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Therapeutic Symptomatic Strategies in the Parasomnias

  • Sleep Disorders (A Iranzo, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

The purpose of this review was to discuss the currently available pharmacologic and non-pharmacologic treatment options for parasomnias.

Recent findings

Recent pathophysiological findings about sleep structure in parasomnias helped understanding several drug mechanisms of action. Serotoninergic theory accounts for the effect of serotoninergic drugs. Study about spectral analysis of sleep showed the effect of clonazepam on spectral bands. Cannabinoids proved to be effective in some of parasomnias, as in many other neurological disorders.

Summary

A series of therapeutic strategies were analyzed and compared. Benzodiazepines, antidepressant drugs, and l-5-hydroxytryptophan may be beneficial in DOA. SSRI and topiramate are effective in SRED. RBD responds to clonazepam, melatonin, and to a lesser extent to dopaminergic and anticholinergic agents. Prazosin and cannabinoids are effective in nightmare disorder. Sleep paralysis may respond to antidepressant agents. Tricyclic antidepressant may be effective in sleep-related hallucinations and exploding head syndrome. Sleep enuresis may be successfully treated with desmopressin, anticholinergic drugs, and imipramine.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Academy of Sleep Medicine, International classification of sleep disorders, rd ed. Darien, IL, 2014.

  2. Stallman H, Kohler M. Prevalence of sleepwalking: a systematic review and meta-analysis. PlosOne. 2016;11(11):10.

    Article  CAS  Google Scholar 

  3. Derry C, Harvey A, Walker M, Duncan J, Berkovic S. NREM arousal parasomnias and their distinction from nocturnal frontal lobe epilepsy: a video EEG Analysis. Sleep. 2009;32(12):1637–44.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Broughton J. Sleep disorders: disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in “dreaming sleep”. Science. 1968;159(3819):8.

    Article  Google Scholar 

  5. Nir Y, Staba R, Andrillon T, Vyazovskiy V, Cirelli C, Fried I, et al. Regional slow waves and spindles in human sleep. Neuron. 2011;70:153–69.

  6. Januszko P, Niemcewicz S, Gajda T, Wolynczyk-Gmaj D, Piotrowska A, Gmaj B, et al. Sleepwalking episodes are preceded by arousal-related activation in the cingulate motor area: EEG current density imagine. Clin Neurophysion. 2016;127:530–6.

  7. Terzaghi M, Sartori I, Tassi G, Didato G, Rustioni V, LoRusso G, et al. Evidence of dissociated arousal states during NREM parasomnia from an intracerebral neurophysiological study. Sleep. 2009;32:409–12.

  8. Gibbs S, Proserpio P, Terzaghi M, Pigorini A, Sarasso S, Lo Russo G, et al. Sleep-related epileptic behaviors and non-REM-related parasomnias: insights from stereo-EEG. Sleep Med Rev. 2016;25:4–20.

  9. Terzaghi M, Sartori I, Tassi L, Rustioni V, Proserpio P, Lorusso G, et al. Dissociated local arousal states underlying essential cliical features of non-rapid eye movement arousal parasomnia: an intracerebral stero-electroencephalographic study. J Sleep Res. 2012;21(5):502–6.

  10. Halasz P, Kelemen A, Szücs A. Physiopathogenetic interrelationship between nocturnal frontal lobe epilepsy and NREM arousal parasomnias. Epilepsy Res Treat. 2012;312693:2012.

    Google Scholar 

  11. Terzaghi M, Manni R. Mapping the features of arousal parasomnias in adults: on the way to better undersand arousal parasomnias and ease differential diagnosis. Sleep Med. 2015;16:1439–40.

    Article  PubMed  Google Scholar 

  12. Siclari F, Khatami R, Urbanlok F, Nobili L, Mahowald MW, Schenck CH, et al. Violence in sleep. Brain. 2010;33(Pt 12):3494–509.

  13. Lopez R, Jaussent I, Scholz S, Bayard S, Montplaisir J, Dauvilliers Y. Functional impairment in adult sleepwalkers: a case-control study. Sleep. 2013;36(3):345–51.

