Other parasomnias

Ten disorders are classified under this category (Table 1). The most common are sleep bruxism, sleep enuresis, and primary snoring.

Sleep bruxism is the third most common parasomnia and it can be bothersome to the bed partner. Bruxism is not a dangerous disorder. However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain. Approximately 8.2% of people experience it at least once a week. Sleep apnea and anxiety disorders are the most prominent risk factors for bruxism. Bruxism could be a reflex to open the airway after an apneic or hypopneic event. Bruxism may improve with treatment of sleep apnea with continuous positive airway pressure. Sleep bruxism does not have a definite cure. The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible. Stress reduction, relaxation, biofeedback, hypnosis and improvement of sleep hygiene have been tried with no persistent or significant improvement. To prevent damage to the teeth, mouth guards or appliances (splints) have been used since the 1930s to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect the teeth from the pressure of clenching. Pharmacologic interventions are indicated for short-term management of patients who experience complications of sleep bruxism, including pain in the temporomandibular joint. Benzodiazepines could be effective because of their muscle-relaxing and anti-anxiety properties. Additionally, they increase the arousal threshold that could precede teeth grinding. (Farid et al., 2004)

Sleep enuresis, more commonly known as bedwetting, refers to the lack of ability to maintain urinary control during sleep. This recurrent involuntary urination is also called nocturnal enuresis, which is characterized by at least two occurrences per month in 3 to 6 years old infants and at least one occurrence per month for older children. Sleep enuresis is observed in 10% of children at the age of 6. The prevalence decreases with age. Approximately 77% of children had enuresis when their parents were enuretic, whereas 44% of children with one parent who was enuretic developed enuresis. Simple behavior modifications can be very effective treatments for children with enuretic episodes. For example, intake of liquids and dietary bladder irritants such as citrus products should be discouraged before bedtime. Taking note of when the enuresis actually occurs, and waking and taking the child to toilet before that hour, can also be very helpful Matthias et al., 2002).

Psychological treatments such as encouragement of self-reliance, participation in management, inculcation of self-respect and responsibility are also recommended by many experts. Physical punishments and coercion, on the other hand, are considered to be the most counterproductive measures and should be avoided at all costs.

Using devices such as bedwetting alarms and moisture alarms, combined with bladder muscle exercises, dietary changes, retention control training etc can also be helpful remedies in treating sleep enuresis. Education, encouragement, and patience are prudent approaches for younger children. For older children who may be embarrassed by the occurrences, and who may be affected by the emotional concerns, more aggressive treatment is recommended. Biofeedback, including enuresis alarms, arousal training and desmopressin have been tried with prominent success rates, although they are associated with high relapse rates. Hypnotherapy and imipramine have been somewhat helpful in the management Schenck et al., 1996).

Primary snoring is reported in 40% to 50% of people over the age of 65 and approximately 25% of the middle-age group. Snoring is usually a symptom of sleep disordered breathing. Oral appliances and otolaryngologic procedures, including velopharyngeal surgery, can effectively resolve snoring. Most of the studies on oral appliances are conducted for treatment of obstructive sleep apnea syndrome, with no clear data on primary snoring. They have decreased the frequency of snoring by 50%.

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