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Approach to abnormal movements and behaviors during sleep

Author
Bradley V Vaughn, MD
Section Editor
Alon Y Avidan, MD, MPH
Deputy Editor
April F Eichler, MD, MPH

INTRODUCTION

Abnormal movements and behaviors during sleep are part of a larger group of nocturnal events that may occur during sleep, wake, or the transitions into or out of sleep. These events are most common early in life, affecting approximately 15 to 20 percent of children and 4 percent of adults [1-4].

Nocturnal events are typically divided into simple behaviors (eg, single movements, repetitive or periodic movements, rhythmical movements) and complex behaviors (eg, sleep talking, sleepwalking, sleep terrors, dream enactment) (table 1). Most simple movements occur during the transition from wake to sleep or sleep to wake or during light, non-rapid eye movement (NREM) sleep (figure 1). Complex behaviors can result from disruption of the control mechanisms of the three normal states of being: wake, NREM sleep, and rapid eye movement (REM) sleep.

Occasionally, simple or complex motor patterns during sleep are a manifestation of seizures, dissociative psychiatric events, or even physiological states such as hypoglycemia. Therefore, clinicians should be aware that nocturnal events may be a manifestation of specific neurologic, medical, psychiatric, or sleep disorders. On the other hand, some of these behaviors, specifically the disorders of arousal and nightmares, may be normal in childhood.

A detailed history, including a clear description from the patient and ideally a bed partner or family witness, is the cornerstone of establishing clues about the underlying etiology. The challenge for the clinician is to recognize when certain nocturnal events signal an underlying, treatable disorder, an emerging neurological abnormality, or a benign age-appropriate episode.

An approach to the evaluation and diagnosis of abnormal movements and behaviors during sleep is presented here. Additional topics on the diagnosis and treatment of specific parasomnias and sleep-related movement disorders in both children and adults can be found elsewhere. (See "Sleepwalking and other parasomnias in children" and "Disorders of arousal from non-rapid eye movement sleep in adults" and "Rapid eye movement sleep behavior disorder" and "Clinical features and diagnosis of restless legs syndrome/Willis-Ekbom disease and periodic limb movement disorder in adults" and "Restless legs syndrome/Willis-Ekbom disease and periodic limb movement disorder in children".)

                   

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Literature review current through: Nov 2016. | This topic last updated: Tue Oct 06 00:00:00 GMT 2015.
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