Slide #1,2,3 : For more information of “memory palaces” see:
Foer, Joshua. “Moonwalking with Einstein: the Art and Science of remembering everything”.
Castle Gates: Parasomnia is made up of 2 Greek words. Para means “to throw beside” similar to
bowling and somnia: the condition of sleep.
State dissociation grid: To be thrown beside the condition of sleep is to be traveling in a state between. A
state that is neither wake nor sleep. Consider the two states: wakefulness and sleep. They are comprised
of volitional movement and consciousness. When someone is sleep walking they have distorted
consciousness. Children may not recognize a parent. If they recognize their parent they may try to swat
them away. There is altered volitional movement. People sleep walking appear clumsy. Obeying
neither of the state rule creates a state in between sometimes called “state dissocation”.
Left garden arch : Sleep related epilepsy. Someone with epilepsy must jump through three clinical hoops:
1. Paroxysmal: It begins suddenly and ends suddenly
2. Stereotypic: It looks the same each time whether it is posturing, grimacing, vocalizations or a
repetitive behavior (picking at clothes, hitting the wall)
3. Abnormal: not a behavior typically done during the day.
Center garden arch: Nightmares occur out of REM sleep. REM sleep is concentrated in the second half of
Right garden arch: Night terrors
Robot: The FLEP (frontal lobe epilepsy) scale is reproduced here:
In summary, if the FLEP scale is greater than or equal to zero it is consistent with frontal lobe epilepsy. If
less than zero it is consistent with a parasomnia.
Reference: Derry C, Davey M, Johns M, Kron K, Glencross D, Marini C, Scheffer I, Berkovic
S. Distinguishing Sleep Disorders from Seizures. Arch Neurol vol 63, May 2006, pp 705-709
Tonsillar hypertrophy grading scale
0+ 1+ 2+ 3+ 4+
David Gozal1, Oscar Sans Capdevila1 and Leila Kheirandish-Gozal1 Metabolic
Alterations and Systemic Inflammation in Obstructive Sleep Apnea among
Nonobese and Obese Prepubertal ChildrenAm. J. Respir. Crit. Care Med. May
15, 2008 vol. 177 no. 10 1142-1149
Maria Pia Villaa, Caterina Malagolab, Jacopo Pagania, Marilisa Montesanoa, Alessandra Rizzolia, Christian
Guilleminaultc, Roberto Ronchetti Rapidmaxillary expansion in children with
obstructive sleep apnea syndrome: 12-month follow-up Sleep Medicine
Volume 8, Issue 2, March 2007, Pages 128–134
The four R’s of restless leg syndrome (RLS)
R= it occurs at rest
R= there is an uRge to move the legs and sometimes arms
R=the restlessness is relieved temporarily by movment
R= because of the autosomal dominant nature of this disease there is very
often a relative with RLS
Parasomnia type Concordance in Concordance in
identical twins fraternal twins
Sleepwalking2 Six time higher N=124
Sleep Terror1 0.15 (n=47) 0 (n=7)
Nightmares1 0.55 (n=28) 0.14 (n=89)
Hublin C, Kaprio J. Genetic aspects of genetic epidemiology of parasomnias. Sleep Medicine
Reviews vol 7, no 5, pp 412-321 2003
Bakwin H. Sleepwalking in twins. Lancet 1970; 466-467.
Ferber R. Solve Your Child’s Sleep Problem. 2006
Hurwitz, T., et al., A retrospective outcome study and review of
hypnosis as treatment of adults with sleepwalking and sleep terror. Journal of Nervous &
Mental Disease., 1991. 179(4): p. 228-33.
Clonazepam (0.5 mg tablets) or 0.1 mg/ml to give o.o1 mg per kg 60 minutes before sleep onset.
Shenck CH, Mahowald MW: Long-term, nighlty benzodiazepine treatment of injurious
parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am J Med
Shenck CH, Mahowald MW: Rapid Eye Movement and Non-REM Sleep Parasomnia.
Primary Psychiatry. 2005;12(8):67-74