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Sleep-related Movement Disorders 

Sleep-related Movement Disorders
Chapter:
Sleep-related Movement Disorders
Author(s):

Paul J. Reading

DOI:
10.1093/med/9780199609536.003.0030
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date: 05 December 2020

As in many areas of sleep medicine, it is often a challenge deciding whether or not movements during sleep reflect truly abnormal nocturnal phenomenona or are simply physiological variants. Indeed, when asleep, subconscious shifts of body position occurring every 15 minutes or so are considered entirely normal, as are minor jerks of the extremities and face, particularly during periods of rapid eye movement (REM) sleep. However, if nocturnal movements are observed to be excessive, violent, or arousing, either to the subject or bed partner, they will usually indicate a defined disorder, especially if the events are stereotypic through the night. Although the second edition of the International Classification of Sleep Disorders (ICSD) was revised in 2005 to include a new section dedicated to movement disorders occurring specifically during the state of sleep, diagnostic precision of such phenomena is often lacking and evidenced-based treatment protocols, when indicated, are poorly developed. Furthermore, if a sleep-related movement disorder is recognized, it can be very difficult to determine its true clinical significance for sleep quality and subsequent daytime wakefulness, especially in the elderly patient.

This chapter addresses those movement disorders that are intimately or exclusively related to the state of sleep or the sleep–wake transition. By convention, parasomnias causing abnormal arousals from deep non-REM sleep, such as sleepwalking or night terrors, will not be covered, although restless legs syndrome is discussed, partly because of its close association with periodic limb movements during sleep.

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