Parasomnias induced by hypnosedatives are rare but serious side effect. Such parasomnias have not been reported with all hypnosedatives. However, frequent use of hypnosedatives, particularly nonbenzodiazepine receptor agonists is associated with parasomnias. Associated symptoms are sleep eating, sleepwalking with object manipulation, sleep conversations, sleep driving, sleep sex and sleep shopping etc. Mechanisms include high affinity for GABAA receptor, interruption of the consolidation phase of memory formation by drug, pharmacokinetic or pharmacodynamic drug-drug interaction and concomitant administration with alcohol. Managements for parasomnias induced by hypnosedatives involve stopping medication, switch to other medications or nonpharmacological treatment, lowest effective dose of NBRAs (Non-Benzodiazepine Receptor Agonists), taking into consideration drug-drug interactions, identification and treatment of underlying disease states.
Eating ; Hypnotics and Sedatives ; Memory ; Parasomnias ; Somnambulism

Somnambulism is defined as a state of dissociated consciousness triggered by impaired arousal, which results in partial wakefulness and partial sleep. No effective therapy or medication has been available for treating children with somnambulism. Herein we present a case in a 4.5-year-old girl, who presented with somnambulism associated with separation anxiety disorder every night in a week. The girl received formal assessment and appropriate interventions, and the symptoms disappeared within a week. The treatment was carried out in 5 stages: diagnosis of the disease, establishment of trust, information collection, supervision, and individualized psychotherapy. Although dreams in childhood can be difficult to interpret, close observation of the behaviors in sleepwalking, as a special form of dream, in addition to the more precise description by the guardians, still provides useful clues to understand those dreams. For children with somnambulism, early intervention with psychotherapy can significantly decrease the false revival of the unconscious desires, and thus may serve as a treatment option other than medications.
Child ; Child, Preschool ; Female ; Humans ; Psychoanalytic Therapy ; Sleep ; Somnambulism ; therapy

INTRODUCTION: In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but considerable harm. As such, there is substantial interest on the forensic ramifications of these sleep behaviours. METHODS: This review examined the diagnostic criteria for parasomnias established in the context of international classification systems; medicolegal case reports; legal frameworks; and court cases in and outside of Singapore, to provide an overview of the implications of NREM parasomnias. RESULTS: Violent or injurious behaviours that occurred in the context of somnambulism, otherwise known as sleepwalking, have challenged traditional legal theories of criminal culpability. Yet little has changed in the application of sleep science to criminal responsibility. In Singapore, the defence of somnambulism has hitherto not been directly raised. Nonetheless, sleep medicine practitioners may increasingly be requested to render their opinions on legal issues pertaining to violent or injurious behaviours allegedly arising during sleep. Although the understanding of NREM parasomnias has improved, there is still a dearth of evidence to support both medical and legal decisions in this area. CONCLUSION NREM parasomnias come with disquieting legal and forensic implications for adjudicating criminal responsibility. There is a need to critically examine legal perspectives on behaviours occurring during sleep. More reliable empirical studies investigating the pathophysiology of NREM parasomnias can offer clearer diagnostic guidelines and address complex behaviours of NREM that often come with medicolegal implications.
Adult ; Humans ; Parasomnias/diagnosis* ; Singapore ; Sleep/physiology* ; Somnambulism/diagnosis*

