Subtypes of NREM Sleep Arousal Disorders reflect varying degrees of wakefulness and NREM sleep simultaneously occurring, or in other words, partially awake occurrences. 

Incomplete awakenings from NREM Disorders are accompanied by either or both subtypes of arousal:
• Sleepwalking Type
• Sleep Terror Type


Subtypes of NREM Sleep Arousal Disorders

NREM Sleep Arousal disorders occur most commonly in childhood and reduce in frequency with increasing age, as they are often outgrown following infancy and childhood and less frequent in adolescence. Remission rates are between 50-60% for those 10-18 years.

Development of NREM Sleep Arousal Disorders

NREM disorders cause clinically significant distress or impairment in social, occupational, and other areas of functioning. Uncommonly, they may result in serious injury to the individual or those consoling them. Those with sleep-relating eating behaviors may later experience poor diabetes control, weight gain, ingestion of inedible foods, or injury from burns or cuts.

Consequences of NREM Sleep Arousal Disorders

There is no association between sleepwalking and serious mental disorders among children, however there may be an association between sleepwalking and major depressive disorder and obsessive-compulsive disorder in adults.

Children or adults with sleep terrors may score higher for depression and anxiety on personality inventories.

Comorbidity in NREM Sleep Arousal Disorders

Sedative use, stress, fatigue, sleep deprivation, and sleep-wake schedule disruptions may increase the likelihood of NREM disorder episodes, and fevers and sleep deprivation may produce a greater frequency of NREM disorders.

There is a high connection of NREM disorders to genetics, in which up to 80% of those who sleepwalk may have a family history of sleepwalking or sleep terrors, thus increasing the risk to offspring to as much as 60% and serving as a predictor of this disorder in future offspring.

Risk and Prognostic Factors for NREM Sleep Arousal Disorders

A psychologist is evaluating several patients with sleep-related complaints. Which of the following patient descriptions most accurately represents the core characteristics of a Non-Rapid Eye Movement (NREM) Sleep Arousal Disorder?

Non-Rapid Eye Movement Sleep Arousal (NREM) Disorders are characterized by repeated episodes incomplete awakenings during sleep that usually last about 1-10 minutes but can also last as long as 1 hour without any recollection. Little to no dream imagery is recalled. 

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The DSM-5-TR separates Sleep-Wake Disorders into the following specific disorders and groups:
-	Insomnia Disorder
-	Hypersomnolence Disorder
-	Narcolepsy
-	Breathing Related Sleep-Disorders*
-	Circadian Rhythm Sleep-Wake Disorders*
-	Parasomnias*
-	Restless Leg Syndrome
-	Substance / Medication-Induced Sleep Disorder
-	Other Specified Insomnia Disorder
-	Unspecified Insomnia Disorder
-	Other Specified Hypersomnolence Disorder
-	Unspecified Hypersomnolence Disorder
-	Other Specified Sleep-Wake Disorder
-	Unspecified Sleep-Wake Disorder

Note: * Groups that separate into further specific disorders

[DSM-5-TR] List of Sleep-Wake Disorders

American Psychiatric Association Publishing. (2022). Non–Rapid Eye Movement Sleep Arousal Disorders. In Diagnostic and statistical manual of mental disorders, fifth edition text revision: DSM-5-TR (5th ed., pp. 452–457). section. 

Non–Rapid Eye Movement Sleep Arousal Disorders from the DSM-V

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

NREM Sleep Arousal Disorders


Narcolepsy is a sleep disorder characterized by an uncontrollable urge to fall asleep at inopportune times. These sleep episodes are frequently accompanied by cataplexy, a sudden loss of muscle tone. Narcoleptic attacks often exhibit features characteristic of REM sleep; for instance, about a third of those with the disorder report experiencing vivid, dream-like hallucinations during an episode.

Narcolepsy

Sleep apnea is a disorder characterized by episodes in which a person's breathing stops during sleep. These cessations can last for 10-20 seconds or longer and often result in brief arousals. Although individuals with sleep apnea may be unaware of these repeated sleep disruptions, they frequently experience significant daytime fatigue. The condition is commonly associated with loud snoring and is more prevalent in overweight people.

Sleep Apnea

A sleep disorder that consists of not getting enough sleep.

Insomnia

A sleep disorder in which someone physically acts out their dream. This disorder typically presents after age 50, is more common in men than women, and usually followed by Parkinson’s and/or dementia symptoms, suggesting it’s the start of widespread neurodegeneration. Usually controlled by anti-anxiety drugs like benzodiazepines at night. 

REM Behavior Disorder

Somnambulism, or sleepwalking, is a condition more common in childhood that can persist into adulthood. It involves episodes of complex behaviors, lasting from seconds to minutes, which are often not remembered. While these episodes most frequently occur during stage 3 slow-wave sleep (SWS), they can happen at any time during a sleep period. Sleepwalkers are not acting out their dreams.

Somnambulism

Insomnia is a common health concern that causes significant distress and disruption in daily life, due to difficulty with and lack of sleep. Insomnia tends to be associated with an increased risk of developing physical health problems, anxiety, and depression.

Insomnia 

Substance/medication-induced sleep disorders are characterized by a severe sleep disturbance that occurs during or soon after substance intoxication, medication exposure, or substance/medicine withdrawal.

Substance/Medication-Induced Sleep Disorder

* Obstructive Sleep Apnea Separate Specific Disorder
* Central Sleep Apnea
* Sleep-Related Hypoventilation


Specific Breathing Sleep-Related Disorders

Circadian rhythm sleep-wake disorders happen when constant patterns of sleep disturbances occur. These disturbances can be caused by a new circadian rhythm or discrepancies between the person’s circadian rhythm and the sleep-wake schedule that is demanded by the person’s social life, occupation, or environment.

Circadian Rhythm Sleep-Wake Disorders

Hypersomnolence disorder consists of sleeping for too many hours at night, trouble staying completely awake after being woken up, or frequent episodes of sleep throughout the day. 

Hypersomnolence Disorder

Reference for Sleep-Wake Disorders

Insomnia, the most prevalent sleep disorder, is characterized by a persistent difficulty in initiating or maintaining sleep. Individuals with this condition often experience significant delays before falling asleep and may wake up frequently during the night, struggling to resume sleep. According to diagnostic criteria, these sleep disturbances must occur at least three nights a week for a minimum of one month.

REM behavior disorder (RBD), sleepwalking, restless leg syndrome, and night terrors are examples of parasomnias, which involve unwanted motor behaviors or experiences during the sleep cycle.

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