Firstly, we need to look carefully at some historical aspects of sleep. Since the time of Greek philosophers, the function of sleep was deeply investigated (Carney, Berry & Geyer, 2012). It is to be noted that in ancient times it was believed that sleep is a state similar to death, and such, the goddess of night, Nxy, was depicted as the mother of both the god of sleep, Hypnos, and the god of death, Thanatos (Carney et al., 2012). In this context, there is also evidence that Aristotle described the sleep as state of relative inattention to the environment and physical immobility and stipulated that sleep displayed the time required to replenish human physical strength lost during wakefulness (Carney et al., 2012). In other words, sleep was described as a time of brain inactivity . In recent years, it has become apparent that, that sleep is an exceedingly active process as demonstrated by highly predictable changes electrical activity of the brain, muscle activity, and autonomic control (Carney et al., 2012).
Analyzing the data presented in Fang’s et al. (2015) research paper, it can be suggested that sleep is a naturally recurring state and biological phenomenon that allows human body and mind to rest and to recreate a day spent energy. In recent years, it has become apparent that, the incidence of sleep disorders has increased worldwide (Fang, Miao, Chen, Sithole & Chung, 2015).
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The International Classification of Sleep Disorders (ICSD) establish seven main categories of sleep disorders which include parasomnias, insomnia disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, sleep-related breathing disorders, and other sleep disorders (Sateia, 2014).
The results of various published studies strongly show clinical evidence that approximately 10% of the Western population suffers from sleep disorders ( Fang et al., 2015 ). The findings of majority studies stated that the incidence of sleep disorders is approximately 23.5% in the Japanese population, and a similar result is observed for Asian populations ( Fang et al., 2015 ).
We have clearly identified above some historical standpoints of sleep as well as the main role of sleep in human life. Moreover, global incidence and general classification of sleep disorders were also reviewed. What is more important at this stage is to explore one of the most widespread group of sleep disorders, called parasomnias. In order to gain a complete understanding of parasomnias we need to look carefully at processes occurring during sleep. With respect to Gary ’s (2003) work, it has to be noted that human consciousness has three separate states of being. Consequently, clinical evidence provides confirmation that each of these states has own features: wake, nonrapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep (Gary, 2003) . Generally, throughout wakefulness, brain reacts to external influence (Gary, 2003) . On the other hand, throughout sleep, the brain reacts to internal influence (Gary, 2003) . With regard to Gary ’s (2003) article, it was found that sleep is subdivided into various stages based on electroencephalographic activity and other behavior such as eye movements and muscle tone. Consequently, Gary (2003) suggest that clinical evidence provide confirmation that during NREM sleep, which accounts about 75% of night’s sleep in human, brain wave activity slows down but muscle tone is remained unchanged. Correspondingly, Gary (2003) state that REM sleep is characterized by electroencephalographic frequency that is in the “wake” range, with explosions of eye movements and muscle atonia. Moreover, it has to be mentioned that REM episodes appear cyclically throughout the night (Gary, 2003) . Furthermore, it has to be stated that according to Gary ’s (2003) paper, the first REM episode occurs 90 minutes after the first sleep start and then reoccurs every 60 to 90 minutes through the remainder of sleep cycle. Analyzing the data present in Gary ’s (2003) research article, it can be can suggested that sleep stages are interspersed with periods of wakefulness that also appear periodically during all night. Also worthy of mention is the fact that the processes which are responsible for switching from one state to another are not determined well (Gary, 2003) . In this context, it has to be considered that parasomnias occur as a result of failure of the switching mechanism from one state to another (Gary, 2003) . On the whole, taking into consideration majority of literature sources, it has to be noted that as usual parasomnias occur as an unfinished awakening from NREM sleep (Gary, 2003) . The Gary ’s (2003) article demonstrates also that during these episodes the brain is reacting to both internal and external influences. Thus, it has to be reiterated that p arasomnias are group of sleep disorders, which can be described as undesirable behavioral, physiological, or experiential events occurring during sleep (Markov, Jaffe & Doghramji, 2006). Quite as evident from Markov et al.’s (2006) paper the fact that parasomnias occur more often in children than in adults. At the same time rapid eye movement sleep behavior disorder is prevalent in adults over 50 (Markov et al., 2006) .
