The REM sleep behavior disorder (RBD) is the parasomnia most commonly associated with an underlying neurological condition (the so-called symptomatic RBD). RBD usually occurs in setting of neurodegenerative diseases such as Lewy body dementia (LBD), Parkinson's disease (PD), and multiple system atrophy (MSA), and it may precede the development of Parkinsonism by many years. The disorders of arousal are the most frequent of the NREM sleep parasomnias. They may be triggered by prior sleep deprivation, alcohol, emotional stress and febrile illness. Different medications have been associated with RBD or REM sleep without atonia (RSWA), particularly psychotrophic and antihypertensive drugs. In the last two decades, some studies have demonstrated that arousals secondary to apneas, hypopneas and irregular breathing can be the trigger for sleepwalking and related disorders in children and adults. Hallucinations, both diurnal and nocturnal, have been described in PD associated with cognitive decline and RBD.

During Rhazes' time, research shows that mater puerorum have been used to describe both epileptic attacks and night terrors. In a case report published in 1953, Sullivan described night terrors as an indication of an emotional problem arising out of certain stages in a child's development. Classically, night terrors arise during the first sleep cycle, usually within 1-3 hours of sleep. Parents identified the following as precipitants: overtiredness, fever, separation, loss, moving, divorce, change of school, death in the family, return to school from vacation, or change of school. The prevalence of sleepwalking and night terrors in first-degree relatives was estimated as being ten times greater than in the general population. Treatment of night terrors can be divided into two categories: behavioral and medical strategies. Night terrors are fascinating entities that share many of the same characteristics of the other parasomnias occurring as arousals from non-rapid eye movement (NREM) sleep.

This chapter focuses on sleepwalking, also known as somnambulism. The symptoms and manifestations that characterize sleepwalking show great variations both within and across predisposed patients. Sleepwalking is more common in childhood than in adulthood, as most children will experience, at least temporarily, one or more of the NREM sleep parasomnias during childhood or early adolescence. Sleep laboratory investigations have yielded considerable information on the polysomnographic characteristics of sleepwalkers. There is a strong genetic component to somnambulism. About 80% of somnambulistic patients have at least one family member affected by this parasomnia, and the prevalence of somnambulism is higher in children of parents with a history of sleepwalking. In addition to the atypical sleep parameters and genetic component reviewed, other factors have been proposed, including psychopathology and deregulation of serotonergic systems. Hypnosis (including self-hypnosis) has been found to be effective in both children and adults presenting with chronic sleepwalking.

Sleepwalking is not the only NREM parasomnia that has been observed to be associated with medication or substance. It is, however, the most common group, the one most familiar to psychiatrists, who noted this as a side effect following initiation or escalation of some medications used for treating their patients, particularly those with bipolar depression in manic episodes, schizoaffective patients and anxiety patients with insomnia. This chapter covers the published reports in which sleepwalking event occurred closely following the initiation of medication and its resolution on withdrawal from the drug. The anti-depressant medications and their effects on sleep, few studies give the effects on slow-wave sleep (SWS). The benzodiazepine that has been most clearly associated with sleep-related eating disorder (SRED) is triazolam, although it is associated with initiation of several other NREM parasomnias.

Four patients had a positive personal history for parasomnias and two- a positive family history. Personal history was positive for parasomnias in two patients. Family history was positive for parasomnias in two patients, for nocturnal groaning in one patient, and for sudden infant death syndrome in one patient. Eight patients were reporting a family history positive for parasomnias and three for nocturnal groaning. Catathrenia is associated with a positive personal or familial history for other parasomnias. There is no drug medication available for catathrenia. Empirical pharmacological treatments with dosulepine, trazodone, clonazepam, paroxetine, carbamazepine, gabapentin, and pramipexole have been unsuccessful or refused. The efficacy of the nCPAP ventilation is still debated. In particular, nCPAP treatment seems effective only when noisy breathing during sleep, diagnosed as catathrenia, is related to the co-existence of expiratory and inspiratory flow limitation with obstructive apneas or hypopneas and consequent intermittent hypoxia.

Arousal parasomnias occur mainly during non-rapid eye movement (NREM) sleep. This group consists of confusional arousals, sleepwalking and sleep terrors. Sleepwalking and sleep terrors can be triggered by stress, sleep deprivation, alcohol ingestion, and almost all sedative medications. This group of parasomnias is composed of three disorders occurring essentially during rapid eye movement (REM) sleep. Sleep paralysis is one of the main symptoms associated with narcolepsy, but it can also occur individually. REM sleep behavior disorder is characterized by a loss of generalized skeletal muscle REM-related atonia and the presence of physical dreamenactment. Polysomnographic recordings of individuals with RBD showed a reduction of the tonic phenomena of REM sleep and the activation of the phasic phenomena. Parasomnias are frequent in the general population; more than 30% of individuals experiences at least one type of parasomnia. At the genetic level, there is growing evidence that many parasomnias have a genetic component.

The sleep disorders that predispose to trauma are: disorders associated with excessive daytime sleepiness, obstructive sleep apnea, upper airway resistance syndrome, periodic limb movement disorder, narcolepsy, cataplexy, sleep paralysis and hypnagogic hallucinations. The disorders associated with behaviors while asleep (parasomnias) are: sleep terrors and sleepwalking and REM sleep behavior disorder. Injury can result from behaviors that occur during sleep. The patient's ability to recall the episode depends partly on the type of the parasomnia (occurrence during non-REM versus REM sleep). The other sleep disorders are recurrent hypersomnia and insomnia. Insomnia can result from multiple causes including psychiatric or general medical disorders, medication effects, substance abuse, and other sleep disorders. Restless legs syndrome (RLS) is another important cause of insomnia. RLS is thought to be related to periodic limb movement disorder and is characterized by lower extremity dysesthesias that occur at rest.