    PubMed  PubMed Central  Google Scholar 

  14. Attarian H. Treatment options for parasomnias. Neurol Clin. 2010;8(4):1089–106.

    Article  Google Scholar 

  15. Howell MJ. Parasomnias: an updated review. Neurotherapeutics. 2012;9(4)

  16. Tinuper P, Bisulli F, Provini F. The parasomnias: mechanisms and treatment. Epilepsia. 2012;53(s7):12–9.

    Article  PubMed  Google Scholar 

  17. Pressman M. Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med Rev. 2007;11(1):5–30.

    Article  PubMed  Google Scholar 

  18. Kotagal S. Treatment of dyssomnias and parasomnias in childhood. Curr Treat Options Neurol. 2012;14(6):630–49.

    Article  PubMed  Google Scholar 

  19. Galbiati A, Rinaldi F, Giora E, Ferini-Strambi L, Marelli S. Behavioural and cognitive-behavioural treatments of parasomnias. Behav Neurol. pp. Article ID 786928, 8 pages, 2015. This is an updated review of non pharmachological therapeutic options in NREM and REM and other rare parasomnias.

  20. Guilleminault C, Kirisoglu C, Bao G, Arias V, Chan A, Li K. Adult chronic sleepwalking and its treatment based on polysomnography. Brain. 2005;128(Pt 5):1062–9.

    Article  PubMed  Google Scholar 

  21. Cochen De Cock V. Sleepwalking. Curr Treat Options Neurol. 2016;18(2):6.

    Article  PubMed  Google Scholar 

  22. Schenck C, Milner D, Hurwitz T, Bundlie S, Mahowald M. A polysomnographic and clinical report on sleep-related injury in 100 adult patients. Am J Psychiatry. 1989;146(9):1166–73.

    Article  PubMed  CAS  Google Scholar 

  23. Schenck C, Mahowald M. Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am J Med. 1996;100(3):333–7.

    Article  PubMed  CAS  Google Scholar 

  24. Attarian H, Zhu L. Treatment options for disorders of arousal: a case series. Int J Neurosci. 2013;123(9):623–5.

    Article  PubMed  CAS  Google Scholar 

  25. Remulla A, Guilleminault C. Sonnambulism (sleepwalking). Expert Opin Pharmacother. 2004;5(10):2069–74.

    Article  PubMed  CAS  Google Scholar 

  26. Reid W, Haffke E, Chu C. Diazepam in intractable sleepwalking: a pilot study. Hillside J Clin Psychiatry. 1984;6(1):49–55.

    PubMed  CAS  Google Scholar 

  27. Berlin R, Qayyum U. Sleepwalking: diagnosis and treatment through the life cycle. 1986;27(11):755–60.

  28. Kavey N, Whyte J, Restor SJ, Gidro-Frank S. Sonnambulism in adults. Neurology. 1990;40(5):749–52.

    Article  PubMed  CAS  Google Scholar 

  29. Cooper A. Treatment of coexistent night-terrors and somnambulism in adults with imipramine and diazepam. J Clin Psychiatry. 1987;48(5):209–10.

    PubMed  CAS  Google Scholar 

  30. Balon R. Sleep terror disorder and insomnia treated with trazodone: a case report. Am Clin Psychiatry. 1994;6(3):161–3.

    CAS  Google Scholar 

  31. Wilson S, Lillywhite A, Potokar JP, Bell C, Nutt D. Adult night terrors and paroxetine. Lancet. 1997;350(9072):185.

    PubMed  CAS  Google Scholar 

  32. Frölich J, Wiater A, Gerd Lehmkuhl J. Successful treatment of severe parasomnias with paroxetine in a 12-year-old boy. Int J Psychiatry Clin Pract. 2001;5(3):215–8.

    Article  Google Scholar 

  33. Lillywhite A, Wilson S, Nutt D. Successful treatment of night terrors and somnambulism with paroxetine. Br J Psychiatry. 1994;164(4):551–4.

    Article  PubMed  CAS  Google Scholar 

  34. Kawashima T, Yamada S. Paroxetine-induced somnambulism. J Clin Psychiatry. 2003;64(4):483.

    Article  PubMed  Google Scholar 

  35. Juszczak G, Swiergiel A. Serotoninergic hypothesis of sleepwalking. Med Hypotheses. 2005;64(1):28–32.

    Article  PubMed  CAS  Google Scholar 

  36. Bruni O, Ferri R, Milano S, Verrillo E. L-5-Hydroxytryptophan treatment of sleep terrors in children. Eur J Pediatr. 2004;163(7):402–7.

