Abstract
BackgroundNon-REM parasomnias are not uncommon conditions in the general population. Current treatment options are based on small case series and reports. In this study, we aimed to present the clinical experience from a large cohort of patients. PatientsFive hundred and twelve patients with Non-REM parasomnia or parasomnia overlap disorder (POD), who had undergone a video polysomnography and were exposed to treatment, were retrospectively identified. Treatment outcome was assessed based on patients’ reports, and treatment approach on a locally accepted hierarchy of interventions. ResultsForty percent of patients were diagnosed with sleepwalking, 23.8% with mixed-phenotype and 10% with POD. Ultimately, 97.2% reported adequate control of their symptoms. Moreover, 60.1% were treated with pharmacotherapy and 32.0% without, consistent across all phenotypes (p = 0.09). Benzodiazepines were the most common drugs prescribed (47.1%, p < 0.05). In the end, 37.7% of our patients were receiving a benzodiazepine as part of their successful treatment, 11.7% an antidepressant, 9.2% a z-drug, and 10.7% melatonin. Finally, 13.2%, 12.1%, and 5.8% of our patients reported good control of their symptoms with sleep hygiene, management of sleep-disordered breathing, and psychological interventions (cognitive behavioral therapy [CBT] or mindfulness-based stress reduction [MBSR]), as monotherapy, respectively. ConclusionThe treatment approach to effective treatment of the patients with Non-REM parasomnias or POD offering first sleep hygiene advice, next treatment of concurrent sleep disorders and management of other priming factors like stress and anxiety, and lastly pharmacotherapy for Non-REM parasomnia is supported by our results. Non pharmacological interventions were effective in one third of our patients, and CBT/MBSR and melatonin appeared promising new treatments.
Highlights
Non rapid eye movement (NREM) parasomnias are abnormal behaviors arising primarily but not exclusively during non-REM stage three (N3) sleep
97.2% (498/512) of the patients reported that their parasomnia manifestations were at least under an acceptable level of control for them individually or they have totally resolved; and 32.0% (164/512) did not require pharmacotherapy, using either sleep hygiene, continuous positive airway pressure (CPAP)/MAD, CBT/Mindfulness-Based Stress Reduction (MBSR), acupuncture or by discontinuing drugs deemed responsible for triggering NREM parasomnia
This study reports the largest cohort of patients diagnosed and treated for NREM parasomnias currently described in the literature, covering the full spectrum of the condition, including those with parasomnia overlap disorder (POD)
Summary
Non rapid eye movement (NREM) parasomnias are abnormal behaviors arising primarily but not exclusively during non-REM stage three (N3) sleep. Patients: Five hundred and twelve patients with Non-REM parasomnia or parasomnia overlap disorder (POD), who had undergone a video polysomnography and were exposed to treatment, were retrospectively identified. 13.2%, 12.1%, and 5.8% of our patients reported good control of their symptoms with sleep hygiene, management of sleep-disordered breathing, and psychological interventions (cognitive behavioral therapy [CBT] or mindfulness-based stress reduction [MBSR]), as monotherapy, respectively. Conclusion: The treatment approach to effective treatment of the patients with Non-REM parasomnias or POD offering first sleep hygiene advice, treatment of concurrent sleep disorders and management of other priming factors like stress and anxiety, and lastly pharmacotherapy for Non-REM parasomnia is supported by our results. Non pharmacological interventions were effective in one third of our patients, and CBT/MBSR and melatonin appeared promising new treatments
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