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Aim: To assess self‐reported parasomnias in patients with sleep disorders and explore relationships with psychiatric illness, comorbidities, subjective sleep assessments, and polysomnographic study results. Methods: Results from intake questionnaires and polysomnographic assessments, collected from 240 sleep centers across 30 US states between 2004 and 2019, were analyzed retrospectively. Of 540,000 total patients, 371,889 who answered parasomnia‐specific questions were included. Patients responding "often" or "always" to parasomnia‐specific questions were considered "symptom‐positive," whereas a "few times" or "never" were considered "symptom‐negative" (controls). Results: The study sample was 54.5% male with mean age 54 years (range, 2–107 years). Frequencies for the different parasomnias were 16.0% for any parasomnia, 8.8% for somniloquy, 6.0% for hypnagogic hallucinations, 4.8% for sleep‐related eating disorder, 2.1% for sleep paralysis, and 1.7% for somnambulism. Frequent parasomnias were highly associated with diagnosed depression (odds ratio = 2.72). All parasomnias were associated with being younger and female and with symptoms of depression, anxiety, insomnia, restless legs, pain, medical conditions, fatigue, and sleepiness. Associations with objective sleep metrics showed characteristics of consolidated sleep and differentiated weakly between nonrapid eye movement sleep and rapid eye movement sleep parasomnias. Machine learning accurately classified patients with parasomnia versus controls (balanced accuracies between 71% and 79%). Benzodiazepines, antipsychotics, and opioids increased the odds of experiencing parasomnias, while antihistamines and melatonin reduced the odds. Z‐drugs were found to increase the likelihood of a sleep‐related eating disorder. Conclusion: Our findings suggest that parasomnias may be clinically relevant, yet understudied, symptoms of depression and anxiety. Further investigation is needed to quantify the nature of multimorbidity, including causality and implications for diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Summary Nightmares are a common symptom in narcolepsy that has not been targeted in prior clinical trials. This study investigated the efficacy of Cognitive Behavioural Therapy for Nightmares (CBT‐N), adapted for narcolepsy, in a small group of adults. Given the high prevalence of lucid dreaming in narcolepsy, we added a promising adjuvant component, targeted lucidity reactivation (TLR), a procedure designed to enhance lucid dreaming and dream control. Using a multiple baseline single‐case experimental design, adults with narcolepsy and frequent nightmares (≥3/week, N = 6) were randomised to a 2 or 4 week baseline and received seven treatment sessions (CBT‐N or CBT‐N + TLR). Across the groups, there was a large effect size (between‐case standardised mean difference [BC‐SMD] = −0.97, 95% CI −1.79 to −0.14, p < 0.05) for reduced nightmare frequency from baseline (M = 8.38/week, SD = 7.08) to posttreatment (M = 2.25/week, SD = 1.78). Nightmare severity improved significantly with large effect sizes on sleep diaries (BC‐SMD = −1.14, 95% CI −2.03 to −0.25, p < 0.05) and the Disturbing Dream and Nightmare Severity Index (z = −2.20, p = 0.03, r = −0.64). Treatment was associated with a reduction for some participants in sleep paralysis, sleep‐related hallucinations, and dream enactment. NREM parasomnia symptoms (z = −2.20, p = 0.03, r = −0.64) and self‐efficacy for managing symptoms (z = −2.02, p = 0.04, r = −0.58) improved significantly with large effect sizes. Participants who underwent TLR (n = 3) all recalled dreams pertaining to their rescripted nightmare. In interviews, participants noted reduced shame and anxiety about sleep/nightmares. This study provides a proof of concept for the application of TLR as a therapeutic strategy with clinical populations, as well as preliminary evidence for the efficacy of CBT‐N in treating narcolepsy‐related nightmares. [ABSTRACT FROM AUTHOR]

Sleep paralysis (SP) is a REM-related parasomnia, characterized by the inability to perform voluntary movements. It is a relatively widespread phenomenon in the general population and, although usually not dangerous, it is experienced with intense fear. The current study aims to evaluate the lifetime prevalence and characteristics of SP in the Italian student population. The study was conducted online, through an online battery of questionnaires. We used the Unusual Sleep Experience Questionnaire to investigate the prevalence of the disorder and the typical characteristics, metacognitive beliefs on the episodes, and previous distress factors. We also collected information about anxiety and depression symptomatology, sleep quality, and circadian preferences. Four hundred and thirty-two participants (333 F, 22.8 ± 2.57 y) took part in the study and 37.5 % of them reported having experienced at least one SP episode in their lifetime. On a physiological level, the most common features were the inability to speak followed by a tingling sensation and the inability to open the eyes, consistent with REM muscle atonia. Cognitive features during episodes include the perception of a presence in the room, followed by the fear of dying. Participants who reported SP had higher anxiety and worse sleep quality, and were more associated with evening chronotypes compared to non-SP responders. Our results show that SP is generally widespread in Italian students, in line with the prevalence reported in previous studies. Further studies could investigate the effects of suggested therapies to decrease the number of episodes of the disorder, especially in those who experience it recurrently. • Sleep paralysis (SP) seems to be a widespread phenomenon in Italian students. • The most common features of SP were the inability to speak and a tingling sensation. • Another common feature of SP was the perception of a presence in the room. • SP participants had higher anxiety and worse sleep quality than non-SP participants. [ABSTRACT FROM AUTHOR]