    Article  PubMed  CAS  Google Scholar 

  37. Sasayama D, Washizuka S, Honda H. Effective treatment of night terrors and sleepwalking with ramelteon. J Child Adolesc Psychopharmacol. 2016;26(10):948.

    Article  PubMed  Google Scholar 

  38. Winkelman J. Clinical and polysomnographic features of sleep-related eating disorder. J Clin Psychiatry. 1998;59(1):14–9.

    Article  PubMed  CAS  Google Scholar 

  39. Schenck C, Hurwitz T, Bundlie S, Mahowald M. Sleep-related eating disorders: polysomnographic correlates of a heterogeneous syndrome distinct from daytime eating disorders. Sleep. 1991;14(5):419–31.

    Article  PubMed  CAS  Google Scholar 

  40. Markov D, Jaffe F, Doghramji K. Update on parasomnias. Psychiatry. 2006;3(7):69–76.

    PubMed  PubMed Central  Google Scholar 

  41. Inoue Y. Sleep-related eating disorder and its associated conditions. Psychiatry Clin Neurosci. 2015;69(6):309–20.

    Article  PubMed  Google Scholar 

  42. Howell M, Schenck C. Restless nocturnal eating: a common feature of Willis-Ekbom syndrome (RLS). J Clin Sleep Med. 2012;8(4):413–9.

    PubMed  PubMed Central  Google Scholar 

  43. Auger R. Sleep-related eating disorders. Psychiatry. 2006;3(11):64–70.

    PubMed  PubMed Central  Google Scholar 

  44. Brion A, Flamand M, Oudiette D, Voillery D, Golmard J, Arnulf I. Sleep-related eating disorder versus sleepwalking: a controlled study. Sleep Med. 2012;13(8):1094–101.

    Article  PubMed  Google Scholar 

  45. Chiaro G, Caletti M, Provini F. Treatment of sleep-related eating disorder. Curr Treat Options Neurol. 2015;17(8):361. Selective serotonin reuptake inhibitors (SSRIs) at mean dosages of 20 to 30 mg/day are considered as first-line treatment of SRED. Topiramate at 100–300 mg/day and clonazepam at 0.5–2.0 mg/day are recommended as alternative options. Treatment of comorbid sleep disorders is of primary importance in SRED related to other parasomnias or sleep disturbances.

    Article  PubMed  Google Scholar 

  46. Schenck C, Hurwitz T, O’Connor K, Mahowald M. Additional categories of sleep-related eating disorders and the current status of treatment. Sleep. 1993;16(5):457–66.

    PubMed  CAS  Google Scholar 

  47. Santin J, Mery V, Elso M, Retamal E, Torres C, Ivelic J. Sleep-related eating disorder: a descriptive study in Chilean patients. Sleep Med. 2014;15(2):163–7.

    Article  PubMed  Google Scholar 

  48. Miyakota T, Yasukawa R, Tsubouchi K, Miura S, Shimizu Y, Sukegawa T. Successful treatment of nocturnal eating/drinking syndrome with selective serotonin reuptake inhibitors. Int Clin Psychopharmacol. 2003;18(3):175–7.

    Google Scholar 

  49. Winkelman J. Efficacy and tolerability of open-label topiramate in the treatment of sleep-related eating disorder: a retrospective case series. J Clin Psychiatry. 2006;67(11):1729–34.

    Article  PubMed  CAS  Google Scholar 

  50. Wilkes J, Nelson E, Osborne M, Demarest K, Olefsky J. Topiramate is an insulin-sensitizing compound in vivo with direct effects on adipocytes in female ZDF rats. Am J Physiol Endocrinol Metab. 2005;288(3):E617–24.

    Article  PubMed  CAS  Google Scholar 

  51. Liang Y, Chen X, Osborne M, DeCarlo S, Jetton T, Demarest K. Topiramate ameliorates hyperglycaemia and improves glucose-stimulated insulin release in ZDF rats and db/db mice. Diabetes Obes Metab. 2005;7(4):360–9.

    Article  PubMed  CAS  Google Scholar 

  52. Winkelman J. Treatment of nocturnal eating syndrome and sleep-related eating disorder with topiramate. Sleep Med. 2003;4(3):243–6.

