Non-REM Parasomnias and REM Sleep Behaviour Disorder

  • Sofia ErikssonEmail author
  • Matthew Walker


Parasomnias are undesirable physical events or experiences associated with sleep. Episodes are usually classified according to the stage of sleep during or from which they occur. Parasomnias frequently involve complex behaviours that may appear purposeful but are not conscious or under deliberate control. Patients are often unaware of episodes that may, however, result in injury and sleep disruption with subsequent daytime symptoms such as excessive daytime somnolence. The consequences of parasomnias are not limited to the patient but often affect the bed partner as well. People are often amnesic for their parasomnia but, with both non-REM parasomnias and REM sleep behaviour disorder (RBD), patients may recall some dream mentation.


  1. American Academy of Sleep Medicine. International classification of sleep disorders. Darien, IL: American Academy of Sleep Medicine; 2014. Scholar
  2. Aurora RN, Zak RS, Maganti RK, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6:85–95.PubMedPubMedCentralGoogle Scholar
  3. Bassetti C, Vella S, Donati F, et al. SPECT during sleepwalking. Lancet. 2000;356:484–5. Scholar
  4. Ben-Hamou M, Marshall NS, Grunstein RR, et al. Spontaneous adverse event reports associated with zolpidem in Australia 2001-2008. J Sleep Res. 2011;20:559–68. Scholar
  5. Boeve BF, Silber MH, Saper CB, et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain. 2007;130:2770–88. Scholar
  6. Bonakis A, Howard RS, Ebrahim IO, et al. REM sleep behaviour disorder (RBD) and its associations in young patients. Sleep Med. 2009;10:641–5. Scholar
  7. Chesson AL, Ferber RA, Fry JM, et al. The indications for polysomnography and related procedures. Sleep. 1997;20:423–87.CrossRefPubMedGoogle Scholar
  8. Derry CP, Davey M, Johns M, et al. Distinguishing sleep disorders from seizures: diagnosing bumps in the night. Arch Neurol. 2006;63:705–9. Scholar
  9. Derry CP, Harvey AS, Walker MC, et al. NREM arousal parasomnias and their distinction from nocturnal frontal lobe epilepsy: a video EEG analysis. Sleep. 2009;32:1637–44.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Dolder CR, Nelson MH. Hypnosedative-induced complex behaviours : incidence, mechanisms and management. CNS Drugs. 2008;22:1021–36.CrossRefPubMedGoogle Scholar
  11. Fantini ML, Corona A, Clerici S, Ferini-Strambi L. Aggressive dream content without daytime aggressiveness in REM sleep behavior disorder. Neurology. 2005;65:1010–5. Scholar
  12. Fois C, Wright M-AS, Sechi G, et al. The utility of polysomnography for the diagnosis of NREM parasomnias: an observational study over 4 years of clinical practice. J Neurol. 2015;262:385–93. Scholar
  13. Hublin C, Kaprio J, Partinen M, et al. Prevalence and genetics of sleepwalking: a population-based twin study. Neurology. 1997;48:177–81.CrossRefPubMedGoogle Scholar
  14. Ju Y-ES. Rapid eye movement sleep behavior disorder in adults younger than 50 years of age. Sleep Med. 2013;14:768–74. Scholar
  15. Khalil A, Wright M-A, Walker MC, Eriksson SH. Loss of rapid eye movement sleep atonia in patients with REM sleep behavioral disorder, narcolepsy, and isolated loss of REM atonia. J Clin Sleep Med. 2013;9:1039–48. Scholar
  16. Kierlin L, Littner MR. Parasomnias and antidepressant therapy: a review of the literature. Front Psych. 2011;2:71. Scholar
  17. Kunz D, Mahlberg R. A two-part, double-blind, placebo-controlled trial of exogenous melatonin in REM sleep behaviour disorder. J Sleep Res. 2010;19:591–6. Scholar
  18. Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28:499–521.CrossRefGoogle Scholar
  19. Lam SP, Fong SYY, Ho CKW, Wing YK. Parasomnia among psychiatric outpatients: A clinical, epidemiologic, cross-sectional study. J Clin Psychiatry. 2008;69:1374–82.CrossRefPubMedGoogle Scholar