The short-term efficacy and safety of daridorexant, a dual orexin receptor antagonist, has been demonstrated in Japanese patients with insomnia disorder. The objective of this study was to evaluate, in a non-overlapping patient population to the short-term study, the long-term safety and efficacy of daridorexant in Japanese patients with insomnia disorder. In this Phase 3 open-label study conducted in Japan, 154 patients with insomnia disorder were randomized to daridorexant 50 mg (n = 102) or 25 mg (n = 52) for 52 weeks. The primary objective was to assess the safety and tolerability of daridorexant for up to 1 year. Secondary exploratory objectives were to evaluate the long-term efficacy of daridorexant on subjective sleep parameters (total sleep time, latency to sleep onset and wake after sleep onset) and daytime functioning (Insomnia Daytime Symptoms and Impacts Questionnaire). The incidence of treatment-emergent adverse events (TEAEs) was 74 % and 58 % in the 50 mg and 25 mg groups respectively. No serious drug-related TEAEs were reported. Both doses improved next-morning sleepiness (Visual Analog Scale) throughout the study. Five adjudicated adverse events of special interest were reported; excessive daytime sleepiness (n = 1, 25 mg; n = 2, 50 mg), sleep paralysis (n = 1, 50 mg) and nightmare (n = 1, 25 mg). Improvements in sleep and daytime functioning were maintained from Week 2 (first assessment) through to Week 52 in both dose groups. Up to 52-weeks, daridorexant was well tolerated with sustained improvement in sleep onset, sleep maintenance and daytime functioning, supporting its long-term use in Japanese patients with insomnia disorder. • In Japanese patients with insomnia disorder daridorexant was safe for up to 1 year. • Daridorexant sustained improvements in nighttime sleep and daytime functioning. • These results support the use of daridorexant as a long-term early treatment option for patients with insomnia disorder in Japan. [ABSTRACT FROM AUTHOR]

Adverse life events are associated with the often-terrifying REM sleep parasomnia of sleep paralysis (SP), but the impact of bereavement on SP has not been specifically examined. This exploratory, mixed-methods study (N = 168) includes qualitative data from 55 participants who described factors they believed led to their SP. Of these, almost half with a traumatic loss listed death-related precipitants. In unadjusted (bivariate) negative binomial regression models, traumatic death, time since death, religiosity, and age estimated increased SP frequency in the prior month, prior year, or both. In multivariable models, traumatic death, time since death, and age estimated increased frequency in the prior month, prior year, or both. Unexpectedly, in all models, as compared to death ≥9 years earlier, prior month SP was greater with death 1–6 years earlier, but not <1 year earlier. Discussion includes the possible role of social constraints in traumatic grief trajectories and care provider recommendations. [ABSTRACT FROM AUTHOR]

Narcolepsy is a chronic central disorder of hypersomnolence most frequently arising during childhood/adolescence. This review article examined the literature concerning the etiology, prevalence, clinical course, and treatment of children with type 1 narcolepsy (NT1). Core symptoms of pediatric NT1 include excessive daytime sleepiness (EDS) and cataplexy, together with disrupted night sleep, sleep paralysis, and hypnagogic and hypnopompic hallucinations that can also occur. This disease frequently presents several comorbidities, such as obesity and precocious puberty, conditions ranging from psychological distress to psychiatric disorders, and cognitive aspects that further worsen the clinical picture. NT1 impairs the quality of life of children, thus calling for an early diagnosis and adequate treatment. To date, pharmacological treatments have been registered for childhood NT1 and can improve symptoms. Non-pharmacological approaches are also essential to improve patients' well-being, ranging from behavioral treatments (e.g., planned napping) to psychosocial interventions (e.g., school programs). Multidisciplinary treatment management and early diagnosis are key factors in order to allow for adequate quality of life and development in children with NT1. [ABSTRACT FROM AUTHOR]

Objective: Using the Food and Drug Administration Adverse Event Reporting System (FAERS) database, four signal detection methods were applied to mine adverse drug events (ADEs) related to use of dual orexin receptor antagonists (DORAs) to provide reference for safe clinical use. Research design and Methods: Data collected from Q3rd 2014 to Q4th 2023 were obtained from the FAERS database. According to the preferred terminology (PT) and systematic organ classification (SOC) of MedDRA v.26.0, the reporting odds ratio (ROR), proportional reporting ratio (PRR), multi-item gamma Poisson shrinker (MGPS), and Bayesian confidence propagation neural network (BCPNN) were used to detect ADE signals. Results: A total of 11,857 DORAs-related adverse reactions were detected, reported with suvorexant, lemborexant, and daridorexant as the main suspected drugs was 8717584, and 2556, respectively. A higher proportion of females than males were reported (57.27% vs. 33.04%). The top 20 positive PT signals from three DORAs showed that "sleep paralysis" ranked first. "Brain fog" was stronger following daridorexant but was not detected for the other two drugs, and "sleep sex" and "dyssomnia" were stronger in suvorexant but not in the other two drugs. Additionally, some PTs occurred that were not included in drug instructions, such as "hangover" and "hypnagogic hallucination." Conclusion: In this study, four algorithms (ROR, PRR, BCPNN, and MGPS) were used to mine the safety signals of DORAs. We identified some potential ADE signals that can promote the rational use of DORAs and improve their safety. [ABSTRACT FROM AUTHOR]

Summary Since the first description of narcolepsy at the end of the 19th Century, great progress has been made. The disease is nowadays distinguished as narcolepsy type 1 and type 2. In the 1960s, the discovery of rapid eye movement sleep at sleep onset led to improved understanding of core sleep‐related disease symptoms of the disease (excessive daytime sleepiness with early occurrence of rapid eye movement sleep, sleep‐related hallucinations, sleep paralysis, rapid eye movement parasomnia), as possible dysregulation of rapid eye movement sleep, and cataplexy resembling an intrusion of rapid eye movement atonia during wake. The relevance of non‐sleep‐related symptoms, such as obesity, precocious puberty, psychiatric and cardiovascular morbidities, has subsequently been recognized. The diagnostic tools have been improved, but sleep‐onset rapid eye movement periods on polysomnography and Multiple Sleep Latency Test remain key criteria. The pathogenic mechanisms of narcolepsy type 1 have been partly elucidated after the discovery of strong HLA class II association and orexin/hypocretin deficiency, a neurotransmitter that is involved in altered rapid eye movement sleep regulation. Conversely, the causes of narcolepsy type 2, where cataplexy and orexin deficiency are absent, remain unknown. Symptomatic medications to treat patients with narcolepsy have been developed, and management has been codified with guidelines, until the recent promising orexin‐receptor agonists. The present review retraces the steps of the research on narcolepsy that linked the features of the disease with rapid eye movement sleep abnormality, and those that do not appear associated with rapid eye movement sleep. [ABSTRACT FROM AUTHOR]

