Causes of parasomnias

Parasomnias occur due to abnormal transitions between the three primary states of being wake, rapid eye movement (REM) sleep, and non rapid eye movement (NREM) sleep. These different states may overlap or intrude into one another, and it is the overlap of wakefulness and NREM sleep that gives rise to confusional arousals, and the intrusion of REM sleep into waking that produces REM sleep behaviour disorder (Matwiyoff et al, 2010). Parasomnias may have genetic basis, but occurrence is usually triggered by heavy physical activity, febrile illness, sleep deprivation, excessive caffeine drinks, hypnotics, and emotional stress. Intake of alcohol increased occurrence of confusional arousal, night terror, and sleepwalking, while heavy intake of caffeinated drink increased occurrence of sleep walking in a population study (Oluwole, 2010).

Arousal disorders

Confusional arousals Sleepwalking Sleep terrors

Sleep-wake transition disorders

Rhythmic movement disorder Sleep starts Sleep-talking Nocturnal leg cramps

Parasomnias usually associated with REM sleep

Nightmares Sleep paralysis

Impaired sleep-related penile erections Sleep-related painful erections REM sleep sinus arrest REM sleep behavior disorder

Other parasomnias

Sleep bruxism Sleep enuresis

Sleep-related abnormal swallowing syndrome Nocturnal paroxysmal dystonia Sudden unexplained nocturnal death syndrome Primary snoring Infant sleep apnea

Congenital central hypoventilation syndrome Sudden infant death syndrome Benign neonatal sleep myoclonus

Table 1. The International Classification of Sleep Disorders classification of parasomnias

Heredity was described for many forms of parasomnias but detailed genetic studies are lacking. The composition of non-REM and REM sleep was shown to have genetic roots. Especially the amount of slow-wave sleep was recently shown to be genetically predisposed by a specific gene, the retinoid acid receptor beta encoding gene (Young, 2008; Maret et al., 2005).

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