Parasomnias

1. Ask patients and family members about any bothersome or dangerous sleepwalking episodes since the last visit and if therapy has reduced the frequency of these events.

2. For RBD, review the sleep diaries and interview bed partners to determine the number and nature of episodes.

3. Inquire about carryover sedation and anterograde amnesia from therapy. outcome evaluation

To determine the success of treatment, evaluate whether the treatment plan restored normal sleep patterns, reduced daytime sequelae, and improved quality of life without causing adverse effects. Schedule patients for follow-up within 3 weeks for insomnia and within 3 months for other sleep disorders. Perform a detailed clinical history to determine the patient's perception of treatment progress and symptoms along with medication effectiveness and side effects.

Instruct patients to keep sleep diaries of nightly sleep (number of hours, number of awakenings, and worsening or improved sleep) and daytime symptoms, along with documentation of episodes such as cataplexy or RBD. Increase medication to effective doses, and if necessary, start additional therapy to control symptoms. Patients with sleep disorders should experience relief of symptoms the first night of drug therapy but may not receive maximal benefit (effect on daytime symptoms) for a few weeks. Perform a detailed history of prescription, nonprescription, and complementary or alternative medications, and review the patient's sleep diary, daytime symptoms, and nonpharmacologic therapies on a regular basis.

Abbreviations Introduced in This Chapter

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