis. In children, the prevalence of sleep terrors is hard to estimate but one in every five will experience at least one episode before age 3.
A person who suffers from REM sleep arousal disorder (non-REM) may experience aggressive behaviour, flashes of light, or loud sounds during their REM sleep. REM sleep arousal disorders are more common in older adults and may be related to certain health conditions, including multiple system atrophy and stroke. Patients may also report experiencing a loud noise in the head, an imaginary flash of light, or a sudden muscle jerk.
The causes of non-REM parasomnias can include a number of conditions, including insomnia and poor sleep hygiene. Several studies have demonstrated that chronic sleep deprivation is a major trigger for NREM parasomnias. Sleep hygiene leaflets can be distributed at the time of assessment. In addition, NREM sleep arousal disorders can overlap with RBD and RWA. RWA often predates Parkinson’s disease and synuclein pathology. It is therefore important to assess symptoms of both diseases, particularly if accompanied by constipation and olfactory deficits.
There are three main types of NREM sleep arousal disorders: confusional arousals, nightmares, and nighttime terrors. All three are common among adults but a small percentage of children may also suffer from them. Nightmares are particularly frightening because the person experiences an unnerving experience and may even scream or cry. A person who experiences a sleep terror will most likely wake up in a state of terror, accompanied by the usual autonomic arousal signs of hyperactivity, such as a rapid heartbeat, fast breathing, and sweating.
Non-rapid eye movement sleep aroused episodes involve an individual becoming partially or fully awake during a brief period of time during sleep. The episodes last from 10 minutes to an hour, and they are disconcerting for both the person experiencing them and the people who are witnesses to them. In order to warrant a course of treatment, the episodes must cause significant clinical distress, including disruption of social relationships and embarrassment to the person experiencing them.
Patients should have a full assessment of their sleep hygiene. Sleep deprivation is a common trigger for these disorders, and recommendations for healthy sleep hygiene can help individuals achieve better sleep quality. Primary care providers should offer patients a sleep hygiene leaflet at the time of their assessment. In addition to NREM parasomnia, NREM sleep arousal disorders may overlap with other conditions, including RBD and RWA. Synuclein pathology may also be associated with NREM sleep arousal disorders, which are not yet treated. Patients with these disorders should be evaluated by a sleep physician as a symptom of another disorder.
Arousal disorders that interfere with the functioning of the brain may be confused or traumatic. People with confusional arousals often experience partial or complete awakenings during sleep. During these episodes, they experience disorientation and confusion about their environment. They may be able to get up but may also feel aggressive. A person experiencing confusional arousal may have trouble concentrating, recollecting their dreams, or acting out.