Sleep and Quality of Life in REM Sleep Parasomnia

Abstract

Parasomnias are abnormal behavioral or physiological events that intrude into the sleep process disrupting its continuity. Parasomnia associated to REM sleep include REM sleep behavior disorder, nightmare disorders, recurrent isolated sleep paralysis (SP), and sleep-related painful erections. The quality of life of patients suffering from parasomnias may vary according to the disorder. REM sleep behavior disorder patients experience recurrent vivid and violent dreams and frequent sleep-related injuries for themselves or bed partners, with possible impacts on personal, couple, and social life. Despite the possible awakening from REM sleep, sleep architecture is usually preserved in RBD. Idiopathic RBD may often precede a neurodegenerative disease, and its diagnosis might imply a psychological burden for patients and their family. The increased risk for neurodegenerative illnesses poses the ethical dilemma whether the patient should or should not be told about, especially in view of the current lack of effective neuroprotective strategies and the lack of knowledge about the precise extent of this risk. Nightmares are intensely disturbing dreams involving a variety of dysphoric emotions, most often fear and anxiety. Nightmares have been correlated to various measures of psychopathology, namely neuroticism, anxiety, depression, but not all studies support this relationship. Personality factors, such as nightmare frequency, nightmare distress (ND), and coping style, appear to be important in modulating the clinical severity of nightmare disorder. Parasomnias, especially nightmare and SP, can lead to postawakening anxiety with difficulty returning to sleep, sleep avoidance, and sleep deprivation, with subsequent insomnia, daytime sleepiness, and intensification of the parasomnia REM-rebound related.