Behavioral and psychiatric treatment of parasomnias

Introduction The successful management of parasomnias frequently requires a combination of pharmacologic, psychological and behavioral treatments. Oftentimes, these events are considered unimportant (or untreatable) events, but a knowledgeable clinician can use them as clues to uncover a significant sleep disorder and to generate a comprehensive treatment plan.In the past, clinicians relied upon traditional pharmacologic agents (e.g. REM suppressants); however, a number of additional treatments are becoming available. With newer forms of psychotherapy, including various treatment approaches underneath the umbrella term “cognitive behavior therapy”, as well as various other treatment options from hypnotherapy to scheduled awakenings, this chapter presents a review of the behavioral and pharmacological treatments commonly recommended for parasomnias (divided into NREM events, REM events, and events in transition between sleep and wakefulness, as treatment options are different depending upon the distinction). This chapter will also include a brief review of the literature, and the various treatment options will be discussed to give the clinician a better understanding of the current available treatment approaches. Treatment of arousal disorders (sleepwalking, night terrors, confusional arousals, sleep-related eating, sleepsex) Disorders of arousal generally encompass the following diagnoses: sleepwalking, night terrors, confusional arousals, sleepsex disorders and sleep-related eating disorders. The overall behavioral and pharmacological treatment for these disorders has significant overlap and will be discussed as a whole, with disorder-specific treatment recommendations mentioned throughout.