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Jordan Roberts, PA-C and Joe Weatherly, DO
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There are over 70 known parasomnias.  The most clinically important occur during non-REM and REM sleep. Non-REM parasomnias include confusional arousals, sleep walking and sleep terrors and occur more frequently in young adults. These events are not recalled REM stage sleep disorders are more frequent in older adults and patients remember the events. The most frequently encountered are rapid eye movement sleep behaviour disorder, recurrent isolated sleep paralysis and nightmare disorder.


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Brett M. -

Thanks for the excellent summary of parasomnias. I'm curious about part of the differentiation between REM disorders and non-REM disorders. Does REM sleep only occur much later into a nights sleep, as discussed in the show? It was my understanding that REM cycles occur multiple times during the night, making it possible for the first REM cycle to occur 90 minutes into sleeping. If that is the case, REM disorders could occur much earlier in the night.


Brett M.

Spencer B., MD -

Hi there! Are there data on the risk of sleepwalking or other significant parasomnias with the use of Z-drugs (zolpidem, etc.)?

Jordan GR -

@Brett M: Great question and insight! REM does indeed occur several times per night, so it would be reasonable AND possible for REM sleep disorders to occur at any part of the night. However, REM sleep peaks over the last half of the night, making this the more likely time for REM sleep disorders to occur.

Jordan GR -

@Spencer B: Sleepwalking with the z–drugs is certainly an interesting and known side effect of these medications, with a fair amount of evidence to back that claim up. Several authors have even tried to quantify the incidence of sleepwalking and the like, and most have found that the risk is there, and is highest with zolpidem (up to ten-fold in one study!) We should note that confirmatory EEG testing is lacking for many of these studies, as you might imagine getting a ton of high quality evidence this way can be a bit cumbersome and expensive. Was there any particular data you were wondering about?

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The Benzos & Fungus Among Us Full episode audio for MD edition 169:10 min - 79 MB - M4AHippo Primary Care RAP March 2017 Summary 563 KB - PDF