Diagnosis and management of nonrapid eye movement parasomnias.
PURPOSE OF REVIEW Nonrapid eye movement (NREM) parasomnias are common sleep disorders that potentially have significant personal, social and forensic implications. They represent a unique opportunity in nature to explore the coexistence of sleep and wake state in the human brain. RECENT FINDINGS Neuroimaging and electroencephalography have advanced our understanding of NREM parasomnia pathophysiology, and the interplay between wakefulness and sleep. These disorders are increasingly viewed as resulting from an evolutionary process with a basis in uni hemispheric brain activity in sleep seen in some animals, maintaining consciousness and ability to act against life threatening situations. Although current classification of NREM parasomnia phenotypes distinguishes between disorders of arousal and other types of behaviours, evidence increasingly points to there being a significant overlap between the various phenotypes. Treatment practice appears more standardized nowadays based on larger case series, but randomized control trials are still needed. SUMMARY NREM parasomnia is a very common disorder of uncertain pathogenesis but of known pathophysiology, the diagnosis of which remains primarily clinical.
Current opinion in pulmonary medicine