Abstract
Restless sleep is a common problem in primary care and sleep clinics. Although insomnia is a common cause of restless sleep, motor disturbances when awake or asleep can also sleep disruption. Examples include sensorimotor complaints that interfere with sleep, such as restless legs syndrome, or episodes of complex motor behaviors during sleep, such as parasomnias. When evaluating this type of restless sleeper, a careful history from the patient – and often bedpartner – is crucial in diagnosing restless legs syndrome and parasomnias. Some of these disorders can be diagnosed solely on clinical basis, while others require video polysomnography confirmation. In this chapter, we present three cases that highlight these disorders. We review cases of REM sleep behavior disorder, non-REM parasomnia, parasomnia overlap disorder, and restless legs syndrome. In each of these sections, we discuss the differential diagnosis, evaluation, and management guidelines for these disorders.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Case 1: REM Sleep Behavior Disorder (Similar Case Has Been Discussed in Chap. 7)
Fantini ML, Corona A, Clerici S, Ferini-Strambi L. Aggressive dream content without daytime aggressiveness in REM sleep behavior disorder. Neurology. 2005;65(7):1010–5.
Fernandez-Arcos A, Iranzo A, Serradell M, Gaig C, Santamaria J. The clinical phenotype of idiopathic rapid eye movement sleep behavior disorder at presentation: a study in 203 consecutive patients. Sleep. 2016;39(1):121–32.
American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien: American Academy of Sleep Medicine; 2014.
Hogl B, Iranzo A. Rapid eye movement sleep behavior disorder and other rapid eye movement sleep parasomnias. Continuum (Minneap Minn). 2017;23(4, Sleep Neurology):1017–34.
Frauscher B, Iranzo A, Gaig C, Gschliesser V, Guaita M, Raffelseder V, et al. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep. 2012;35(6):835–47.
Stiasny-Kolster K, Sixel-Doring F, Trenkwalder C, Heinzel-Gutenbrunner M, Seppi K, Poewe W, et al. Diagnostic value of the REM sleep behavior disorder screening questionnaire in Parkinson’s disease. Sleep Med. 2015;16(1):186–9.
Dauvilliers Y, Schenck CH, Postuma RB, Iranzo A, Luppi PH, Plazzi G, et al. REM sleep behaviour disorder. Nat Rev Dis Primers. 2018;4(1):19.
Haba-Rubio J, Frauscher B, Marques-Vidal P, Toriel J, Tobback N, Andries D, et al. Prevalence and Determinants of REM Sleep Behavior Disorder in the General Population. Sleep. 2017;41(2):zsx197.
Kang SH, Yoon IY, Lee SD, Han JW, Kim TH, Kim KW. REM sleep behavior disorder in the Korean elderly population: prevalence and clinical characteristics. Sleep. 2013;36(8):1147–52.
Bjornara KA, Dietrichs E, Toft M. REM sleep behavior disorder in Parkinson’s disease--is there a gender difference? Parkinsonism Relat Disord. 2013;19(1):120–2.
Peever J, Luppi PH, Montplaisir J. Breakdown in REM sleep circuitry underlies REM sleep behavior disorder. Trends Neurosci. 2014;37(5):279–88.
Boeve BF, Silber MH, Ferman TJ, Lin SC, Benarroch EE, Schmeichel AM, et al. Clinicopathologic correlations in 172 cases of rapid eye movement sleep behavior disorder with or without a coexisting neurologic disorder. Sleep Med. 2013;14(8):754–62.
Iranzo A, Fernandez-Arcos A, Tolosa E, Serradell M, Molinuevo JL, Valldeoriola F, et al. Neurodegenerative disorder risk in idiopathic REM sleep behavior disorder: study in 174 patients. PLoS One. 2014;9(2):e89741.
Schenck CH, Boeve BF, Mahowald MW. Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series. Sleep Med. 2013;14(8):744–8.
Schenck CH, Mahowald MW, Kim SW, O'Connor KA, Hurwitz TD. Prominent eye movements during NREM sleep and REM sleep behavior disorder associated with fluoxetine treatment of depression and obsessive-compulsive disorder. Sleep. 1992;15(3):226–35.
Aurora RN, Zak RS, Maganti RK, Auerbach SH, Casey KR, Chowdhuri S, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6(1):85–95.
Case 2: Parasomnia Overlap Disorder
Irfan M, Schenck CH, Howell MJ. Non-rapid eye movement sleep and overlap parasomnias. Continuum (Minneap Minn). 2017;23(4, Sleep Neurology):1035–50.
Dumitrascu O, Schenck CH, Applebee G, Attarian H. Parasomnia overlap disorder: a distinct pathophysiologic entity or a variant of rapid eye movement sleep behavior disorder? A case series. Sleep Med. 2013;14(11):1217–20.
