Does the Patient Have Abnormal Movements at Night?

Abstract

Sleep-related movement disorders are generally characterized by simple movements that disturb sleep or the ability to fall asleep. These disorders manifest symptoms of nocturnal sleep disturbance and daytime sleepiness or tiredness. In order to make an accurate diagnosis, an all-night video recording is desired to differentiate these disorders from parasomnias. Sleep-related movement disorders or congenital simple movements can cause disturbed sleep. All-night recordings are recommended to differentiate the sleep-related movement disorder from parasomnias. Patients are usually unaware of movements or sleep disturbance. Sleep-related rhythmic movement disorders are repetitive and stereotyped with rhythmic motor behaviors. These movements occur during drowsiness or early sleep and involve large muscle groups and include body rocking, head rolling, or head banging. They are more common in children and infants. In most situations, they do not have any significant consequences. Many sleep-related movement disorders are a result of a medical condition due to side effects or withdrawal from medication or a substance, or they could be an isolated symptom or normal variant. Many of these disorders of movement tend to overlap with other sleep conditions including parasomnias. In general, parasomnias are undesirable physical events that occur when falling asleep, during sleep, or while waking up. They include abnormal sleep-related complex movements, behaviors, and autonomic nervous system activity. They significantly contrast with sleep-related movement disorders. Parasomnias tend to result in injuries, sleep disruption, and adverse health effects. Sometimes they affect the patient, the bed partner, or both. Non-REM-related parasomnias include confused arousals, sleepwalking, and sleep terrors. Patients tend to have a partial or complete amnesia for episodes. REM-related parasomnias include a REM behavior disorder also known as RBD. It predominantly occurs in middle-aged to elderly males. However, it is often associated with an underlying neurologic disorder such as Parkinson’s disease, multiple system atrophy, narcolepsy, cerebrovascular accident, or Lewy body dementia. Nightmare disorder is apparent during rapid eye movement sleep and often leads to awakening with a bowel movement. While prevalent in the general population, this is common in children. Nightmares are frequently associated with psychopathology such as posttraumatic stress disorder. The patient remembers the dreams and can describe the nightmare, which usually involves threats to survival, security, or physical activity. Nightmares can have a negative impact on family functioning and lead to daytime sleepiness, fatigue, or low energy. It can also impair occupational or educational functions.