Introduction: Recurrent isolated sleep paralysis (RISP) is a rapid eye movement sleep (REM) parasomnia, characterized by the loss of voluntary movements upon sleep onset and/or awakening with preserved consciousness. Evidence suggests microstructural changes of sleep in RISP, although the mechanism of this difference has not been clarified yet. Our research aims to identify potential morphological changes in the brain that can reflect these regulations. Materials and methods: We recruited 10 participants with RISP (8 women; mean age 24.7 years; SD 2.4) and 10 healthy control subjects (w/o RISP; 3 women; mean age 26.3 years; SD 3.7). They underwent video-polysomnography (vPSG) and sleep macrostructure was analyzed. After that participants underwent magnetic resonance imaging (MRI) of the brain. We focused on 2-dimensional measurements of cerebellum, pons and thalamus. Statistical analysis was done in SPSS program. After analysis for normality we performed Mann-Whitney U test to compare our data. Results: We did not find any statistically significant difference in sleep macrostructure between patients with and w/o RISP. No evidence of other sleep disturbances was found. 2-dimensional MRI measurements revealed statistically significant increase in cerebellar vermis height (p = 0.044) and antero-posterior diameter of midbrain-pons junction (p = 0.018) in RISP compared to w/o RISP. Discussion: Our results suggest increase in size of cerebellum and midbrainpons junction in RISP. This enlargement could be a sign of an over-compensatory mechanism to otherwise dysfunctional regulatory pathways. Further research should be done to measure these differences in time and with closer respect to the frequency of RISP episodes. [ABSTRACT FROM AUTHOR]

Background and objective: A prospective, postmarketing observational study was conducted to evaluate the safety and efficacy of lemborexant (LEM) tablets in daily clinical practice in Japan. No other studies of a similar size have been conducted since the marketing approval of LEM, making this the first report of its kind. Methods: Insomnia patients (n = 550) administered LEM (5–10 mg daily) for the first time were enrolled. Adverse events were collected for target events (somnolence, parasomnia, narcolepsy and associated conditions, suicidal ideation and suicidal behavior). Overall improvement of insomnia symptoms was assessed by the investigator based on the patient's complaint. Subjective sleep onset latency (sSOL) and subjective total sleep time (sTST) were investigated as sleep parameters. Results: A case report form was obtained from 539 patients. The incidence of adverse drug reactions (ADRs) was 7.65% for somnolence, 1.76% for nightmares, 0.59% for abnormal dreams, and 0.20% for sleep paralysis. No serious ADRs or ADRs related to suicidal ideation or suicidal behavior were observed. The efficacy rate at the final evaluation was 80.83%. Decreased sSOL and increased sTST were observed as assessed starting from Week 8 of treatment. Conclusion: Based on the results of this study, the safety result was consistent with the safety profile described in the current package insert. Efficacy results also indicated that LEM is clinically useful. [ABSTRACT FROM AUTHOR]

REM parasomnias, or rapid eye movement sleep parasomnias, are a group of sleep disorders that occur during the REM stage of sleep. These parasomnias can lead to a range of behaviors including vivid and intense dreams, nightmares, sleep paralysis and REM behavior disorder (RBD). RBD is a particularly dangerous form of REM parasomnias, in which the person physically acts out their dreams during REM sleep. This can lead to injuries to themselves or a sleeping partner. REM parasomnias can be caused by a variety of factors, including medications, substance use, and underlying medical conditions. They may also be associated with sleep deprivation and high stress levels. Their treatment may include a combination of behavioral therapy and medication. Behavioral therapy can help the person develop strategies to reduce the occurrence of parasomnias. Medication can help regulate sleep cycles or manage any underlying medical conditions. These disorders can disrupt daily life and can be dangerous if left untreated. In conclusion, REM parasomnias are a group of sleep disorders that can lead to a range of behaviors during REM sleep, including vivid and intense dreams, nightmares, sleep paralysis, and RBD. RBD is a dangerous form of REM parasomnias. Treatment for REM parasomnias may involve a combination of behavioral therapy and medication, and it is important to seek medical help if these disorders are suspected. [ABSTRACT FROM AUTHOR]

To obtain insight in the spectrum of narcolepsy symptoms and associated burden in a large cohort of patients. We used the Narcolepsy Monitor, a mobile app, to easily rate the presence and burden of 20 narcolepsy symptoms. Baseline measures were obtained and analyzed from 746 users aged between 18 and 75 years with a reported diagnosis of narcolepsy. Median age was 33.0 years (IQR 25.0–43.0), median Ullanlinna Narcolepsy Scale 19 (IQR 14.0–26.0), 78% reported using narcolepsy pharmacotherapy. Excessive daytime sleepiness (97.2%) and lack of energy were most often present (95.0%) and most often caused a high burden (79.7% and 76.1% respectively). Cognitive symptoms (concentration 93.0%, memory 91.4%) and psychiatric symptoms (mood 76.8%, anxiety/panic 76.4%) were relatively often reported to be present and burdensome. Conversely, sleep paralysis and cataplexy were least often reported as highly bothersome. Females experienced a higher burden for anxiety/panic, memory, and lack of energy. This study supports the notion of an elaborate narcolepsy symptom spectrum. Each symptom's contribution to the experienced burden varied, but lesser-known symptoms did significantly add to this as well. This emphasizes the need to not only focus treatment on the classical core symptoms of narcolepsy. [ABSTRACT FROM AUTHOR]

The pathophysiology of recurrent isolated sleep paralysis (RISP) has yet to be fully clarified. Very little research has been performed on electroencephalographic (EEG) signatures outside RISP episodes. This study aimed to investigate whether sleep is disturbed even without the occurrence of a RISP episode and in a stage different than conventional REM sleep. 17 RISP patients and 17 control subjects underwent two consecutive full-night video-polysomnography recordings. Spectral analysis was performed on all sleep stages in the delta, theta, and alpha band. EEG microstate (MS) analysis was performed on the NREM 3 phase due to the overall high correlation of subject templatemaps with canonical templates. Spectral analysis showed a significantly higher power of theta band activity in REM and NREM 2 sleep stages in RISP patients. The observed rise was also apparent in other sleep stages. Conversely, alpha power showed a downward trend in RISP patients' deep sleep. MS maps similar to canonical topographies were obtained indicating the preservation of prototypical EEG generators in RISP patients. RISP patients showed significant differences in the temporal dynamics of MS, expressed by different transitions betweenMS C and D and between MS A and B. Both spectral analysis and MS characteristics showed abnormalities in the sleep of non-episodic RISP subjects. Our findings suggest that in order to understand the neurobiological background of RISP, there is a need to extend the analyzes beyond REM-related processes and highlight the value of EEG microstate dynamics as promising functional biomarkers of RISP. [ABSTRACT FROM AUTHOR]

