Disorders of arousal | Sleep-related eating disorder | REM sleep behavior disorder | REM nightmares | Recurrent isolated sleep paralysis | Psychiatric events | Nocturnal seizures | |
Behavior | Confused, semi-purposeful movement with eyes open | Eating high caloric or unusual foods with eyes open | Sometimes combative, violent dream enactment with eyes closed | Vivid, disturbing dreams, may end with a sudden jolt or jerk | Inability to move with preservation of eye and diaphragmatic movement | Variable, may involve panic or dissociative symptoms | Dependent on location of epileptic focus; may be brief jerks, simple or complex stereotypical behavior |
Age of onset | Childhood or adolescence | Variable | Older adults | Childhood or adulthood | Variable | Adolescence to adulthood | Variable |
Family history | Yes | Unknown | No | No | No | No | Variable |
Time of occurrence | First third of night | First half of night | During REM sleep | Second half of the night most common (during REM sleep) | Upon awakening | Any time | Any time, but more likely in first half of night |
Frequency | Once per night but not every night | Variable | Variable; a few times per month to nightly | May be nightly | Variable, less than weekly | Variable | Frontal lobe seizure can occur multiple times per night; less often for temporal lobe seizures |
Duration | Minutes | Minutes | Seconds to a minute | Movement lasts seconds | Seconds to a minute | Variable (usually minutes or longer) | Usually less than 3 minutes |
Memory of event | Usually none | Usually none, or limited | Fragmentary to full dream recall | Yes | Yes | None | Variable |
Stereotypical movements | No | No | No | No | No | No | Yes |
PSG findings | Arousals from slow-wave sleep | Arousal from NREM sleep | Excessive EMG tone during REM sleep | Awakening out of REM sleep appearing distressed | Arousal from REM sleep | Occur from wake state | Epileptiform activity |
Associated clinical findings | May indicate another problem causing arousals (eg, sleep apnea) | Morning anorexia, unexplained weight gain, comorbid RLS | May be associated with parkinsonism, narcolepsy, or medications (antidepressants) | May be associated with stress, psychological trauma, or medication effect | None (benign) | Other features of an underlying psychiatric disorder (eg, panic, anxiety, depression) | May find focal neurologic deficits |
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