In further support of examining of parasomnias, we also need to look at the prevalence of parasomnias among different age groups. The results of published studies strongly show that parasomnias are widespread between the ages of 3 and 13 years (Laberge, Tremblay, Vitaro & Montplaisir, 2000). Based on these study results, it can be concluded that approximately 78% of all children studied had at least 1 parasomnia (Laberge et al., 2000). From examining Laberge et al’s (2000) research paper, it is crucial to note that sleepwalking usually initiates in childhood and not so often in adolescence. Moreover, in majority of cases, the state is disappearing approximately at the age of 10 years (Laberge et al., 2000). Also worthy of mention is the fact that, according to observations at age 13 years, sleepwalking was still persisting in 24.1% of sleepwalkers (Laberge et al., 2000). Much more interesting the fact that according to Laberge et al’s (2000) research article, sleepwalking and night terrors were reported more frequently in boys than in girls.
We have clearly established above the physiological aspects of sleep as well as the pathological processes that occurs when the normal process of sleep is disturbed. In further support of examining of parasomnias, we also need to look at classification of parasomnias. With respect to Gary (2003) parasomnias may be classified depending on sleep stage, type of behavior and age of onset. Further, we will investigate in detail classification of parasomnias based on sleep stages.
The first group of parasomnias is nonrapid eye movement (NREM) parasomnias. Quite as evident from Gary’s (2003) paper that NREM parasomnias are the most common group of parasomnias. It includes confusional awakenings, sleep terrors, and sleepwalking (Gary, 2003).
Thus, it is crucial to review more specifically the main subgroups of NREM parasomnias.
The first subgroup of NREM parasomnias is confusional awakening. Regarding the relevant articles, i.e., Gary (2003) , it has to be emphasized that confusional awakening are widespread in children under age 5. Additionally, it has to be stated that the episodes consist of arousal with confusion, mild agitation and slow speech (Gary, 2003). In fact, according to Gary’s (2003) observations, there is evidence that groaning or crying may signal the episode, which usually continues for 5 to 10 minutes. Moreover, it is found that the child commonly cannot be aroused. Furthermore, it has to be noted, that attempts to awake the child may extend the parasomnia (Gary, 2003).
The second subgroup of NREM parasomnias is sleep terrors, which are the most dramatic of the NREM disorders (Gary, 2003). Onset is sudden with a cry followed by autonomic and behavioral features of strong fear (Gary, 2003). According to Gary (2003), the pathogenesis is an extremely precipitous arousal from stage 3-4 NREM sleep. Based on observations, it can be concluded that the child may sit in bed or begin to run about the room as if trying to escape from an unseen danger (Gary, 2003). Also worthy of mention is the fact that during sleep terrors the child appears to be awake with open eyes and awkward movement (Gary, 2003). What is more important is that the child may be injured by running into furniture or leave the house (Gary, 2003). As a result, according to Gary (2003) the child, who cannot be awakened, will return to sleep in 5 to 15 minutes.
The third subgroup of NREM parasomnias is sleepwalking which characterized by motor behavior, such as standing at the bedside or opening doors and walking out of the house (Gary, 2003). With respect to the numerous observations, the sleepwalking may be calm or nervous. In contrast to sleep terrors, sleepwalking occurs without the terror attack. Sleepwalking is most common in children aged 4 to 8 years. Despite the fact that sleepwalking is mainly a childhood disorder, it also occurs in 2% of the adult population (Gary, 2003). Regarding the relevant articles, it has to be emphasized that sleepwalking can be described by such night behavior as walking around the house, doing household chores, having a conversation, and what is more important is that driving car was observed as well (Gary, 2003).