    Article  PubMed  Google Scholar 

  53. Provini F, Albani F, Vetrugno R, Vignatelli L, Lombardi C, Plazzi G. A pilot double-blind placebo-controlled trial of low-dose pramipexole in sleep-related eating disorder. Eur J Neurol. 2005;12(6):432–6.

    Article  PubMed  CAS  Google Scholar 

  54. Cornella C, Nadrdine T, Diederich N, Stebbins G. Sleep-related violence, injury and REM sleep behavior disorder in Parkinsons’s disease. Neurology. 1998;51:526–9.

    Article  Google Scholar 

  55. McCarter S, St Louis E, Boswell C, Dueffert L, Slocumb N, Boeve B, et al. Factors associated with injury in REM sleep behavior disorder. Sleep Med. 2014;15(11):1332–8.

  56. Olson E, Boeve B, Silber M. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain. 2000;123(Pt 2):331–9.

    Article  PubMed  Google Scholar 

  57. Aurora R, Zak R, Maganti R, Auerbach S, Casey K, Chowdhuri S, et al. Standards of Practice Committee and American Academy of Sleep Medicine, Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6(1):85–95.

  58. Frauscher B, Jennum P, Ju Y, Postuma R, Arnulf I, Cochen De Cock V, et al. Comorbidity and medication in REM sleep behavior disorder: a multicenter case-control study. Neurology. 2014;82(12):1076–9.

  59. Postuma R, Gagnon J, Tuineaig M, Bertrand J, Latreille V, Desjardins C, et al. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal? Sleep. 2013;36(11):1579–85.

  60. Parish J. Violent dreaming and antidepressant drugs: or how paroxetine made me dream that I was ghting Saddam Hussein. J Clin Sleep Med. 2007;3:529–31.

    PubMed  PubMed Central  Google Scholar 

  61. Schenck C, Mahowald M, Kim S, O’Connor K, Hurwitz T. Prominent eye movements during nrem sleep and rem sleep behavior disorder associated with uoxetine treatment of depression and obsessive-compulsive disorder. Sleep. 1992;15:226–35.

    Article  PubMed  CAS  Google Scholar 

  62. Schutte S, Doghramji K. REM behavior disorder seen with venlafaxine (efexor). Sleep Res. 1996;364:25.

    Google Scholar 

  63. Onofrj M, Thomas A, Nash J, Wilson S, Potokar J, Nutt D. Mirtazapine induces REM sleep behavior disorder (RBD) in parkinsonism—correspondence. Neurology. 2003;1161:61.

    Google Scholar 

  64. Tan L, Zhou J, Liang B, Li Y, Lei F, Du L, et al. A case of quetiapine-induced rapide eye movement sleep behavior disorder. Biol Psychiatry. 2016;79(5):e11–2.

  65. Iranzo A, Santamaria J. Bisoprolol-induced rapid eye movement sleep behavior disorder. Am J Med. 1999;107:390–2.

    Article  PubMed  CAS  Google Scholar 

  66. Silber M. REM sleep behavior disorder associated with barbiturate withdrawal. Sleep Res. 1996;371:25.

    Google Scholar 

  67. Manni R, Ratti P, Terzaghi M. Secondary “incidental” REM sleep behavior disorder: do we ever think of it? Sleep Med. 2011;12(Suppl 2):S50–3.

    Article  PubMed  Google Scholar 

  68. Chiu H, Wing Y, Lam L. Sleep-related injury in the elderly—an epidemiological study in Hong Kong. Sleep. 2000;23:1–5.

    Article  Google Scholar 

  69. Wing Y, Lam S, Li S. REM sleep behaviour disorder in Hong Kong Chinese: clinical outcome and gender comparison. J Neurol Neurosurg Psychiatry. 2008;79:1415–6.

    Article  PubMed  CAS  Google Scholar 

  70. Schenck C, Mahowald M. A polysomnographic, neurologic, psychiatric, and clinical outcome report on 70 consecutive cases with REM sleep behavior disorder (RBD): sustained clonazepam efficacy in 89.5% of 57 treated patients. Clev Clin J Med. 1990;57(Suppl):S9–S23.

    Google Scholar 

  71. Mahowald M, Schenck C. Principles and practice of sleep medicine, 4th ed. In: Rem Sleep Parasomnias. Philadelphia: Elsevier Saunders; 2005.