Sexual hallucinations are little known, yet often extremely burdening, phenomena. In this systematic review, we summarize what is known about their phenomenology, prevalence, etiopathology, ensuing distress, and treatment options. Sexual hallucinations can be experienced as genital or orgasmic sensations, although other sensory modalities can also be involved. With the notable exception of orgasmic auras in the context of epilepsy, sexual hallucinations tend to be distressing and embarrassing in nature. Our analysis of 79 studies (together describing 390 patients) indicates that sexual hallucinations aremore frequent in women than in men, with a sex ratio of 1.4:1, and that they aremost prevalent in schizophrenia spectrum disorders, with rates ranging from 1.4% in recently admitted patients to 44% in chronically hospitalized patients. Other underlying conditions include epilepsy, the incubus phenomenon (possibly the most prevalent cause in the general population, associated with sleep paralysis), narcolepsy, and sedative use. As regards the sedative context, we found more medicolegal than purely medical cases, which sadly underlines that not all sexually explicit sensations experienced in anesthesia practice are indeed hallucinations. In the absence of evidence-based treatment protocols for sexual hallucinations, practice-based guidelines tend to focus on the underlying condition. Further research is needed, especially in the fields of substance abuse, posttraumatic stress disorder, and borderline personality disorder, where only anecdotal information on sexual hallucinations is available. Moreover, awareness of sexual hallucinations among health professionals needs to be improved in order to facilitate counseling, diagnosis, and treatment. [ABSTRACT FROM AUTHOR]

– Narcolepsy type 1 (NT1) is a rare chronic sleep disorder, usually arising by adolescence that negatively impacts quality of life. It is characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic/hypnopompic hallucinations, sleep paralysis and sleep fragmentation. The goals of this work were to characterize NT1 adolescents regarding sleep characteristics, health-related quality of life (HRQoL) and future life perspectives and later to compare this group with a control group of healthy adolescents (HA). – Transversal descriptive/analytical study including NT1 patients followed in a sleep center of a tertiary hospital and 23 HA. Data were collected through an online survey, fulfilled by the participants, including four sections: demographics; questionnaire evaluating sleep and EDS; questionnaire evaluating HRQoL; inquiry regarding future perspectives. An extra section for the NT1 group only, comprising questions about the characterization of narcolepsy, was included. 22 NT1 adolescents were included, with a median age of 15.0 years-old. Beyond EDS, all had presented cataplexy - 19 still reported it. Twenty patients took psychostimulants regularly for EDS, while 13 patients took venlafaxine or fluoxetine for cataplexy. Nineteen adolescents took regular naps and 19 maintained psychological appointments. Self-reported sleep quality was similar between groups (p = 0.112). EDS was identified in seven NT1 patients and none in the control group. HRQOL was significantly lower in NT1 patients only for the physical well-being domain (p = 0.001). Regarding future perspectives, results were similar, except for a lower probability of getting a driver's license in NT1 patients, despite no statistical significance (p = 0.104). Daytime sleepiness is difficult to control in NT1, despite specialized treatment. HRQoL was similar between groups in all domains except for the physical well-being. Despite good adherence to pharmacological and non-pharmacological treatments (namely psychological therapy) that account for these good results, the physical well-being domain is difficult to manage. • NT1 is characterized by sleepiness and cataplexy that can affect quality of life. • All aspects of NT1 adolescents' quality of life must be taken into account. • NT1 adolescents presented a lower HRQoL only for the physical well-being domain. • Pharmacological and non-pharmacological therapies are crucial for controlling NT1. • Sleepiness is difficult to control despite specialized treatment. [ABSTRACT FROM AUTHOR]

The article discusses pragmatically marked structures in Kagayanen language, a Western Austronesian language spoken in the central Philippines. Topics discussed include negative constructions, non-declarative speech acts and special focus constructions. Also discussed are interjections and the general pro-form kwa.

The article discusses morphosyntactically defined verb classes in Kagayanen language which is a Western Austronesian language spoken in the central Philippines. Topics discussed include situation types, volitionality and semantic transitivity, and change of state. Also discussed are the classes of verbal roots, roots describing non-volitional intransitive situations and roots describing volitional intransitive situations.

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Sleep paralysis, described as Kabus in Persian medicine (PM), is a state during sleep in which a person senses heaviness on the chest without the ability to speak or move. This study aims to review sleep paralysis from the viewpoint of Persian medicine. Five original reference books on PM were reviewed and data about the definition, etiology, and clinical features of sleep paralysis were extracted. Two main etiologies have been mentioned: evaporation of vapor to the brain and brain dystemperament due to cold reaching the brain; both of which cause weakness and dysfunction of the brain. PM recommends low-cost and available remedies for sleep paralysis such as dietary modification, oral and topical herbal medications, and manual interventions like “Fasd” (phlebotomy). Recent studies have shown the neuroprotective effect of these herbal drugs which can improve cognition and memory. Further studies are needed to evaluate the efficacy of the recommended remedies for sleep paralysis.