Manni R, Toscano G, Terzaghi M. Therapeutic symptomatic strategies in the parasomnias. Curr Treat Options Neurol. 2018;20(7):26.
Zadra A, Desautels A, Petit D, Montplaisir J. Somnambulism: clinical aspects and pathophysiological hypotheses. Lancet Neurol. 2013;12(3):285–94.
Horvath A, Papp A, Szucs A. Progress in elucidating the pathophysiological basis of nonrapid eye movement parasomnias: not yet informing therapeutic strategies. Nat Sci Sleep. 2016;8:73–9.
Kales A, Soldatos CR, Bixler EO, Ladda RL, Charney DS, Weber G, et al. Hereditary factors in sleepwalking and night terrors. Br J Psychiatry. 1980;137:111–8.
Petit D, Pennestri MH, Paquet J, Desautels A, Zadra A, Vitaro F, et al. Childhood sleepwalking and sleep terrors: a longitudinal study of prevalence and familial aggregation. JAMA Pediatr. 2015;169(7):653–8.
Pressman MR. Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med Rev. 2007;11(1):5–30; discussion 1-3.
Di Fabio N, Poryazova R, Oberholzer M, Baumann CR, Bassetti CL. Sleepwalking, REM sleep behaviour disorder and overlap parasomnia in patients with Parkinson’s disease. Eur Neurol. 2013;70(5-6):297–303.
Drakatos P, Marples L, Muza R, Higgins S, Gildeh N, Macavei R, et al. NREM parasomnias: a treatment approach based upon a retrospective case series of 512 patients. Sleep Med. 2019;53:181–8.
Case 3: Restless Leg Syndrome
Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med. 2014;15(8):860–73.
Ferre S, Garcia-Borreguero D, Allen RP, Earley CJ. New insights into the neurobiology of restless legs syndrome. Neuroscientist. 2018; https://doi.org/10.1177/1073858418791763.
Koo BB. Restless leg syndrome across the globe: epidemiology of the restless legs syndrome/willis-ekbom disease. Sleep Med Clin. 2015;10(3):189–205.
Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005;165(11):1286–92.
Berger K, Luedemann J, Trenkwalder C, John U, Kessler C. Sex and the risk of restless legs syndrome in the general population. Arch Intern Med. 2004;164(2):196–202.
Becker PM, Sharon D. Mood disorders in restless legs syndrome (Willis-Ekbom disease). J Clin Psychiatry. 2014;75(7):e679–94.
Novak M, Winkelman JW, Unruh M. Restless legs syndrome in patients with chronic kidney disease. Semin Nephrol. 2015;35(4):347–58.
Patatanian E, Claborn MK. Drug-induced restless legs syndrome. Ann Pharmacother. 2018;52(7):662–72.
Rye DB. The molecular genetics of restless legs syndrome. Sleep Med Clin. 2015;10(3):227–33.
Connor JR, Ponnuru P, Wang XS, Patton SM, Allen RP, Earley CJ. Profile of altered brain iron acquisition in restless legs syndrome. Brain. 2011;134(Pt 4):959–68.
Earley CJ, Allen RP, Beard JL, Connor JR. Insight into the pathophysiology of restless legs syndrome. J Neurosci Res. 2000;62(5):623–8.
Winkelmann J, Allen RP, Hogl B, Inoue Y, Oertel W, Salminen AV, et al. Treatment of restless legs syndrome: evidence-based review and implications for clinical practice (revised 2017). Mov Disord. 2018;33(7):1077–91.
Connor JR, Wang XS, Allen RP, Beard JL, Wiesinger JA, Felt BT, et al. Altered dopaminergic profile in the putamen and substantia nigra in restless leg syndrome. Brain. 2009;132(Pt 9):2403–12.
Garcia-Borreguero D, Silber MH, Winkelman JW, Hogl B, Bainbridge J, Buchfuhrer M, et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation. Sleep Med. 2016;21:1–11.
Voon V, Schoerling A, Wenzel S, Ekanayake V, Reiff J, Trenkwalder C, et al. Frequency of impulse control behaviours associated with dopaminergic therapy in restless legs syndrome. BMC Neurol. 2011;11:117.
Silber MH, Becker PM, Buchfuhrer MJ, Earley CJ, Ondo WG, Walters AS, et al. The appropriate use of opioids in the treatment of refractory restless legs syndrome. Mayo Clin Proc. 2018;93(1):59–67.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Torres Rivera, E., Malkani, R.G. (2021). Restless Sleeper. In: Sahni, A.S., Sampat, A., Attarian, H. (eds) Sleep Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-65302-6_4
Download citation
DOI: https://doi.org/10.1007/978-3-030-65302-6_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-65301-9
Online ISBN: 978-3-030-65302-6
eBook Packages: MedicineMedicine (R0)