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Partial Arousals and Sleep-related Dissociative States THE PARASOMNIAS

Stephen H. Sheldon, D.O., F.A.A.P. Professor of Pediatrics Northwestern University Feinberg School of Medicine Director, Sleep Medicine Center Ann and Robert Lurie Childrens Hospital of Chicago

Parasomnias
NREM SLEEP REM SLEEP SLEEP/WAKE TRANSITION OTHER

NREM Sleep/Arousal Disorders

Spectrum Somniloquy Sleep Terrors Sleepwalking Agitated Sleep Walking Confusional Arousals

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NREM Sleep/Arousal Disorders

Diagnostic Approach

History and Physical Examination

Videotaping Polysomnography (EEG/CNS Imaging)

NREM Sleep Partial Arousal Disorder

Clinical Findings

NREM Sleep Partial Arousal Disorder

Clinical Findings First 1/3 1/2 of the Sleep Period

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NREM Sleep Partial Arousal Disorder

Clinical Findings First 1/3 1/2 of the Sleep Period Abrupt Sudden Onset

NREM Sleep Partial Arousal Disorder

Clinical Findings First 1/3 1/2 of the Sleep Period Abrupt Sudden Onset Intense Autonomic Discharges

NREM Sleep Partial Arousal Disorder

Clinical Findings First 1/3 1/2 of the Sleep Period Abrupt Sudden Onset Intense Autonomic Discharges Relatively Short Duration

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NREM Sleep Partial Arousal Disorder

Clinical Findings First 1/3 1/2 of the Sleep Period Abrupt Sudden Onset Intense Autonomic Discharges Relatively Short Duration Amnesia for Event

NREM Sleep Partial Arousal Disorder

Clinical Findings First 1/3 1/2 of the Sleep Period Abrupt Sudden Onset Intense Autonomic Discharges Relatively Short Duration Amnesia for Event Age of Onset

NREM Sleep Partial Arousal Disorder

Clinical Findings Age of Onset

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NREM Sleep Partial Arousal Disorder

Clinical Findings Age of Onset 18 months

NREM Sleep Partial Arousal Disorder

Clinical Findings Age of Onset 18 months < 18 months = WNL (We Never Looked)

NREM Sleep Partial Arousal Disorder

Clinical Findings Age of Onset 18 months < 18 months = WNL

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NREM Sleep Partial Arousal Disorder

Clinical Findings Age of Onset 18 months < 18 months = WNL =

(We Never Looked)

NREM Sleep Partial Arousal Disorder

Polysomnographic Findings

NREM Sleep Partial Arousal Disorder

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NREM Sleep Partial Arousal Disorder

NREM Sleep Partial Arousal Disorder

This 13-year-old Patients Problem Occurs Every Night

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NREM Sleep Partial Arousal Disorder

Approach to Management

MULTIDISCIPLINARY

NREM Sleep Partial Arousal Disorder

Education / Reassurance Protect From Injury Sleep Hygiene Environmental Triggers Treat Medical/Psychological Problems

NREM Sleep Partial Arousal Disorder

Relaxation Training Scheduled Waking Brushing / Combing Aromatherapy Competitive Auditory Inhibition ---------------------------------------Medication

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REM Sleep Parasomnias

Nightmares Sleep Paralysis REM-Sleep Motor Disorder

REM Sleep Parasomnia

NIGHTMARE

REM Sleep Parasomnia

Nightmares
Clinical Features

10

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REM Sleep Parasomnia

Nightmares
Clinical Features Second Half to Last Third of Sleep Period

REM Sleep Parasomnia

Nightmares
Clinical Features Second Half to Last Third of Sleep Period Good Dream Gone Bad

REM Sleep Parasomnia

Nightmares
Clinical Features Second Half to Last Third of Sleep Period Good Dream Gone Bad Transitions to Wake

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REM Sleep Parasomnia

Nightmares
Clinical Features Second Half to Last Third of Sleep Period Good Dream Gone Bad Transitions to Wake Mild to Moderate Autonomic Discharge

REM Sleep Parasomnia

Nightmares
Clinical Features Second Half to Last Third of Sleep Period Good Dream Gone Bad Transitions to Wake Mild to Moderate Autonomic Discharge Vivid Dream Recall

REM Sleep Parasomnia

Nightmares
Polysomnographic Features

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REM Sleep Parasomnia

NIGHTMARE

REM Sleep Parasomnia

Sleep Paralysis

C/C: Difficulty Waking Up

CAN
T WAKE UP

WON
T WAKE UP

REM Sleep Parasomnia Sleep Paralysis

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REM Sleep Parasomnia

REM-sleep Motor Disorder (RBD)

REM Sleep Parasomnia

REM-sleep Motor Disorder (RBD)

Wake/Sleep Transition Disorders

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Wake/Sleep Transition Disorders

Wake/Sleep Transition Disorders

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