"Suffering in Babylon: Ludlul bēl nēmeqi and the Scholars, Ancient and Modern" by Alan Lenzi is a comprehensive exploration of the Poem of the Righteous Sufferer, a prominent Babylonian literary masterpiece. Lenzi offers various approaches to understanding the poem, delving into its historical context and analyzing its themes and language. The book also examines the poem's place in Babylonian education and its relationship to other texts. Lenzi's work is well-researched and respectful of the Babylonian culture, making it a valuable resource for anyone studying this ancient text. [Extracted from the article]

Objective: The objectives of this study are to evaluate the prevalence and incidence of Narcolepsy type 1 and type 2 and to determine the prevalence of narcolepsy diagnosis criteria in the US general population. Methods: This longitudinal study was conducted in the adult US general population in two occasions. The initial interviews included 15 states (Arizona, California, Colorado, Florida, Idaho, Missouri, New York, North Carolina, North Dakota, Oregon, Pennsylvania, South Dakota, Texas, Washington, and Wyoming). The follow-up interviews, was done three years later in eight of these states. Of the 19,136 contacted individuals, 15,929 completed the initial interview and 10,931 completed the follow-up. Participants were interviewed using the Sleep-EVAL system, an artificial intelligence tool. Narcolepsy Type 1 (with cataplexy) and Narcolepsy Type 2 (without cataplexy) were defined according to the ICSD-3 classification. Symptoms of narcolepsy were assessed by frequency per week and duration. Medical visits and diagnoses were also collected. Results: Participants were aged between 18 and 102 years of age (mean 45.8 ± 17.9 years), 51.3 % were women. The prevalence of narcolepsy with cataplexy was 12.6 per 100,000 individuals (95 % C.I., 0 to 30) and narcolepsy without cataplexy was 25.1 per 100,000. The incidence per year was 2.6 per 100,000 individuals (95 % C.I., 0 to 11). Conclusions: Narcolepsy is a rare condition affecting 37.7/100,000 individuals (126,191 individuals in the current US population). Our US general population prevalence is in line with rates found in community-based studies but lower than what is reported in claim database studies.

Night‐time is a period of great significance for many people who report paranormal experiences. However, there is limited understanding of the associations between sleep variables and seemingly paranormal experiences and/or beliefs. The aim of this review is to improve our understanding of these associations while unifying a currently fragmented literature‐base into a structured, practical review. In this pre‐registered scoping review, we searched for relevant studies in MEDLINE (PubMed), PsycINFO (EBSCO), Web of Science and EMBASE using terms related to sleep and ostensibly paranormal experiences and beliefs. Forty‐four studies met all inclusion criteria. All were cross‐sectional and most investigated sleep paralysis and/or lucid dreaming in relation to ostensibly paranormal experiences and paranormal beliefs. Overall, there were positive associations between many sleep variables (including sleep paralysis, lucid dreams, nightmares, and hypnagogic hallucinations) and ostensibly paranormal experiences and paranormal beliefs (including those of ghosts, spirits, and near‐death experiences). The findings of this review have potential clinical implications such as reducing misdiagnosis and treatment development and provide foundations for further research. Our findings also highlight the importance of understanding why so many people report 'things that go bump in the night'. [ABSTRACT FROM AUTHOR]

Excessive fatigue in adolescents is a growing concern as it impacts various aspects of their lives. Research on its prevalence and contributing factors in specific popula‑ tions, especially in developing countries, is scarce. This study examines the prevalence of excessive fatigue among Moroccan adolescents and its association with demographic characteristics, parasomnias, depressive symptoms, and academic performance. In this cross‑sectional study, we assessed excessive fatigue among 800 Moroccan adolescents (aged 12‑20 years) in Settat province, using a comprehensive questionnaire including Pichot's Fatigue Scale (PFS), Patient Health Questionnaire 9 (PHQ‑9), parasomnia questionnaire, and demographic questionnaire. The primary outcome was excessive fatigue, while covariates included demographic factors, physical health, regular exercise, depressive symptoms, and specific parasomnias. Associations were analyzed using cross‑tabulation analysis, chi‑squared tests, and correlation analysis. Excessive fatigue was prevalent in 8.4% of partici‑ pants. Female adolescents had significantly higher adjusted odds of experiencing excessive fatigue than male adolescents, with an adjusted odds ratio (AOR) of 3.07 [95% CI (1.48, 6.37), P=0.003]. Excessive fatigue was significantly associated with nightmares, sleep paralysis, and hypnagogic hallucinations. A strong positive linear correlation was observed between fatigue and depressive symptoms (r=0.746, P<0.001). This study highlights the prevalence of excessive fatigue among Moroccan adolescents, emphasizing the importance of addressing gender‑specific issues, sleep habits, and mental health support. Further research is needed to understand the underlying mechanisms and explore the role of lifestyle and socio‑cultural contexts [ABSTRACT FROM AUTHOR]

Narcolepsy type 1 is a primary sleep disorder caused by deficient hypocretin transmission leading to excessive daytime sleepiness and cataplexy. Opioids have been suggested to increase the number of hypocretin-producing neurons. We aimed to assess opioid use and its self-reported effect on narcolepsy type 1 symptom severity through a literature review and questionnaire study. We systematically reviewed literature on opioid use in narcolepsy. We also recruited 100 people with narcolepsy type 1 who completed an online questionnaire on opioid use in the previous three years. The main questionnaire topics were the indication for use, and the possible effects on narcolepsy symptom severity. Structured follow-up interviews were conducted when opioid use was reported. The systematic literature review mainly showed improvements in narcolepsy symptom severity. Recent opioid use was reported by 16/100 questionnaire respondents, who had used 20 opioids (codeine: 7/20, tramadol: 6/20, oxycodone: 6/20, fentanyl: 1/20). Narcolepsy symptom changes were reported in 11/20. Positive effects on disturbed nocturnal sleep (9/20), excessive daytime sleepiness (4/20), hypnagogic hallucinations (3/17), cataplexy (2/18), and sleep paralysis (1/13) were most pronounced for oxycodone (4/6) and codeine (4/7). Opioids were relatively frequently used compared to a similarly young general Dutch sample. Oxycodone and, to a lesser extent, codeine were associated with self-reported narcolepsy symptom severity improvements. Positive changes in disturbed nocturnal sleep and daytime sleepiness were most frequently reported, while cataplexy effects were less pronounced. Randomised controlled trials are now needed to verify the potential of opioids as therapeutic agents for narcolepsy. • We investigated the effects of opioids use on narcolepsy symptom severity. • Opioids mainly improved disturbed nocturnal sleep and excessive daytime sleepiness. • Narcolepsy symptom relief was clearest for oxycodone or codeine. • Randomised controlled trials are needed to verify the therapeutic potency of opioids. • Concurrent opioid and sodium oxybate use should be more carefully monitored. [ABSTRACT FROM AUTHOR]