In further support of examining of parasomnias, we also need to look at the second group of parasomnias called rapid eye movement (REM) behavior disorder that occurs during REM sleep. Quite as evident, that REM behavior disorder occurs during the second part of the night (Gary, 2003). Consequently, mentioned state can be described by such night behavior as lunging out of bed or striking a bed partner (Gary, 2003). What is more important is that behavior may be aggressive against the bed partner such as striking out with leg or arm (Gary, 2003). Hence, it can be concluded that the mechanism of the outburst is due to the lack of muscle atonia, which often accompanies REM sleep and prevents motor movement during REM sleep (Gary, 2003).
Further, we will explore the third group of parasomnias called sleep disorders not dependent on sleep stage. This group of sleep disorders includes sleep talking, teeth grinding and bed rocking. On the whole, analyzing the data present in Gary’s (2003) article, it can be suggested that sleep disorders not dependent on sleep stage are less worrying and less aggressive in contrast to described above two groups of parasomnias. It is to be noted that such sleep disorders require no treatment, with the exception of teeth grinding which may require a mouth guard in order to prevent injury to the teeth. It is found that the main causes of sleep disorders not dependent on sleep stage are emotional distress and poor sleep hygiene (Gary, 2003).
We have deeply investigated above classification of sleep disorders as well as carefully explore differences between main groups and subgroups of parasomnias. Further, we will investigate the underlying causes of development of parasomnias. The results of published studies show that parasomnias may have genetic causes. However, occurrence is often associated with emotional stress, sleep deprivation, febrile illness, excessive caffeine drinks, alcohol, hypnotics, and heavy physical activity (Hizli & Tarhan, 2012). In this context, there is also clinical evidence confirming that patients with history of psychological traumas or post-traumatic stress disorder, victims of physical or sexual abuse have a predisposition to development of parasomnias (Ahmed & Thorpy, 2010).
After critical examination of the various literature sources and evaluation of the relevant scientific data, it can be concluded that parasomnias represent a large group of sleep disorders that cause not ordinary nocturnal behavior. From clinical point of view, it can be concluded that parasomnias are states that arise as brain transitions between REM sleep, non-REM sleep, and wakefulness (Markov et al., 2006). According to numerous literature sources, the term "parasomnia" applies to a wide range of sleep disorders associated with sleep. It is important to conclude that parasomnias classified based on sleep stage, type of behavior and age of onset.
These behavioral responses and experiences, usually occurring during sleep, in most cases are rare and transient. However sometimes sleep disorders can occur quite often and become so disturbing that medical care may require. Summarizing, it can be suggested that parasomnias can contribute to impaired academic or occupational performance, disturbances of mood and social adjustment (Ahmed & Thorpy, 2010).
References
Ahmed, I., & Thorpy, M. (2010). Clinical evaluation of parasomnias. The Parasomnias And Other Sleep-Related Movement Disorders , 19-33. http://dx.doi.org/10.1017/cbo9780511711947.006
Carney, P., Berry, R., & Geyer, J. (2012). Clinical sleep disorders (2nd ed.). Philadelphia: Lippincott Williams & Wilkins.
Hizli, F. G., & Tarhan, N. (2012). Parasomnias . INTECH Open Access Publisher.
Fang, H., Miao, N., Chen, C., Sithole, T., & Chung, M. (2015). Risk of Cancer in Patients with Insomnia, Parasomnia, and Obstructive Sleep Apnea: A Nationwide Nested Case-Control Study. J. Cancer , 6 (11), 1140-1147. http://dx.doi.org/10.7150/jca.12490
Gary, L. (2003). Parasomnias. Wisconsin Medical Journal , 102 (1), 32-35.
Laberge, L., Tremblay, R., Vitaro, F., & Montplaisir, J. (2000). Development of Parasomnias From Childhood to Early Adolescence. PEDIATRICS , 106 (1), 67-74. http://dx.doi.org/10.1542/peds.106.1.67
Markov, D., Jaffe, F., & Doghramji, K. (2006). Update on Parasomnias: A Review for Psychiatric Practice. Psychiatry (Edgmont) , 3 (7), 69–76.) (Markov et al. 2006)
Sateia, M. (2014). International Classification of Sleep Disorders-Third Edition. Chest , 146 (5), 1387-1394. http://dx.doi.org/10.1378/chest.14-0970
