CHICAGO — Sleep is as essential to life and productivity during the day as it can be elusive and frustrating come nightfall. Plenty of people struggle with sleeping issues such as insomnia or sleep apnea, but the silver lining to these conditions is that there is a wealth of well-vetted guidelines and evidence-based treatments available to help. However, that’s not the case for more uncommon conditions — like sexsomnia.
Researchers from Northwestern University warn that the outlook is much less promising for patients diagnosed with arousal disorders such as sleepwalking, sleep eating, sleep terrors (screaming and intense fear while asleep), and sexsomnia (engaging in sexual activity during sleep). While these sleeping conditions are often the subject of jokes on television, they can be legitimately dangerous for patients if left untreated.
Despite that, the team at Northwestern says there are currently no consensus treatment guidelines on how best to address these disorders.
Led by Jennifer Mundt, assistant professor of neurology at the Northwestern University Feinberg School of Medicine, study authors performed the first-ever systematic review on the treatment of NREM (non-rapid eye movement) parasomnias. Many of the 72 studied publications published between 1909 and 2023 were only case reports or uncontrolled trials.
“These disorders can be dangerous and result in injuries to the sleeper or loved ones, so it’s important that symptoms are evaluated and treated,” Prof. Mundt says in a media release. “And we need to have guidelines, so patients are getting the most effective treatment, which is not necessarily a medication.”
All in all, Prof. Mundt stresses the need for randomized, controlled trials in order to gauge the efficacy of behavioral treatments for these parasomnias. While performing their analysis, study authors noted that the treatments with the most evidence of effectiveness include hypnosis, cognitive behavioral therapy, better sleep hygiene, and scheduled awakenings (waking the patient up shortly before the time they usually experience a parasomnias episode).
Prof. Mundt usually specializes in behavioral treatments for various sleep disorders like insomnia, nightmares, NREM parasomnias, narcolepsy, and idiopathic hypersomnia. In many cases, patients don’t even remember what they did the night before, or may only have a vague recollection of it.
“Some people don’t know they have it or what’s going on with them at night,” Prof. Mundt explains. “They may not come into a sleep clinic until they’ve injured themselves. Or, they say, ‘My kitchen had all these wrappers on the counter, so I know I was eating.’”
“I’ve had some people video themselves at night, trying to confirm what’s happening. It’s unsettling to not know what you are doing in your sleep. I’ve seen people who have ended up in the emergency room with cuts or lacerations from punching a window or mirror or wall.”
“I’ve had people who have taken medication in their sleep or eaten so much they feel sick the next morning. The brain tends to want to eat junk food, like salty, sweet and fatty snacks. Some people eat so much they feel uncomfortable or gain weight. One colleague had a patient who ate a whole block of cheese in their sleep.”
Researchers estimate that the lifetime prevalence for parasomnias is 6.9 percent when it comes to sleepwalking, 10 percent for sleep terrors, 18.5 percent for confusional arousals, 7.1 percent for sexsomnia, and 4.5 percent for sleep-related eating. Some of these disorders (sleepwalking, sleep terrors, confusional arousals) tend to be more common during adolescence and usually remit by adulthood. Sexsomnia and sleep-related eating, on the other hand, typically begin in adulthood.
“Doctors often tell parents their children will grow out of it. But not everyone grows out of it,” Prof. Mundt concludes.
The study is published in the journal Sleep Medicine.
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