In this article, we closely examine the pre-Romantic artist Henry Füssli's version of The Nightmare (1781), observing how he not only accurately depicted the described and identified characteristics of the sleep disorder known as sleep paralysis, but also personified the affected sleeper's own sensations through his work. We undertake a comprehensive review of his work in order to explore the motivations behind Füssli's interest in depicting parasomnia, and attempt to understand the pictorial corporeality inspired by this phenomenon. To achieve the latter aim, we examined the different determining factors belonging to the Burkean aesthetic categories of beauty and the sublime. This approach highlights how Füssli managed to capture parasomnia in his work under a misogynistic gaze through the idea of the sublime, and the importance of its iconic and repeated representation in art. Through this, we can observe, understand, and precisely interpret the psychophysical effects of this experience on the viewer and detect the pleasure of scopophilia in Füssli's male gaze.

Summary: Previous studies have found significant associations between paranormal beliefs and sleep variables. However, these have been conducted on a small scale and are limited in the number of sleep variables investigated. This study aims to fill a gap in the literature by investigating paranormal beliefs in relation to a wide range of sleep variables in a large sample. Participants (N = 8853) completed a survey initiated by the BBC Focus Magazine. They reported on their demographics, sleep disturbances and paranormal beliefs. Poorer subjective sleep quality (lower sleep efficiency, longer sleep latency, shorter sleep duration and increased insomnia symptoms) was associated with greater endorsement of belief in: (1) the soul living on after death; (2) the existence of ghosts; (3) demons; (4) an ability for some people to communicate with the dead; (5) near‐death experiences are evidence for life after death; and (6) aliens have visited earth. In addition, episodes of exploding head syndrome and isolated sleep paralysis were associated with the belief that aliens have visited earth. Isolated sleep paralysis was also associated with the belief that near‐death experiences are evidence for life after death. Findings obtained here indicate that there are associations between beliefs in the paranormal and various sleep variables. This information could potentially better equip us to support sleep via psychoeducation. Mechanisms underlying these associations are likely complex, and need to be further explored to fully understand why people sometimes report "things that go bump in the night". [ABSTRACT FROM AUTHOR]

Recent studies have begun to understand sleep not only as a whole-brain process but also as a complex local phenomenon controlled by specific neurotransmitters that act in different neural networks, which is called "local sleep". Moreover, the basic states of human consciousness—wakefulness, sleep onset (N1), light sleep (N2), deep sleep (N3), and rapid eye movement (REM) sleep—can concurrently appear, which may result in different sleep-related dissociative states. In this article, we classify these sleep-related dissociative states into physiological, pathological, and altered states of consciousness. Physiological states are daydreaming, lucid dreaming, and false awakenings. Pathological states include sleep paralysis, sleepwalking, and REM sleep behavior disorder. Altered states are hypnosis, anesthesia, and psychedelics. We review the neurophysiology and phenomenology of these sleep-related dissociative states of consciousness and update them with recent studies. We conclude that these sleep-related dissociative states have a significant basic and clinical impact since their study contributes to the understanding of consciousness and the proper treatment of neuropsychiatric diseases. [ABSTRACT FROM AUTHOR]

We present a case of recurrent fearful isolated sleep paralysis in a 52-year-old male of Indo-Caribbean ethnicity with obstructive sleep apnea (OSA). Recurrent sleep paralysis is a widely under-reported yet worrisome symptom of various sleep disorders. Although a benign condition in most cases, sleep paralysis in a minority of patients causes great distress. Some patients exhibit bedroom avoidance behavior, whereas others experience bedtime anxiety, making it difficult to fall asleep. This leads to poor sleep quality and sleep deprivation, which can greatly impact a person’s overall health. As in our case, this led to a vicious “lack of sleep” cycle where a patient who had bedtime anxiety and could not fall asleep, owing to his recurrent isolated sleep paralysis, also had poor quality sleep secondary to his OSA. This increases morbidity and has many potential consequences, which may include cardiovascular events, cognitive decline, and motor vehicular accidents. Sometimes, simply addressing the underlying medical condition cures the recurrent sleep paralysis as in this case where continuous positive airway pressure for OSA cured the recurrent sleep paralysis. One of our goals is to raise awareness of recurrent sleep paralysis so that patients can seek medical help and would not have to live with the anguish of the condition. Coming forward will also assist medical researchers in furthering their understanding of sleep paralysis.

The author examines the concept of “sleep paralysis” from the point of view of biology and folk culture. The key components of this concept, highlighted by various authors, touches on the main problems related to this concept, including the relationship between biological and cultural in the context of sleep paralysis, are presented. In addition, the work describes possible interpretations of sleep paralysis, mythological characters associated with it in the folklore of different peoples of the world, and folklore genres in which it is reflected. Moreover, the article contains examples of narratives about cases of sleep paralysis in folklore; outside the cultural tradition, where mythological characters associated with sleep paralysis are known; as well as an example of the appearance of mythological characters connected with manifestations of sleep paralysis not in a mythological text, but in other folklore genres.

Another symptom of narcolepsy is cataplexy, which is a sudden loss of muscle tone triggered by strong emotions such as laughter, excitement, or anger. However, antidepressants have been tried to boost dopamine production to keep patients awake and active. Narcolepsy is a chronic neurological disorder that affects the brain's ability to regulate sleepwake cycles. [Extracted from the article]