    Chapter  Google Scholar 

  72. Abad V, Guilleminault C. Review of rapid eye movement behavior sleep disorders. Review of rapid eye movement behavior sleep disorders. 2004;157–63:4.

    Google Scholar 

  73. Raskind M, Peterson K, Williams T, Hoff D, Hart K, Holmes H, et al. A trial of prazosin for combat trauma PTSD with nightmares in active-dury soldiers returned from Iraq and Afghanistan. Am J Psychiatry. 2013;170:1003–10.

  74. Schenck C, Bundlie S, Ettinger M, Mahowald M. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep. 1986;9(2):293–308.

    Article  PubMed  CAS  Google Scholar 

  75. Li S, Lam S, Zhang J, Yu M, Chan J, Liu Y, et al. A prospective, naturalistic follow-up study of treatment outcomes with clonazepam in rapid eye movement sleep behavior disorder. Sleep Med. 2016;21:114–20. Thirty-nine iRBD patients (mean age at diagnosis: 68.3 ± 7.8 years) were studied with a follow-up duration of 28.8 ± 13.3 months. Clonazepam treatment proved to differentially change dream effect and content and to reduce verbal and motor behaviors. However, residual RBD symptoms persisted.

  76. McCarter S, Boswell C, St Louis E, Dueffert L, Slocumb N, Boeve B, et al. Treatment outcomes in REM sleep behavior disorder. Sleep Med. 2013;14(3):237–42.

  77. Terzaghi M, Sartori I, Rustioni V, Manni R. Sleep disorders and acute nocturnal delirium in the elderly: a comorbidity not to be overlooked. Eur J Intern Med. 2014;25(4):350–5.

    Article  PubMed  Google Scholar 

  78. Lapierre O, Montplaisir J. Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology. 1992;42(7):1371–4.

    Article  PubMed  CAS  Google Scholar 

  79. Ferri R, Rundo F, Silvani A, Zucconi M, Bruni O, Ferini-Strambi L, et al. REM sleep EEG instability in REM sleep behavior disorder and clonazepam effects. Sleep. 2017;40(8):1.

  80. Ferri R, Marelli S, Ferini-Strambi L, Oldani A, Colli F, Schenck CH, et al. An observational clinical and video-polysomnographic study of the effects of clonazepam in REM sleep behavior disorder. Sleep Medicine. 2013;14(1):24–9.

  81. Kunz D, Mahlberg R. A two-part, double-blind, placebo-controlled trial of exogenous melatonin in REM sleep behavior disorder. J Sleep Res. 2010;19(4):591–6.

    Article  PubMed  Google Scholar 

  82. Xie Z, Chen F, Li W, Geng X, Li C, Meng X, et al. A review of sleep disorders and melatonin. Neurol Res. 2017;39(6):559–65.

  83. Boeve B, Silber M, Ferman T. Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med. 2003;281–4:4.

    Google Scholar 

  84. Kunz D, Bes F. Melatonin as a therapy in REM sleep behavior disorder patients: an open-labaled pilot study on the possible influencec of melatonin on REM-sleep regulation. Mov Disord. 1999;14(3):507–11.

    Article  PubMed  CAS  Google Scholar 

  85. Nomura T, Kawase S, Watanabe Y, Nakashima K. Use of ramelteon for the treatment of secondary REM sleep behavior disorder. Intern Med. 2013;52(18):2123–6.

    Article  PubMed  Google Scholar 

  86. Esaki Y, Kitajima T, Koike S, Fujshiro H, Iwata Y, Tsuchiya A, et al. An open-labeled trial of ramelteon in idiopathic rapid eye movement sleep Behavior Disorder. Clin Sleep Med. 2016;12(5):689–93.

  87. Bonakis A, Economou N, Papageorgiou S, Vagiakis E, Nanas S, Paparrigopoulos T. Agomelatine may improve REM sleep behavior disorder symptoms. J Clin Psychipharmacol. 2012;32(5):732–4.

    Article  Google Scholar 

  88. Fantini M, Cagnon J, Filipini D, Montplaisir J. The effects of pramipexole in REM sleep behavior disorder. Neurology. 2003;61(10):1418–20.

    Article  PubMed  CAS  Google Scholar 

  89. Schmidt M, Koshal V, Schmidt H. Use of pramipexole in REM sleep behavior disorder: results from a case series. Sleep Med. 2006;7(5):418–23.

