23
AASMMembershipSectionsNewsletter
■
Issue #5
UniversityMedical Center, andSleep
Medicineat NorthwesternUniversity.
HeobtainedaMasters of Science
degree inClinical Research from
theRushGraduateCollege in 2007.
Dr. Videnovicwas appointed as an
Assistant Professor of Neurology at
NorthwesternUniversity Feinberg
School of Medicine in 2007. He
moved toMGH in2013. Dr. Videnovic
cares for patientswithParkinson’s
diseaseandMovement Disorders.
His research programs have been
focusedon the interface of sleep,
circadianbiology andmovement
disorders aswell as on clinical trails
inneurology.
Michel Cramer Bornemann, MD
Dr. Bornemann is the co-Director
of theMinnesotaRegional Sleep
DisordersCenter at Hennepin
CountyMedical Center in
Minneapolis, Minnesota. He is an
Assistant Professor holding joint
appointments in theDepartments
of Neurology andMedicineat the
University of MinnesotaMedical
School.Additionally, Dr. Cramer
Bornemann is a faculty instructor
in theDepartment of Biomedical
Engineering at theUniversity of
MinnesotaGraduateSchool, Twin
Cities. Hehas several ongoing
researchprojects in the field of
SleepDisorders andhas received
funding fromawide variety of
sources including theNational
Institutes of Health, theAcademic
HealthCenter at theUniversity of
Minnesota, aswell as frommedical
technology and pharmaceutical
industries. His undergraduate degree
inPhilosophy complements his
work in neuroscience to developa
dialogue tobetter understand the
interplay between oscillating levels
of consciousness and behaviors that
may arise from sleep.
SteeringCommitteeProfiles
Continued>>
remains unchanged, therebymaintaining
the foundation for essential characteristics
whichdistinguish it from theother sleep
disorders, it provides only a limited scope
inwhich tobest understand thebroad
continuumof expressions attributed to
parasomnias. The ICSD-3 attempts to
elaborateuponour understandingof
parasomnias fromoneprimarily consisting
of an arguablydisparate set of clinical
characteristics toone that is basedfirmly
upon theunifyingneuroscientificparadigm
of statedissociation.
The concept that sleep andwakefulness
arenot invariablymutually exclusive states,
and that the various state-determining
variables ofwakefulness,NREM sleep and
REM sleepmayoccur simultaneouslyor
oscillate rapidly is thekey tounderstanding
primaryparasomnias. Recent advances in
neurophysiology, coupledwith sophisticated
neurodiagnostic imagingmodalities, now
reveal that the three states aremodulatedby
ahost of influences including thedegreeof
aminergic and cholinergicneurochemical
bias, CNS activation and thedegreeof
endogenous vs. exogenous input. Under
normal physiologic conditions,which
includehomeostaticdrive and circadian
rhythmicity, theprocess of statedeclaration
ismaintained in a stable andpredictable
fashion throughout a24hour period.
However, as the components of sleep
frequentlydissociate andoscillate, sleep
andwakemaybe rendered into a state that
isnot yet fullydeclared, therebyfinding
itself in anunstable temporary condition-
or statedissociation. Thus, sleep and
wake, aswell as its associated features of
consciousness andunconsciousness, are
not dichotomous states as theyoccur on a
spectrum and are considered evanescent.
Theprimaryparasomnias are clinical
phenomena that appear as thebrain
becomes reorganized across states, and
therefore areparticularly apt tooccur
during transitions between states.The
admixtureofwakefulness andNREM
sleep explains thedisorders of arousal-
confusional arousals, somnambulism and
sleep terrors. The admixtureofwakefulness
andREM sleep explains cataplexy, sleep
paralysis, hypnagogichallucinations, lucid
dreaming and thepersistenceofmotor
activityduringREM sleep (REMSleep
BehaviorDisorder). Theparadigmof state
dissociation allows for theunderstandingof
unusual - if not bizarre - humanbehaviors
and/or experiences that previouslyhad
defied explanation. This paradigm sets a
platformwhich invites rigorous scientific
inquiry, allowing for thedevelopment of
testablehypotheseswhich canbe verified
if true… and falsified if false.As reflected
by the inclusionof references byAllan
Hobson andTassinari et al., advances in
Somnology andCognitiveNeuroscience
continue to supplant long-heldpopular
beliefs thatDreamEnactment Behaviors
are the consequenceof
“wish fulfillment”
or attempts at inner conflict resolution that
hadbeenhiddenby formidablepsychic
censorship.
Given that admixtures ofwakefulness
with eitherNREM sleeporREM sleep
often result in adistinctive arrayof
patterns ofmotor expression alongwith
alterations in consciousness, an attemptwas
made in the ICSD-3 to further delineate
thoseparasomnias,which arise from
NREM sleep to those fromREM sleep.
This reorganization ismost apparent in
the sectiondedicated toNREM-related
parasomnias.Here, confusional arousals,
sleepwalking, and sleep terrors areno longer
a collectionof separate conditions; instead,
they are seen as arising from a similar
platform and explicitlyorganized as subsets
under theunifiedheadingof disorders of
arousal (DOA).Despite the appreciationof
theunitarynatureof disorders of arousal,
these conditionswill retain their unique
ICD-9 and ICD-10 coding to facilitate
appropriatedocumentation andmedical
recordingkeeping.The formal designation
of sleep-related abnormal sexual behaviors,
