Nightmare Disorder and Isolated Sleep Paralysis

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Abstract

Nightmare disorder and recurrent isolated sleep paralysis are rapid eye movement (REM) parasomnias that cause significant distress to those who suffer from them. Nightmare disorder can cause insomnia due to fear of falling asleep through dread of nightmare occurrence. Hyperarousal and impaired fear extinction are involved in nightmare generation, as well as brain areas involved in emotion regulation. Nightmare disorder is particularly frequent in psychiatric disorders and posttraumatic stress disorder. Nonmedication treatment, in particular imagery rehearsal therapy, is especially effective. Isolated sleep paralysis is experienced at least once by up to 40% of the general population, whereas recurrence is less frequent. Isolated sleep paralysis can be accompanied by very intense and vivid hallucinations. Sleep paralysis represents a dissociated state, with persistence of REM atonia into wakefulness. Variations in circadian rhythm genes might be involved in their pathogenesis. Predisposing factors include sleep deprivation, irregular sleep–wake schedules, and jetlag. The most effective therapy consists of avoiding those factors.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13311-020-00966-8.

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Most cited references 42

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Disturbed dreaming, posttraumatic stress disorder, and affect distress: a review and neurocognitive model.

Ross Levin, Tore Nielsen (2007)

Nightmares are common, occurring weekly in 4%-10% of the population, and are associated with female gender, younger age, increased stress, psychopathology, and dispositional traits. Nightmare pathogenesis remains unexplained, as do differences between nontraumatic and posttraumatic nightmares (for those with or without posttraumatic stress disorder) and relations with waking functioning. No models adequately explain nightmares nor have they been reconciled with recent developments in cognitive neuroscience, fear acquisition, and emotional memory. The authors review the recent literature and propose a conceptual framework for understanding a spectrum of dysphoric dreaming. Central to this is the notion that variations in nightmare prevalence, frequency, severity, and psychopathological comorbidity reflect the influence of both affect load, a consequence of daily variations in emotional pressure, and affect distress, a disposition to experience events with distressing, highly reactive emotions. In a cross-state, multilevel model of dream function and nightmare production, the authors integrate findings on emotional memory structures and the brain correlates of emotion. (c) 2007 APA, all rights reserved

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Best practice guide for the treatment of REM sleep behavior disorder (RBD).

Timothy Morgenthaler, Kannan Ramar, Ashley Casey … (2010)

Modifying the sleep environment is recommended for the treatment of patients with RBD who have sleep-related injury. Level A Clonazepam is suggested for the treatment of RBD but should be used with caution in patients with dementia, gait disorders, or concomitant OSA. Its use should be monitored carefully over time as RBD appears to be a precursor to neurodegenerative disorders with dementia in some patients. Level B Clonazepam is suggested to decrease the occurrence of sleep-related injury caused by RBD in patients for whom pharmacologic therapy is deemed necessary. It should be used in caution in patients with dementia, gait disorders, or concomitant OSA, and its use should be monitored carefully over time. Level B Melatonin is suggested for the treatment of RBD with the advantage that there are few side effects. Level B Pramipexole may be considered to treat RBD, but efficacy studies have shown contradictory results. There is little evidence to support the use of paroxetine or L-DOPA to treat RBD, and some studies have suggested that these drugs may actually induce or exacerbate RBD. There are limited data regarding the efficacy of acetylcholinesterase inhibitors, but they may be considered to treat RBD in patients with a concomitant synucleinopathy. Level C.

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Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans

Murray Raskind, Elaine R. Peskind, Bruce Chow … (2018)

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Author and article information

Contributors

Birgit Högl: birgit.ho@i-med.ac.at

Journal

Journal ID (nlm-ta): Neurotherapeutics

Journal ID (iso-abbrev): Neurotherapeutics

Title: Neurotherapeutics

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1933-7213

ISSN (Electronic): 1878-7479

Publication date (Electronic): 23 November 2020

Publication date PMC-release: 23 November 2020

Publication date (Print): January 2021

Volume: 18

Issue: 1

Pages: 100-106

Affiliations

GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of Neurology, , Medical University of Innsbruck (MUI), ; Anichstrasse 35, 6020 Innsbruck, Austria

Article

Publisher ID: 966

DOI: 10.1007/s13311-020-00966-8

PMC ID: 8116464

PubMed ID: 33230689

SO-VID: 96abc7f4-a97f-4295-af09-4f99103d674f

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date accepted : 3 November 2020

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ScienceOpen disciplines: Neurology

Keywords: dream,rem sleep,rem muscle atonia,polysomnography,parasomnia,rem sleep behavior disorder.

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ScienceOpen disciplines: Neurology

Keywords: dream, rem sleep, rem muscle atonia, polysomnography, parasomnia, rem sleep behavior disorder.

Nightmare Disorder and Isolated Sleep Paralysis

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Abstract

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Karger: Neurology and Neuroscience

Most cited references 42

Disturbed dreaming, posttraumatic stress disorder, and affect distress: a review and neurocognitive model.

Best practice guide for the treatment of REM sleep behavior disorder (RBD).

Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans

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