Live Recordings (Sleep Medicine Trends 2026)-21 Parasomnias

Video Transcription

Video Summary

The speaker reviews parasomnias—undesirable motor or verbal behaviors arising from sleep or sleep–wake transitions—emphasizing the ICSD-3 framework separating non-REM disorders of arousal (confusional arousals, sleepwalking, sleep terrors) from REM-related parasomnias (notably REM sleep behavior disorder, RBD). Non-REM parasomnias are far more common in children, often triggered by sleep deprivation, stress, medications (especially “Z-drugs”), and obstructive sleep apnea (OSA). Confusional arousals are milder, while sleepwalking can involve complex, risky behaviors with important forensic implications; a famous case (Kenneth Parks) illustrates how documented parasomnia can affect legal outcomes. Sleep terrors feature intense autonomic arousal and are highly distressing for families. Diagnostic workup is largely history and home video; polysomnography is reserved for atypical, frequent, or dangerous events and to rule out mimics such as nocturnal seizures and OSA.<br /><br />Treatment prioritizes safety, sleep hygiene, treating comorbid sleep disorders, scheduled awakenings, and behavioral therapies (including hypnosis/CBT-I); medications (e.g., clonazepam, melatonin, some antidepressants) have limited trial evidence but can help.<br /><br />Sleep-related eating disorder (SRED), now classified under non-REM parasomnias, may involve hazardous ingestion and injuries; management includes removing hazards, addressing triggers, and selected medications (e.g., topiramate, SSRIs).<br /><br />For RBD, the talk highlights pseudo-RBD from OSA, antidepressant controversies, PSG markers of REM sleep without atonia, counseling on neurodegenerative risk, and strict bedroom safety. Brief updates cover recurrent isolated sleep paralysis and nightmare disorder, favoring CBT-based treatments and noting doxazosin as an emerging option.

Keywords

parasomnias

ICSD-3 classification

non-REM disorders of arousal

sleepwalking forensic implications

sleep terrors

sleep-related eating disorder (SRED)

REM sleep behavior disorder (RBD)

polysomnography and obstructive sleep apnea (OSA)