Disorders of arousal (DoA) episodes, such as sleepwalking, are not a uniform state but involve varying levels of consciousness and responsiveness. In a retrospective questionnaire, 81% of 61 adult patients reported occasional conversations during episodes. Auditory stimulation during N3 sleep triggered episodes in only 7 of 157 trials, and only one patient indirectly responded to verbal prompts. Analysis of 364 home video-recorded episodes from 19 patients found 37 instances of discussion with a bed partner. Patients' ongoing mental content influenced their responses and perception of the outside world. These findings highlight limitations in current diagnostic criteria for DoA.
A new multidimensional scale, the Nightmare Severity Index (NSI), was tested in 102 patients, mostly women (64%) and outpatients (76%) with mood disorders (depression 31%, bipolar disorder 41%) and frequent PTSD comorbidity (44%). The NSI assesses nightmare frequency, emotional impact, diurnal impact, and nocturnal impact. The questionnaire showed good internal consistency (Cronbach's alpha >0.7) and was well suited for factor analysis. Higher NSI scores corresponded to individuals meeting DSM-5/ICSD-3 criteria for nightmare disorder. The NSI appears to be a promising tool for clinical assessment of nightmare severity.