PURPOSE: Nocturnal enuresis (NE) is one of the most common problems in childhood. NE has a multifactorial etiology and is influenced by sleep and arousal mechanisms. The aim of the present study was to prospectively evaluate sleep problems and patterns in children with NE compared with normal healthy controls. METHODS: Twenty-eight children with NE and 16 healthy controls were included in the study. To evaluate sleep habits and disturbances, parents and children filled out a questionnaire that included items about sleep patterns and sleep-related behaviors prior to treatment for NE. Demographic factors and other data were compared for the two groups based on the responses to the sleep questionnaire. RESULTS: Night awakening, sleepwalking, and periodic limb movements were more prevalent in children with NE, but symptoms of sleep-disordered breathing were not increased in this group. There were statistically significant differences in periodic limb movements and daytime sleepiness between the two groups. CONCLUSION: Children with NE seemed to have more sleep problems such as night awakening, sleepwalking, and periodic limb movements. In addition, a higher level of daytime sleepiness and hyperactivity in patients with NE suggested a relationship between NE and sleep disorders.
Arousal ; Child* ; Demography ; Extremities ; Humans ; Nocturnal Enuresis* ; Parents ; Prospective Studies ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Somnambulism

OBJECTIVES: In order to evaluate the possible relationship between sleep and personality characteristics, it is desirable to adopt the personality theory with biological basis because sleep is a physiological phenomenon. The purpose of this study was to investigate their possible relationship using the personality dimensions of Eysenck, which is well known as a biological personality theory. METHODS: Sleep Questionnaires regarding the weekday sleep habits and the sleep disorders and Eysenck's Personality Questionnaire were administered to 532 university students. Data analysis was based on 509 students who gave reliable information. Firstly, the descriptive statistics of the scores on four personality dimensions(psychoticism, neuroticism, extraversion, lie)and sleep characteristics were obtained. Secondly, the possible relationships between each personality dimension and sleep characteristics (the weekday sleep habits and sleep disorders)were tested by calculating Pearson's product moment correlations. RESULTS: The four personality dimensions' scores and weekday sleep habits of subjects were within a normal range. The highest frequency of sleep disorder was induction difficulty of sleep and the lowest was sleep walking. Psychoticism was positively correlated with bedtime, rise time, sleep latency, number of awakening, regularity of sleep, frequency and duration of nap and doze, frequency of sleep disorders, while negatively correlated with the quality of sleep, and the score of circadian rhythm. The correlations between neuroticism and sleep characteristics were similar to those of psychoticism. Extraversion was positively correlated with the quality of sleep and the score of circadian rhythm, while not correlated with sleep disorders. Lie was positively correlated with the score of circadian rhythm, but negatively correlated with sleep latency, regularity of sleep, frequency and duration of nap and doze, and sleep disorders. CONCLUSIONS: The higher psychoticism and neuroticism, the poorer sleep habits and the higher frequency of sleep disorders. The higher extraversion, the better quality of sleep and the closer morningness. The higher lie, the closer morningness, the more regularity of sleep, the less sleepiness of daytime, and the less frequency of sleep disorders. These findings suggest that there exist the close relationships between Eysenck's personality dimensions and sleep characteristics.
Circadian Rhythm ; Extraversion (Psychology) ; Humans ; Physiological Phenomena ; Surveys and Questionnaires ; Reference Values ; Sleep Wake Disorders ; Somnambulism ; Statistics as Topic

We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 microg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Brain ; Clonazepam ; Entropy* ; Female ; Humans ; Metabolism ; Middle Aged ; Paroxetine ; Propofol* ; Somnambulism* ; Suburethral Slings ; Valproic Acid

We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 microg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Brain ; Clonazepam ; Entropy* ; Female ; Humans ; Metabolism ; Middle Aged ; Paroxetine ; Propofol* ; Somnambulism* ; Suburethral Slings ; Valproic Acid