Background: Sleep paralysis and lucid dreams are two states of consciousness that are connected to REM sleep but are defined by higher awareness in contrast to regular REM sleep. Despite these similarities, the two states differ widely in their emotional tone and their perceived controllability. This review aims to summarize the current research containing sleep paralysis and lucid dreams. However, given the sparsity of the research, one single topic cannot be chosen. Methods: Articles containing both lucid dreams as well as sleep paralysis were searched for in the following databanks: MEDLINE, Scopus, Web of Science, PsycInfo, PsycArticles, and PSYNDEX. Further, citations of the found papers were examined. Results: 10 studies were included in the review. Most of the studies were surveys, but there was also a case study, a randomized trial, and an observational EEG study. The numbers of participants ranged from a single participant in the case study to 1928 participants in a survey. The main findings were that correlations between sleep paralysis and lucid dreaming were positive and significant in most of the studies. Conclusions: There is a connection between lucid dreaming and sleep paralysis. However, research is still very limited and diverse in the methodologies used. Future research should build standardized methods for examining the two phenomena. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to determine the prevalence of sleep paralysis (SP) in medical students from the University of Buenos Aires (UBA). Materials and Methods: An ad hoc questionnaire based on the diagnosis of SP and a demographic survey was electronically presented to students of Internal Medicine at the School of Medicine of the UBA. The respondents answered both questionnaires using Google Forms®. Results: The prevalence of SP was 40.7% (95% CI 33.5-47.8). A higher percentage of the respondents (76%) reported experiencing SP-related anxiety. An association between self-perceived quality of sleep and the incidence of SP was found (χ²: 12.712, P = 0.002). The highest frequency was hypnopompic SP (55.55%), and the highest percentage (55.4%) suffered from SP less than once every 6 months. Most respondents (59.5%) reported having started with SP symptoms after 18 years of age, and the highest percentage (66.2%) had exacerbated their symptoms at college. The frequency of the Incubus phenomenon was 14.5% (95% CI 6.2-23). Most respondents (70.8%) denied the association of SP with religious or paranormal beliefs. Conclusion: SP is highly prevalent in medical students and is associated with poor sleep habits and perceived poor sleep quality. Clinicians should be aware of this parasomnia to avoid a misdiagnosis of psychosis and inform sufferers of the nature of SP. [ABSTRACT FROM AUTHOR]

Isolated sleep paralysis is a benign but frightening condition characterised by a temporary inability to move at sleep onset or upon awakening. Despite the prevalence of this condition, little is known concerning its clinical features, associated demographic characteristics, and prevention as well as disruption strategies. An online cross-sectional study was conducted. The sample comprised 3523 participants who had reported at least one lifetime episode of ISP and 3288 participants without a lifetime episode. Participants answered a survey including questions about sleep quality, sleep paralysis, and sleep paralysis prevention/disruption techniques. A total of 6811 participants were investigated (mean age = 46.9, SD = 15.4, age range = 18–89, 66.1% female). Those who reported experiencing ISP at least once during their lives reported longer sleep onset latencies, shorter sleep duration, and greater insomnia symptoms. Females (vs. male) and younger (vs. older) participants were more likely to experience ISP. Significant fear during episodes was reported by 76.0% of the participants. Most people (63.3%) who experienced ISP believed it to be caused by 'something in the brain'. A minority endorsed supernatural causes (7.1%). Five prevention strategies (e.g., changing sleep position, adjusting sleep patterns) with at least 60.0% effectiveness, and five disruption strategies (e.g., physical/bodily action, making noise) with varying degrees of effectiveness (ranging from 29.5 to 61.8) were identified through open-ended responses. ISP is associated with shorter sleep duration, longer sleep onset latency, and greater insomnia symptoms. The multiple prevention and disruption techniques identified in this study support existing treatment approaches and may inform subsequent treatment development. Implications for current diagnostic criteria are discussed. • Isolated sleep paralysis is associated with poorer sleep quality. • There are common prevention/disruption techniques used for isolated sleep paralysis. • A possible revision of the current diagnostic criteria for the condition is needed. Statement of significance : Sleep paralysis is sometimes described as a frightening experience which causes fear. There is a paucity of knowledge regarding clinical features of isolated sleep paralysis (paralysis that appears without signs of other sleep disorders such as narcolepsy), its associated demographic characteristics, and perceptions of aetiology as well as prevention and disruption techniques. This study extended existing work by investigating these topics in depth and found that ISP was linked to sleep problems, gender, and age. Five prevention and five disruption techniques for ISP were also identified that can be considered in future work. The results have potential clinical implications such as providing information that could eventually help to improve treatment for the condition and could be useful in future revisions of the diagnostic criteria. [ABSTRACT FROM AUTHOR]

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In parapsychological literature, out-of-body experiences (OBEs) appear closely correlated to the phenomenon of sleep paralysis (SP), with some authors referring to the SP state as a "gate" or "launching pad" for OBEs. Given the notorious difficulty of eliciting OBEs voluntarily using conventional methods, this paper proposes a novel methodology for eliciting OBEs, involving the induction of SP as a precursor condition. The relationship between sleep onset rapid eye movement (SOREM) sleep, SP, and OBEs are discussed, as is the work of earlier researchers who first elicited SOREM and sleep paralysis in the sleep laboratory. The results of preliminary testing of this methodology are briefly described. [ABSTRACT FROM AUTHOR]

Abstract Background Sleep paralysis (SP) is a transitional dissociative state associated with the REM sleep phase that affects approximately 28.3% of the student population during their lifetime. The reasons for the high prevalence of SP in the student population are not entirely clear. Research indicates possible influencing factors such as the intensification of anxiety symptoms, a tendency to worry, the presence of PTSD symptoms, and behavioral factors such as the consumption of psychoactive substances (caffeine, alcohol, nicotine), sleep deprivations and poor sleep hygiene. The study aimed to assess the prevalence of SP and determine the risk factors for the occurrence of SP in the population of Polish students. Methods The study used a battery online consisting of a set of questionnaires 1) a personal questionnaire, 2) the SP-EPQ, 3) the PCL −5, 4) the STAI-T, 5) the PSWQ. The questionnaire was sent via Facebook to 4500 randomly selected students from different universities in Poland. The questionnaire was completed by 2598 students. To unify the participant sample, people over 35 were excluded from the study (45 students). Ultimately, data from 2553 students were analyzed. Results A total of 33.14% of individuals experienced at least one episode of SP in their lives. The highest odds ratio for SP was associated with: the presence of three or more health problems (OR: 2.3; p = 0.002), the presence of any mental disorder (OR: 1.77; p = 0.002), including mood disorders (OR: 2.07; p = 0.002), suffering from at least one somatic disease (OR: 1.34; p = 0.002), a high level of anxiety as a constant personality trait (OR: 1.20; p = 0.035) and smoking (OR: 1.48; p = 0.0002), alcohol consumption (OR: 1.52; p