  20. Licis AK, Desruisseau DM, Yamada KA, et al. Novel genetic findings in an extended family pedigree with sleepwalking. Neurology. 2011;76:49–52. Scholar
  21. Lopez R, Jaussent I, Scholz S, et al. Functional impairment in adult sleepwalkers: a case-control study. Sleep. 2013;36:345–51. Scholar
  22. Manni R, Terzaghi M, Repetto A. The FLEP scale in diagnosing nocturnal frontal lobe epilepsy, NREM and REM parasomnias: data from a tertiary sleep and epilepsy unit. Epilepsia. 2008;49:1581–5. Scholar
  23. Mayer G, Bitterlich M, Kuwert T, et al. Ictal SPECT in patients with rapid eye movement sleep behaviour disorder. Brain. 2015;138:1263–70. Scholar
  24. McCarter SJ, Boswell CL, St Louis EK, et al. Treatment outcomes in REM sleep behavior disorder. Sleep Med. 2013;14:237–42. Scholar
  25. McCarter SJ, St Louis EK, Duwell EJ, et al. Diagnostic thresholds for quantitative REM sleep phasic burst duration, phasic and tonic muscle activity, and REM atonia index in REM sleep behavior disorder with and without comorbid obstructive sleep apnea. Sleep. 2014;37:1649–62. Scholar
  26. Morrison I, Rumbold JMM, Riha RL. Medicolegal aspects of complex behaviours arising from the sleep period: a review and guide for the practising sleep physician. Sleep Med Rev. 2014;18:249–60. Scholar
  27. Ohayon MM, Caulet M, Priest RG. Violent behavior during sleep. J Clin Psychiatry. 1997;58:369–76. quiz 377.CrossRefPubMedGoogle Scholar
  28. Ohayon MM, Mahowald MW, Dauvilliers Y, et al. Prevalence and comorbidity of nocturnal wandering in the U.S. adult general population. Neurology. 2012;78:1583–9. Scholar
  29. Oudiette D, De Cock VC, Lavault S, et al. Nonviolent elaborate behaviors may also occur in REM sleep behavior disorder. Neurology. 2009a;72:551–7. Scholar
  30. Oudiette D, Leu S, Pottier M, et al. Dreamlike mentations during sleepwalking and sleep terrors in adults. Sleep. 2009b;32:1621–7.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Pilon M, Montplaisir J, Zadra A. Precipitating factors of somnambulism: impact of sleep deprivation and forced arousals. Neurology. 2008;70:2284–90. Scholar
  32. Postuma RB, Gagnon J-F, Montplaisir J. Rapid eye movement sleep behavior disorder as a biomarker for neurodegeneration: the past 10 years. Sleep Med. 2013a;14:763–7. Scholar
  33. Postuma RB, Gagnon J-F, Tuineaig M, et al. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal? Sleep. 2013b;36:1579–85. Scholar
  34. Schenck CH, Mahowald MW. Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am J Med. 1996;100:333–7. Scholar
  35. Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep. 1986;9:293–308.CrossRefPubMedGoogle Scholar
  36. Schenck CH, Boyd JL, Mahowald TW. A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep. 1997;20:972–81.CrossRefPubMedGoogle Scholar
  37. Schenck CH, Boeve BF, Mahowald MW. Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series. Sleep Med. 2013;14(8):744. Scholar
  38. Shapiro CM, Trajanovic NN, Fedoroff JP. Sexsomnia--a new parasomnia? Can J Psychiatry. 2003;48:311–7.CrossRefPubMedGoogle Scholar
  39. Vignatelli L, Bisulli F, Provini F, et al. Interobserver reliability of video recording in the diagnosis of nocturnal frontal lobe seizures. Epilepsia. 2007;48:1506–11. Scholar
  40. Wilson SJ, Lillywhite AR, Potokar JP, et al. Adult night terrors and paroxetine. Lancet. 1997;350:185.PubMedGoogle Scholar
  41. Zadra A, Desautels A, Petit D, Montplaisir J. Somnambulism: clinical aspects and pathophysiological hypotheses. Lancet Neurol. 2013;12:285–94. Scholar

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© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.National Hospital for Neurology and NeurosurgeryLondonUK
  2. 2.UCL Institute of NeurologyLondonUK

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