Review

.2023 Nov:111:36-53.

doi: 10.1016/j.sleep.2023.09.004. Epub 2023 Sep 6.

Behavioral and psychological treatments for NREM parasomnias: A systematic review

Jennifer M Mundt¹, Matthew D Schuiling², Chloe Warlick³, Jessica R Dietch⁴, Annie B Wescott⁵, Muriel Hagenaars⁶, Ansgar Furst⁷, Kazem Khorramdel⁸, Kelly G Baron⁹

Affiliations

¹ Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall 11th Floor, 710 N Lake Shore Drive, Chicago, IL, 60611, USA; Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, USA. Electronic address: jennifer.mundt@nm.org.
² Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 119, Indianapolis, IN, 46202, USA. Electronic address: mschuil@iu.edu.
³ Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL, 60611, USA. Electronic address: chloe.warlick@nm.org.
⁴ School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA. Electronic address: jessee.dietch@oregonstate.edu.
⁵ Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA. Electronic address: annie.wescott@northwestern.edu.
⁶ Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, Netherlands. Electronic address: m.a.hagenaars@uu.nl.
⁷ War Related Illness and Injury Study Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Mailcode 151Y, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, USA; Polytrauma System of Care, VA Palo Alto Health Care System, USA. Electronic address: ajfurst@stanford.edu.
⁸ Department of Psychology and Education Science, Shiraz University, Shiraz, Fars, 71345, Iran. Electronic address: khoramdel.psy@gmail.com.
⁹ Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Suite A, Room 142, Salt Lake City, UT, 84108, USA. Electronic address: kelly.baron@utah.edu.

PMID:37716336
PMCID: PMC10591847
DOI: 10.1016/j.sleep.2023.09.004

Review

Behavioral and psychological treatments for NREM parasomnias: A systematic review

Jennifer M Mundt et al. Sleep Med.2023 Nov.

.2023 Nov:111:36-53.

doi: 10.1016/j.sleep.2023.09.004. Epub 2023 Sep 6.

Authors

Jennifer M Mundt¹, Matthew D Schuiling², Chloe Warlick³, Jessica R Dietch⁴, Annie B Wescott⁵, Muriel Hagenaars⁶, Ansgar Furst⁷, Kazem Khorramdel⁸, Kelly G Baron⁹

Affiliations

¹ Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall 11th Floor, 710 N Lake Shore Drive, Chicago, IL, 60611, USA; Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, USA. Electronic address: jennifer.mundt@nm.org.
² Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 119, Indianapolis, IN, 46202, USA. Electronic address: mschuil@iu.edu.
³ Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL, 60611, USA. Electronic address: chloe.warlick@nm.org.
⁴ School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA. Electronic address: jessee.dietch@oregonstate.edu.
⁵ Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA. Electronic address: annie.wescott@northwestern.edu.
⁶ Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, Netherlands. Electronic address: m.a.hagenaars@uu.nl.
⁷ War Related Illness and Injury Study Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Mailcode 151Y, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, USA; Polytrauma System of Care, VA Palo Alto Health Care System, USA. Electronic address: ajfurst@stanford.edu.
⁸ Department of Psychology and Education Science, Shiraz University, Shiraz, Fars, 71345, Iran. Electronic address: khoramdel.psy@gmail.com.
⁹ Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Suite A, Room 142, Salt Lake City, UT, 84108, USA. Electronic address: kelly.baron@utah.edu.

PMID:37716336
PMCID: PMC10591847
DOI: 10.1016/j.sleep.2023.09.004

Abstract

Background: Non-rapid eye movement (NREM) parasomnias are often benign and transient, requiring no formal treatment. However, parasomnias can also be chronic, disrupt sleep quality, and pose a significant risk of harm to the patient or others. Numerous behavioral strategies have been described for the management of NREM parasomnias, but there have been no published comprehensive reviews. This systematic review was conducted to summarize the range of behavioral and psychological interventions and their efficacy.

Methods: We conducted a systematic search of the literature to identify all reports of behavioral and psychological treatments for NREM parasomnias (confusional arousals, sexsomnia, sleepwalking, sleep terrors, sleep-related eating disorder, parasomnia overlap disorder). This review was conducted in line with PRISMA guidelines. The protocol was registered with PROSPERO (CRD42021230360). The search was conducted in the following databases (initially on March 10, 2021 and updated February 24, 2023): Ovid (MEDLINE), Cochrane Library databases (Wiley), CINAHL (EBSCO), PsycINFO (EBSCO), and Web of Science (Clarivate). Given a lack of standardized quantitative outcome measures, a narrative synthesis approach was used. Risk of bias assessment used tools from Joanna Briggs Institute.

Results: A total of 72 publications in four languages were included, most of which were case reports (68%) or case series (21%). Children were included in 32 publications and adults in 44. The most common treatment was hypnosis (33 publications) followed by various types of psychotherapy (31), sleep hygiene (19), education/reassurance (15), relaxation (10), scheduled awakenings (9), sleep extension/scheduled naps (9), and mindfulness (5). Study designs and inconsistent outcome measures limited the evidence for specific treatments, but some evidence supports multicomponent CBT, sleep hygiene, scheduled awakenings, and hypnosis.

Conclusions: This review highlights the wide breadth of behavioral and psychological interventions for managing NREM parasomnias. Evidence for the efficacy of these treatments is limited by the retrospective and uncontrolled nature of most research as well as the infrequent use of validated quantitative outcome measures. Behavioral and psychological treatments have been studied alone and in various combinations, and recent publications suggest a trend toward preference for multicomponent cognitive behavioral therapies designed to specifically target priming and precipitating factors of NREM parasomnias.

Keywords: Confusional arousal; Parasomnia; Sexsomnia; Sleep terror; Sleep-related eating; Sleepwalking.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Figure 1.**
Flow diagram of identification and selection process for reports included in review.

**Figure 2.**
Frequency of behavioral and psychological treatments in studies of NREM parasomnias.

See this image and copyright information in PMC

References

1. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. American Academy of Sleep Medicine; 2014.
1. Drakatos P, Leschziner G. Diagnosis and management of nonrapid eye movement-parasomnias. Curr Opin Pulm Med. 2019;25(6):629–635. doi:10.1097/MCP.0000000000000619 - DOI - PubMed
1. Irfan M, Schenck CH, Howell MJ. NonREM Disorders of Arousal and Related Parasomnias: an Updated Review. Neurotherapeutics. 2021;18(1):124–139. doi:10.1007/s13311-021-01011-y - DOI - PMC - PubMed
1. Bruni O, DelRosso LM, Melegari MG, Ferri R. The Parasomnias. Child Adolesc Psychiatr Clin N Am. 2021;30(1):131–142. doi:10.1016/j.chc.2020.08.007 - DOI - PubMed
1. Silber MH. Parasomnias Occurring in Non-Rapid Eye Movement Sleep. Continuum (Minneap Minn). 2020;26(4):946–962. doi:10.1212/CON.0000000000000877 - DOI - PubMed

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Behavioral and psychological treatments for NREM parasomnias: A systematic review

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Behavioral and psychological treatments for NREM parasomnias: A systematic review

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Conflict of interest statement

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