Objectives: Pregnancy is often associated with reduced sleep quality and an increase in sleep disorders, such as restless leg syndrome, obstructive sleep apnea, and insomnia. There are few studies investigating the prevalence of parasomnias in pregnancy, although they may be expected to be a significant problem, as disturbed sleep in this time period in addition to these sleep disorders may trigger parasomnia episodes. Methods: We conducted a survey using an online questionnaire focusing on a comparison of the prevalence of parasomnias in three time periods: 3 months before pregnancy, during pregnancy, and 3 months after delivery. We also inquired about psychiatric and neurological comorbidities, current anxiety and depression symptoms, and pregnancy complications. Results: A total of 325 women (mean age 30.3 ± 5.3 years) participated in the online survey. The overall number of reported parasomnias increased during pregnancy compared to the 3 months before pregnancy (p < 0.001) and decreased after childbirth (p < 0.001). Specifically, we found a significant increase in sleepwalking (p = 0.02) and night terrors (p < 0.001), as well as in vivid dreams (p < 0.001) and nightmares (p < 0.001) during pregnancy. A similar significant increase during pregnancy was reported for head explosion (p < 0.011). In contrast, the number of episodes of sleep paralysis increased after delivery (p = 0.008). At the individual level, an increase in the severity/frequency of individual parasomnia episodes was also observed during pregnancy. Participants whose vivid dreams/nightmares persisted after delivery had higher BDI-II and STAI-T scores. Our data also suggest a significant impact of migraines and other chronic pain, as well as complications during pregnancy, on the presence of parasomnia episodes in our cohort. Conclusions: We have shown that the prevalence of parasomnias increases during pregnancy and needs to be targeted, especially by non-pharmacological approaches. At the same time, it is necessary to inquire about psychiatric and neurological comorbidities and keep in mind that more sleep disorders may be experienced by mothers who have medical complications during pregnancy. [ABSTRACT FROM AUTHOR]

Summary: Sleep paralysis is characterized by the incapacity to perform voluntary movements during sleep/wake transitions, and could bring great discomfort. During sleep paralysis, out‐of‐body experiences can occur. Out‐of‐body experiences refers to the sensation of being outside of the physical body and perceiving the world from this outside perspective; however, they are pleasant in comparison with other sleep paralysis hallucinations. Lucid dreams are dreams in which a subject becomes aware of being dreaming while the dream occurs. Here, we designed an online survey to study the predominant and specific emotions during sleep paralysis and/or out‐of‐body experience events as well as the somatosensory perceptions that preceded their occurrence. The sample (N = 329) was divided into experimental groups depending on the presence/absence of out‐of‐body experiences, capacity to induce (or not) out‐of‐body experiences, and perception/no‐perception of the sleep paralysis. We showed that more positive emotions were associated with out‐of‐body experiences and more negative emotions were associated with sleep paralysis episodes, and for those who claim the ability to induce out‐of‐body experiences, positive emotions were more frequent in their episodes. We found that subjects perceived auditory, tactile and visual sensations before sleep paralysis episodes, and we proposed that these could be an "aura" of sleep paralysis. Furthermore, subjects that had out‐of‐body experiences but had never felt the sleep paralysis, perceived tactile and visual sensations to the same extent as subjects with out‐of‐body experiences that felt the sleep paralysis. Therefore, we proposed that the "aura" recognition could be used under controlled conditions for out‐of‐body experiences induction in patients with sleep paralysis to diminish the negative symptoms associated with sleep paralysis episodes. [ABSTRACT FROM AUTHOR]

Shift work disorder (SWD) may affect medical residents because their workload, academic demands and extended work hours. This condition set residents at risk of more sleep disorders. The study compared parasomnias among residents with and without shift work disorder (SWD) and weighed their relative risk (RR) for each parasomnia. One hundred twenty-six residents participated in the study. The Munich Parasomnia Screening questionnaire and the Barger Questionnaire for SWD were used for the screening of parasomnias and SWD, respectively. Means and percentages of studied variables were compared between groups. Relative risk (RR) was calculated for each type of parasomnia. The more frequent parasomnias in residents with SWD the RR (and 95% confidence intervals) were: sleep terrors, 5.60 (1.84–17.01); confusional arousals, 3.73 (1.84–7.56); sleep paralysis, 3.27 (1.53–6.93); hypnagogic/hypnopompic hallucinations, 2.55 (1.03–6.28); somniloquies, 2.45 (1.21–4.92); and nightmares, 2.01 (1.54–2.62). Our data suggest that residents who experience SWD may be at risk of having lower threshold for the occurrence of rapid eye movement (REM) and non-REM (NREM) sleep parasomnias. Additional research is needed to confirm these results, and to further identify the contribution to this association. [ABSTRACT FROM AUTHOR]

We investigated sleep paralysis (SP) with an online questionnaire. Our sample consisted of 380 participants who experienced at least one SP. In this paper, we present the relation of SP to extraordinary experiences, paranormal beliefs, and absorption. We used a German questionnaire, Fragebogen zur Phänomenologie außergewöhnlicher Erfahrungen (PAGE-R-II), to assess the extent to which people with SP have had other extraordinary experiences, a German translation of the Belief in the Supernatural Scale (BitSS), and a German version of the Tellegen Absorption Scale (TAS). Our hypotheses regarding a positive correlation between the frequency of SP and certain forms of extraordinary experiences, paranomal/ supernatural beliefs, and absorption were only partially confirmed. We found an expected significant correlation between the frequency of SP and the expression on the PAGE dimensions “Dissociation” and “External,” but not between SP frequency and the other scales. The group (55%) reporting paranormal experiences during SP had highly significant higher mean scores on the PAGE, BitSS, and TAS. There were also significant correlations between the applied scales and specific hallucinatory perceptions and emotions, which leads us to believe that two main types of experiencing SP may exist: one mainly connected with typical negative emotions and a more external focus of experience, and another characterized by positive emotions and more internally experienced perceptions. This hypothesis requires further investigations.