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Management of non-rapid eye movement (NREM) parasomnias in adults

	Confusional arousals	Sleep terrors	Sleepwalking	Sleep-related abnormal sexual behavior	Sleep-related eating disorder
Environmental safety	Pad nearby furniture Lower mattress to the floor and/or use a ground-floor bedroom Secure doors and windows (locks, alarms, barriers) Remove sharp and dangerous objects from bedroom, including firearms
Behavioral management	Avoid sleep deprivation Maintain consistent and regular sleep-wake cycles Identify and eliminate potential triggers, including medications* and alcohol Treat comorbid sleep disorders^¶ Educate patients, bed partners, and bystanders
Scheduled awakenings	X	X	X
Pharmacotherapy	Clonazepam	Clonazepam	Clonazepam	Clonazepam SSRI	Clonazepam SSRI Topiramate Dopamine agonist^Δ

NREM: non-rapid eye movement; SSRI: selective serotonin reuptake inhibitor.
* A variety of drugs may precipitate NREM arousal parasomnias, including sedative-hypnotic drugs, especially nonbenzodiazepine benzodiazepine receptor agonists (eg, zolpidem), anticholinergics, antipsychotics, and lithium.
¶ Most commonly implicated sleep disorders are obstructive sleep apnea, restless legs syndrome (especially for sleep-related eating disorder), and periodic limb movement disorder.
Δ For sleep-related eating disorder associated with restless legs syndrome.

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