This relationship becomes less clear with the realization that some of the medications used to treat psychiatric disorders may themselves be linked to the onset of parasomnias.
Etiologies of the parasomnias vary based upon diagnoses, although some research has suggested correlations between specific parasomnias and psychiatric disorders ( Ohayon et al., 1999 Winkelman et al., 1999). The International Classification of Sleep Disorders categorizes parasomnias into (1) disorders of arousal from NREM (non-rapid eye movement) sleep – these include somnambulism, confusional arousals, and sleep terrors (2) disorders of REM (rapid eye movement) sleep – these include REM sleep behavior disorder (RBD), nightmares, and recurrent isolated sleep paralysis and (3) other parasomnias – these include sleep-related dissociative disorder, sleep enuresis, exploding head syndrome, catathrenia or sleep groaning, hypnagogic or hypnopompic hallucinations, sleep-related eating disorders, and parasomnias due to drug, other substance, or medical condition (Table 1 – note not all of the parasomnias are discussed in this article given limited existing literature American Academy of Sleep Medicine, 2005). Parasomnia sufferers may complain of unwanted interruptions from sleep, injury to themselves, or to their bed partner during periods of motor activation, and dysphoria relating to the burden of shouldering these negative sequelae. Parasomnias are a diagnostic grouping of sleep disorders that include abnormal sleep-related behaviors, dreams, or autonomic changes that manifest during transitions from wakefulness to sleep, or within transitions between sleep stages. There is a potential for selective serotonin reuptake inhibitors, tricyclic antidepressants, and serotonin–norepinephrine reuptake inhibitors to suppress REM, as well as the anticholinergic properties of the individual drugs to further disturb normal sleep architecture. In general, knowledge of the mechanisms of action of the medications, particularly with regard to the impact on sleep architecture, can provide some guidance. As such, practice guidelines are lacking regarding specific direction to the clinician who may be faced with a patient who has developed a parasomnia that appears to be temporally related to use of an antidepressant. There exists a varying level of evidence linking the use of antidepressant medication to the parasomnias, ranging from larger, more comprehensive studies in the area of REM sleep behavior disorder to primarily case reports in the NREM parasomnias.
2 Pulmonary, Critical Care and Sleep Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.1 David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
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