    Article  PubMed  Google Scholar 

  90. Sasai T, Matsuura M, Ionue Y. Factors associated with the effect of pramipexole on symptoms of idiopathic REM sleep behavior disorder. Parkinsonism and Related Disorders. 2013;19:153–7.

    Article  PubMed  Google Scholar 

  91. Rye D. Contributions of the pedunculopontine region to normal and altered REM sleep. Sleep. 1997;20(9):757–88.

    Article  PubMed  CAS  Google Scholar 

  92. Ringman J, Simmons J. Treatment of REM sleep behavior disorder with donepezil: a report of three cases. Neurology. 2000;55(6):870–1.

    Article  PubMed  CAS  Google Scholar 

  93. Di Giacopo R, Fasano A, Quaranta D, Della Marca G, Bove F, Bentivoglio A, et al. Mov Disord. 2012;27(4):559–61.

    Article  PubMed  CAS  Google Scholar 

  94. Brunetti V, Losurdo A, Testani E, Lapenta L, Mariotti P, Marra C, et al. Rivastigmine for refractory REM behavior disorder in mild cognitive impairment. Curr Alzheimer Res. 2014;11(3):267–73.

  95. Massironi G, Galluzzi S, Frisoni G. Drug treatment of REM sleep behavior disorders in dementia with Lewy bodies. Int Psychogeriatr. 2003;15(4):377–83.

    Article  PubMed  Google Scholar 

  96. Boeve B, Silber M, Ferman T. Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med. 2003;4(4):281–4.

    Article  PubMed  Google Scholar 

  97. Yeh S, Yeh P, Schenck C. Rivastigmine.induced REM sleep behavior disorder (RBD) in a 88-year-old man with Alzheimer’s disease. J Clin Sleep Med. 2010;6(2):192–5.

    PubMed  PubMed Central  Google Scholar 

  98. Terzaghi M, Arnaldi D, Rizzetti M, Minafra B, Cremascoli R, Rustioni V, et al. Analysis of video-polysomnographic sleep findings in dementia with Lewy Bodies. Mov Disord. 2013;28(10):1416–23.

  99. Babson K, Sottile J, Morabito D. Cannabis, cannabinoids, and sleep: a review of the literature. Curr Psychiatry Rep. 2017;19(4):23.

    Article  PubMed  Google Scholar 

  100. Chagas M, Eckeli A, Zuardi A, Pena-Pereira M, Sobreira-Neto M, Sobreira E, et al. Cannabidiol can improve complex sleep-related behaviors associated with rapid eye movement sleep behavior disorder in Parkinson’s disease patients: a case series. J Clin Pharm Ther. 2014;39(5):564–6.

  101. Bonakis A, Howard R, Williams A. Narcolepsy presenting as REM sleep behaviour disorder. Clin Neurol Neurosurg. 2008;518–20:110.

    Google Scholar 

  102. Anderson K, Shneerson J. Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam. J Clin Sleep Med. 2009;5(3):235–9.

    PubMed  PubMed Central  Google Scholar 

  103. Jung Y, St Louis E. Treatment of REM sleep behavior disorder. Curr Treat Options. 2016;18(11):50. This is a comprehensive review of therapeutic options in RBD. Melatonin 3–12 mg and clonazepam 0.25–2 mg with most advisable dosages of 6 and 0.5 mg respectively are considered as first-line treatment. Alternative second- and third-line therapies with anecdotal efficacy of temazepam, lorazepam, zolpidem, zopiclone, pramipexole, donepezil, ramelteon, agomelatine, cannabinoids, and sodium oxybate are reported. Non-pharmacological options are also considered.

    Article  Google Scholar 

  104. Moghadam K, Pizza F, Primavera A, Ferri R, Plazzi G. Sodium oxybate for idiopathic REM sleep behavior disorder: a report on two patients. Sleep Med. 2017;31:16–21.

    Article  Google Scholar 

  105. Shneerson J. Successful treatment of REM sleep behavior disorder with sodium oxybate. Clin Neuropharmacol. 2009;32(3):158–9.

    Article  PubMed  CAS  Google Scholar 

  106. Aurora R, Zak R, Auerbach S, Casey K, Chowdhueri S, Karippot A, et al. Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med. 2010;6(4):389–401.

