Psych · Specialty psychiatry — sleep medicine interface
Parasomnias
Also known as Disorders of arousal · NREM parasomnia · Sleepwalking · Somnambulism · Sleep terrors · Night terrors · Confusional arousals · Nightmare disorder · REM sleep behaviour disorder · REM sleep behavior disorder · RBD · Sleep-related eating disorder · Sexsomnia
Exam-exhaustive fellowship atlas on parasomnias — NREM disorders of arousal versus REM parasomnias (nightmare disorder, RBD), ICSD-3/DSM-5-TR nosology, epidemiology, state-dissociation and RSWA mechanisms, RBD–synucleinopathy risk, differential from seizures/OSA/drug behaviours, video-PSG, bedroom safety, melatonin/clonazepam for RBD, IRT and prazosin nuance for nightmares, and BAP/AASM guideline deltas. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Injurious dream enactment or bed-partner assault during sleep — treat as RBD/safety emergency until evaluated; remove weapons and secure the sleep environment the same night
- Adult-onset atypical nocturnal events with stereotypy, clustering, or daytime neurological signs — exclude nocturnal seizures and evolving synucleinopathy
- New complex sleep behaviours after Z-drugs or alcohol — stop the precipitant and reassess before escalating sedatives
- Idiopathic RBD with new anosmia, REM atonia loss, subtle motor change, or cognitive decline — neurology pathway for prodromal synucleinopathy
- PTSD nightmares with escalating suicidal ideation linked to nocturnal terror — simultaneous risk management and nightmare-focused care
- Sexsomnia or SRED with forensic, consent, or injury risk — safety, medication review, and specialist sleep/forensic interface
Meet the patient
A 68-year-old retired teacher is sent by his wife. Three times this month he has punched and kicked her in bed; he remembers nothing, but reports vivid dreams of being chased by dogs. He cannot smell his morning coffee any more, and his handwriting has grown smaller.[7][6]
Two exam questions are now live, and you must answer both at consultant depth: is this NREM or REM? and is his wife safe to sleep next to him tonight? Everything below is the answer to those two questions.[4][5]
References16ShowHide
- [1]Wilson SJ, Nutt DJ, Alford C, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders J Psychopharmacol, 2010.PMID 20813762
- [2]Wilson S, Anderson K, Baldwin D, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update J Psychopharmacol, 2019.PMID 31271339
- [3]Sateia MJ International classification of sleep disorders-third edition: highlights and modifications Chest, 2014.PMID 25367475
- [4]Aurora RN, Zak RS, Maganti RK, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD) J Clin Sleep Med, 2010.PMID 20191945
- [5]Howell M, Avidan AY, Foldvary-Schaefer N, et al. Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline J Clin Sleep Med, 2023.PMID 36515157
- [6]Postuma RB, Iranzo A, Hu M, et al. Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study Brain, 2019.PMID 30789229
- [7]Schenck CH, Bundlie SR, Ettinger MG, et al. Chronic behavioral disorders of human REM sleep: a new category of parasomnia Sleep, 1986.PMID 3505730
- [8]Zadra A, Desautels A, Petit D, et al. Somnambulism: clinical aspects and pathophysiological hypotheses Lancet Neurol, 2013.PMID 23415568
- [9]Morgenthaler TI, Auerbach S, Casey KR, et al. Position paper for the treatment of nightmare disorder in adults: an American Academy of Sleep Medicine position paper J Clin Sleep Med, 2018.PMID 29852917
- [10]Aurora RN, Zak RS, Auerbach SH, et al. Best practice guide for the treatment of nightmare disorder in adults J Clin Sleep Med, 2010.PMID 20726290
- [11]Raskind MA, Peskind ER, Hoff DJ, et al. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder Biol Psychiatry, 2007.PMID 17069768
- [12]Raskind MA, Peskind ER, Chow B, et al. Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans N Engl J Med, 2018.PMID 29414272
- [13]Ohayon MM, Guilleminault C, Priest RG Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders J Clin Psychiatry, 1999.PMID 10221293
- [14]Schenck CH, Mahowald MW Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults Am J Med, 1996.PMID 8629680
- [15]Galbiati A, Verga L, Giora E, et al. The risk of neurodegeneration in REM sleep behavior disorder: A systematic review and meta-analysis of longitudinal studies Sleep Med Rev, 2019.PMID 30503716
- [16]Castelnovo A, Lopez R, Proserpio P, et al. NREM sleep parasomnias as disorders of sleep-state dissociation Nat Rev Neurol, 2018.PMID 29959394