Descriptive Psychopathology: The Signs and Symptoms of ...

170 Section 3: Examination domainsTable 7.4. International classification of sleep disordersDyssomniasPeriodic limb movement disorderRestless leg syndromeNocturnal eating and drinking disorderParasomniasArousal disorders: confusional arousal, sleep walking, sleep terrorsSleep–wake transition disorders: rhythmic movement disorder,sleep starts, nocturnal leg crampsREM-related parasomnias: sleep paralysis, REM behavior disorderOther parasomniasSleep bruxism, benign neonatal myoclonusparticularly the elderly. Movements are repetitive, occurring at regular intervals.Patients with sleep apnea often have the syndrome. Thirty percent of patients alsoexperience restless leg syndrome.Restless leg syndrome is exacerbated during inactivity and is worse at night,particularly the first half. It is characterized by leg movements during sleep thatmay throw the covers from the bed. Patients also experience an urge to move withassociated uncomfortable sensations (dysesthesias) such as burning, itching,grabbing, “worms” moving under the skin, and an inner restlessness. Patientstry to relieve these sensations by rubbing, stretching, or getting out of bed andstanding or walking. A family history of restless leg syndrome is reported in halfof sufferers. The syndrome is also associated with narcolepsy, sleep apnea, Huntington’sdisease, amyotrophic lateral sclerosis, and myelopathies and peripheralneuropathies. Twenty percent of patients with Parkinson’s disease have thesyndrome. About 80% of patients with restless leg syndrome also have rhythmicmovement disorder described below.A nocturnal eating and drinking disorder has been described. It is a form ofsleep automatism. Patients exhibit eating and drinking movements immediatelyupon waking and may get out of bed and eat compulsively. Other proceduralmovements such as washing dishes, getting dressed and undressed, and drivinga vehicle are reported. Continuous oral–facial automatisms with chewing andswallowing, and lip-smacking are also seen during sleep. Disorganized utterancesoccur. One to several episodes nightly last a few minutes each, andmost patients report experiencing the episodes while “half asleep”. Partial orcomplete amnesia in the morning for the events is common. Some patients willhave other dyssomnias or narcolepsy.