  107. Kung S, Espinel Z, Lapid M. Treatment of nightmares with prazosin: a systematic review. Mayo Clin Proc. 2012;87:890–900.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  108. George K, Kebejian L, Ruth L, Miller C, Himelhoch S. tsaMeta-analysis of the efficacy and safety of prazosin versus placebo for the treatment of nightmares and sleep disturbances in adults with posttraumatic stress disorder. J Trauma Dissociation. 2016;17(4):494–510. The meta-analysis document the efficacy of prazosin in treating PTSD-related nightmares. Prazosin proved to be well tolerated and not to induce arterial hypertension, when carefully titrated.

  109. Hudson S, Whiteside T, Lorenz R, Wargo K. Prazosin for hte treatment of nightmares related to posttraumatic stess disorder: a review of the literature. The primary Care Companion to CNS disorders. 2012;14(2)

  110. Miller K, Brownlow J, Woodward S, Gehrman P. Sleep and dreaming in posttraumatic Stress disorder. Curr Psychiatry Rep. 2017;19(10):71.

    Article  PubMed  Google Scholar 

  111. Miyazaki S, Uchida S, Mukai J, Nishihara K. Clonidine effects on all-night human sleep: opposite action of low- and medium-dose clonidine on human NREM-REM sleep proportion. Psychiatry Clin Neurosci. 2004;58(2):138–44.

    Article  PubMed  CAS  Google Scholar 

  112. Kinzie J, Leung P. Clonidine in Cambodian patients with posttraumatic stress disorder. J Nerv Ment Dis. 1989;177(9):546–50.

    Article  PubMed  CAS  Google Scholar 

  113. Kinzie J, Sack R, Riley C. The polysomnographic effects of clonidine on sleep disorders in posttraumatic stress disorder: a pilot study with Cambodian patients. J Nerv Ment Dis. 1994;182(10):585–7.

    Article  PubMed  CAS  Google Scholar 

  114. Roitman P, Mechoulam R, Cooper-Kazaz R, Shalev A. Preliminary, open-label, pilot study of add-on oral Δ9-tetrahydrocannabinol in chronic post-traumatic stress disorder. Clin Drug Investig. 2014;34(8):587–91. Ten patients with chronic PTSD received Δ9-tetrahydrocannabinol 5 mg bid as add-on treatment, with significant improvement in global symptom severity, sleep quality, and frequency of nightmares.

    Article  PubMed  CAS  Google Scholar 

  115. Jetly R, Heber A, Fraser G, Boisvert D. The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology. 2015;51:585–8.

    Article  PubMed  CAS  Google Scholar 

  116. Cameron C, Watson D, Robinson J. Use of a synthetic cannabinoid in a correctional population for posttraumatic stress disorder-related insomnia and nightmares, chronic pain, harm reduction, and other indications: a retrospective evaluation. J Clin Psychopharmacol. 2014;34(5):559–64.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  117. Jeffreys M, Capehart B, Friedman M. Pharmacotherapy for posttraumatic stress disorder: review with clinical application. J Rehabil Res Dev. 2012;49(6):703–15.

    Article  PubMed  Google Scholar 

  118. Detweiler M, Pagadala B, Candelario J, Boyle J, Detweiler J, Lutgens B. Treatment of post-traumatic stress disorder nightmares at a Veterans Affairs Medical Center. J Clin Med. 2016;5(12):117.

    Article  PubMed Central  CAS  Google Scholar 

  119. Terzaghi M, Ratti P, Manni F, Manni R. Sleep paralysis in narcolepsy: more than just a motor dissociative phenomenon? Neurol Sci. 2012;33(1):169–72.

    Article  PubMed  Google Scholar 

  120. Hishikawa Y, Ida H, Nakai K, Kaneko Z. Treatment of narcolepsy with imipramine (tofranil) and desmethylimipramine (pertofran). Neurol Sci. 1966;3(5):453–61.

    Article  CAS  Google Scholar 

  121. Guilleminault C, Raynal D, Takahashi S, Carskadon M, Dement W. Evaluation of short-term and long-term treatment of the narcolepsy syndrome with clomipramine hydrochloride. Acta Neurol Scand. 1976;54(1):71–87.

