Other Dyssomnias

Kleine-Levin syndrome

Kleine-Levin syndrome is a recurrent form of hypersomnia that affects a person three or four times a year. Doctors do not know the cause of this syndrome. It is marked by two to three days of sleeping 18-20 hours per day, an abnormally uninhibited sexual drive, apathy, compulsive eating, and irritability. Men are three times more likely than women to have the syndrome.

The disorder primarily affects adolescent males. When awake, affected individuals may exhibit irritability, lethargy, and/or apathy. They may also appear confused (disoriented) and experience hallucinations. Symptoms of Kleine-Levin syndrome are cyclical. An affected individual may go for weeks or months without experiencing symptoms. When present, symptoms may persist for days to weeks. In some cases, the symptoms associated with Kleine-Levin syndrome eventually disappear with advancing age. However, episodes may recur later during life.

Sleep Starts

Sleep starts are so common that they almost don’t count as a sleep disorder. Most have experience them - a sudden, often violent, jerk of the entire body or one or more body segments that occurs upon falling asleep. Sleep starts are also known as hypnic or hypnagogic jerks. Somewhat related are: a visual sleep start - usually a sensation of blinding light coming from inside the eyes or head and an auditory sleep start - a loud snapping noise that seems to come from inside the head.

Contributing factors that can lead to sleep starts include stress, exercise before bed, and caffeine or other stimulants.

At times, many jerks may occur one after another. They can be frequent, intense, and repetitive. Intense or frequent sleep starts may lead to a fear of falling asleep.

In most people, they only occur from time to time. Sleep starts affect all ages and both men and women.

REM Behavior Disorder (RBD)

Normally, in REM sleep the skeletal muscles are paralyzed. To an external observer, the only movement the sleep body appears to make during REM are normal breathing and fluttering of the eyes. This period of paralysis is called atonia. Contrary to some popular belief, people do not typically “act out” their dreams, at least the dreams that occur duing REM (as many, but not most dreams do.)

For people with a rare type of parasomia, called simply REM Behavior Disorder (RBD), muscle atonia does not occur. These people move their bodies during REM sleep. At their worst, these behaviors can be violent or injurious to the sleeper and may disrupt sleep continuity.

The vast majority of patients afflicted by RBD are older men, over age 45, although women and children as young as 10 years old have been diagnosed. People typically do not remember RBD episodes. Approximately 25% of their RBD patients reported sleep talking, yelling, and excessive limb twitching and jerking during sleep.

Sleep experts have found that half of RBD patients have no discernable underlying cause, while half have a neurological condition that may be related to the RBD. RBD can be one of the first symptoms of childhood narcolepsy.

Conditions which may be linked include subarachnoid hemorrhage, dementia, Parkinson’s disease, cerebrovascular disease, multiple sclerosis, brain stem lesions, and tumors (both benign and cancerous). A doctor may wish to order a brain MRI for a patient diagnosed with RBD. The benzodiazapine anticonvulsant Klonopin (clonazepam) is the treatment of choice for RBD.

Lighter side: An academic paper published last year examined sleep disburbances in Disney animated films. The authors noticed a dog in Cinderella had dream-enactment that resembled RBD and other incidences of RBD were observed in Lady and the Tramp (1955) and The Fox and the Hound (1981), and Pluto’s Judgment Day (1935). The authors conclude "Disney screenwriters were astute observers of sleep and its disorders."

Nocturnal Paroxysmal Dystonia

Nocturnal paroxysmal dystonia is a disorder where the person behaves as if he or she has had an epileptic fit during sleep. Such attacks may take place seven to eight times during one night and each attack last from fifteen to sixty seconds. These attacks typically take place during the non-REM period of sleep. The patient may also wake up from sleep after such a seizure. The behavior pattern of people who suffer from this affliction may also include somnambulism or what is more commonly known as night walking.

Some researchers believe that this disorder is exactly similar to frontal lobe epilepsy but the clinical evidence is not absolutely conclusive. The most common form of treatment of this disorder follows the same route as that taken for treating an epilepsy patient.

Sleep Disorders

Dyssomnias

Parsomnias

"It’s been a hard day’s night
I’ve been workin´ like a dog
It’s been a hard day’s night
And I’ll be sleepin´ like a log…. "

(John Lennon and Paul McCartney)