Arousal disorders present a significant potential for harm, yet a recent study reveals a lack of consensus regarding their optimal treatment. While sleep disorders such as sleep apnea and insomnia benefit from well-established treatment guidelines developed by sleep specialists, the landscape is markedly different for arousal disorders. Arousal disorders encompass a diverse range of conditions, including sexsomnia (engaging in sexual activities during sleep), sleepwalking (moving around or even performing complex tasks like driving while asleep), sleep terrors (screaming and experiencing intense fear during sleep), and sleep eating. Jennifer Mundt, an assistant professor of neurology at Northwestern University Feinberg School of Medicine, notes that unlike nearly all other sleep disorders, there are no agreed-upon treatment guidelines for arousal disorders.
In a recently published study in the journal Sleep Medicine, Mundt conducted the first systematic review of treatments for NREM (non-rapid eye movement) parasomnias. Many of the 72 publications spanning from 1909 to 2023 consisted of case reports or uncontrolled trials. Mundt emphasized the importance of evaluating and treating these disorders due to their potential dangers and injuries to affected individuals or their loved ones. She also stressed the need for clear guidelines to ensure patients receive the most effective treatment, which may not necessarily involve medication. Mundt further emphasized the requirement for randomized, controlled trials to determine the efficacy of behavioral treatments for these parasomnias.
The study identified several promising treatments with substantial evidence supporting their effectiveness, including cognitive behavioral therapy, hypnosis, sleep hygiene practices, and scheduled awakenings (waking the sleeper shortly before their usual parasomnias episode occurs). Mundt, a specialist in behavioral treatments for various sleep disorders, including insomnia, nightmares, NREM parasomnias, narcolepsy, and idiopathic hypersomnia, emphasized that patients often have little or no recollection of their unusual nocturnal behaviors. Some individuals may not even be aware of their condition until they sustain injuries, discover evidence of nighttime activities, or notice unusual symptoms the next morning.
Arousal disorders, including sleepwalking, sleep terrors, and confusional arousals (when someone is in a confused state while remaining in bed), are more common in childhood and frequently resolve during adolescence. In contrast, sexsomnia and sleep-related eating typically manifest in adulthood. Although doctors often reassure parents that children will outgrow these disorders, Mundt emphasizes that not everyone does.
In conclusion, arousal disorders pose a significant medical challenge due to their potential for harm and the lack of consensus on treatment. The study conducted by Jennifer Mundt sheds light on potential therapeutic approaches, but further research is needed to establish robust treatment guidelines for these complex conditions.