Sleep-related eating disorder (SRED) is a newly recognized parasomnia that describes a clinical condition of compulsive eating under an altered level of consciousness during sleep. Recently, it is increasingly recognized in clinical practice. The exact etiology of SRED is unclear, but it is assumed that SRED might share features of both sleepwalking and eating disorder. There have been also accumulating reports of SRED related to the administration of various psychotropic drugs, such as zolpidem, triazolam, olanzapine, and combinations of psychotropics. Especially, zolpidem in patients with underlying sleep disorders that cause frequent arousals, may cause or augment sleep related eating behavior. A thorough sleep history is essential to recognition and diagnosis of SRED. The timing, frequency, and description of food ingested during eating episodes should be elicited, and a history of concurrent psychiatric, medical, sleep disorders must also be sought and evaluated. Interestingly, dopaminergic agents as monotherapy were effective in some trials. Success with combinations of dopaminergic and opioid drugs, with the addition of sedatives, has also been reported in some case reports.
Arousal ; Benzodiazepines ; Consciousness Disorders ; Dopamine Agents ; Eating ; Feeding and Eating Disorders ; Feeding Behavior ; Humans ; Hypnotics and Sedatives ; Parasomnias ; Psychotropic Drugs ; Pyridines ; Sleep Wake Disorders ; Somnambulism ; Triazolam

Dehumidifying agents are commonly used to remove moisture and odors and are not meant for oral ingestion. The hazards of accidental oral ingestion of dehumidifying agents are not well known. A 31-year-old man with autism drank the liquid desiccant contained in the barrel of a dehumidifier while sleepwalking. The desiccant mainly consisted of calcium chloride. He was taken to the emergency center with persistent vomiting and underwent gastric lavage. The patient was treated for hypercalcemia due to calcium chloride poisoning. He eventually died of multiple organ failure. Autopsy findings were as follows: acute suppurative pneumonia, intra-abdominal inflammation, liver necrosis, acute pancreatitis, and gastrointestinal hemorrhage. Calcium chloride has relatively low toxicity; however, when ingested orally, it can cause severe internal damage, and even death. We suggest active preventive measures to ensure the safe use of dehumidifying agents.
Adult ; Autistic Disorder ; Autopsy ; Calcium Chloride ; Eating ; Emergencies ; Gastric Lavage ; Gastrointestinal Hemorrhage ; Humans ; Hypercalcemia ; Inflammation ; Liver ; Multiple Organ Failure ; Necrosis ; Odors ; Pancreatitis ; Pneumonia ; Poisoning ; Silica Gel ; Somnambulism ; Vomiting

PURPOSE: To investigate the frequency of childhood sleep problems at pediatric clinics in Seoul and Gyeonggi provinces. METHODS: Children (n=936) and their parents who visited 5 primary and 1 secondary pediatric outpatient clinics were invited to complete a Pediatric Sleep Questionnaire. RESULTS: Among patients, 901 (96.3%) answered questionnaires in sufficient detail for evaluation. The participant's mean age was 4.35±3.02 years (range, 0–18 years). The male to female ratio was 1:0.93 (466 boys, 435 girls). Habitual snoring (>3 day/week) was reported in 16.9% of the participants. The prevalence of habitual snoring in children <2 years and those between 2–5 years was 9% and 18%, respectively. Sleep disordered breathing was found in 15.1% (106 of 700) of children >2 years. Insomnia was reported in 13.2% of children. The prevalence of sleepwalking, night terrors, and bruxism, is 1.6%, 19%, and 21.1%, respectively. Snoring was associated with increased incidence of sleepwalking, night terrors, and bruxism. Age was associated with insomnia and habitual snoring (P<0.05). Insomnia was more prevalent in younger (21%) than in older children (6%). Snoring was more frequent in both preschool (34%) and school-aged children (33%). The frequency of sleep disordered breathing and insomnia did not vary significantly with gender. However, snoring was more prevalent in boys. CONCLUSION: Sleep problems are frequent among children in Korea. Children with snoring have an increased risk of sleepwalking, night terror, and bruxism. Primary clinicians should consider children's sleep habits to improve their health.
Adolescent* ; Ambulatory Care Facilities ; Bruxism ; Child* ; Female ; Gyeonggi-do ; Humans ; Incidence ; Korea ; Male ; Night Terrors ; Parents ; Prevalence ; Seoul ; Sleep Apnea Syndromes ; Sleep Initiation and Maintenance Disorders ; Snoring ; Somnambulism