    Article  PubMed  CAS  Google Scholar 

  122. Mitler M, Hajdukovic R, Erman M, Koziol K. Narcolepsy. J Clin Neurophysion. 1990;7(1):93–118.

    Article  CAS  Google Scholar 

  123. Koran L, Rahavan S. Fluoxetine for isolated sleep paralysis. Psychosomatics. 1993;34(2):184–7.

    Article  PubMed  CAS  Google Scholar 

  124. Schrader H, Kayed K, Bendixen Markset A, Treidene H. The treatment of accessory symptoms in narcolepsy: a double-blind cross-over study of a selective serotonin re-uptake inhibitor (femoxetine) versus placebo. Acta Neurol Scand. 1986;74(4):297–303.

    Article  PubMed  CAS  Google Scholar 

  125. Abad V, Guilleminault C. New developments in the management of narcolepsy. Nat Sci Sleep. 2017;9:39–57.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Frese A, Summ O, Evers S. Exploding head syndrome: six new cases and review of the literature. Cephalalgia. 2014;34(10):823–7.

    Article  PubMed  Google Scholar 

  127. Sachs C, Svanborg E. The exploding head syndrome: polysomnographic recordings and therapeutic suggestions. Sleep. 1991;14(3):263–6.

    Article  PubMed  CAS  Google Scholar 

  128. Chakravarty A. Exploding head syndrome: report of two new cases. Cephalalgia. 2008;28(4):399–400.

    Article  PubMed  CAS  Google Scholar 

  129. Jacome D. Exploding head syndrome and idiopathic stabbing headache relieved by nifedipine. Cephalalgia. 2001;21(5):617–8.

    Article  PubMed  CAS  Google Scholar 

  130. Palikh G, Vaughn B. Topiramate responsive exploding head syndrome. J Clin Sleep Med. 2010;6(4):382–3.

    PubMed  PubMed Central  Google Scholar 

  131. Sharpless B. Exploding head syndrome. Sleep Med Rev. 2014;18(6):489–93.

    Article  PubMed  Google Scholar 

  132. Harari M. Nocturnal enuresis. J Paediatr Child Health. 2013;49(4):264–71.

    Article  PubMed  Google Scholar 

  133. Caldwell P, Nankivell G, Sureshkumar P. Simple behavioural interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2013;(7):CD003637.

  134. Jain S, Bhatt G. Advances in the management of primary monosymptomatic nocturnal enuresis in children. Paediatr Int Child Health. 2016;36(1):7–14.

    Article  PubMed  Google Scholar 

  135. Kuwertz-Bröking E, von Gontard A. Clinical management of nocturnal enuresis. Paediatr Nephrol. 2017;

  136. Glazener C, Evans J, Cheuk D. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2005;(2):CD005230.

  137. Neveus T, Eggert P, Evans J, Macedo A, Rittig S, Tekgül S, et al. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children’s Continence Society. J Urol. 2010;183(2):441–7.

  138. Nevéus T. Nocturnal enuresis-theoretic background and practical guidelines. Pediatr Nephrol. 2011;26(8):1207–14.

    Article  PubMed  PubMed Central  Google Scholar 

  139. Gish P, Mosholder A, Truffa M, Johann-Liang R. Spectrum of central anticholinergic adverse effects associated with oxybutynin: comparison of pediatric and adult cases. J Pediatr. 2009;432–434:155.

    Google Scholar 

  140. 4th International Consultation on Incontinence, 2009.

  141. Yu J, Yan Z, Zhou S, Han F, Xiao F, Han J, et al. Desmopressin plus anticholinergic agent in the treatment of nocturnal enuresis: a meta-analysis. Exp Ther Med. 2017;14(4):2875–84. The efficacy and safety of the therapy combining desmopressin and anticholinergics compared with desmopressin monotherapy in treating nocturnal enuresis is stressed.

  142. Deshpande A, Caldwell P, Sureshkumar P. Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics). Cochrane Database Syst Rev. 2012;12:CD002238.

    PubMed  Google Scholar 

  143. Varley C. Sudden death of a child treated with imipramine. Case study. J Child Adolesc Psychopharmachol. 2000;10:321–5.

    Article  CAS  Google Scholar 

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Manni, R., Toscano, G. & Terzaghi, M. Therapeutic Symptomatic Strategies in the Parasomnias. Curr Treat Options Neurol 20, 26 (2018). https://doi.org/10.1007/s11940-018-0508-3

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