24
AASMMembershipSectionsNewsletter
■
Issue #5
AmericanAcademy
of SleepMedicine
Ramadevi Gourineni, MD
Dr. Gourineni is aNeurologist
and specialist in the field of
SleepMedicine. She obtained
hermedical degree fromKurnool
Medical School inAndhraPradesh,
India. Her Neurology training
was completed at theUniversity
of Illinois, Chicago, IL. Shealso
completed2 fellowships. The first
onewas inEEG andSleep at Loyola
University, Maywood, ILand the
secondwas inSleepMedicine at
NorthwesternUniversity, Chicago, IL.
Sheworked for two years at Loyola
University as anAssistant Professor
inNeurology. She is currently an
AssociateProfessor inNeurology
at NorthwesternFeinbergSchool
of Medicine. Her clinical practice
is inSleepMedicine and she is the
Director of the InsomniaProgram at
theNorthwesternSleepDisorders
Center.
ErikK. St. Louis, MD
Dr. St. Louis isHeadof theSection
of SleepNeurology,Associate
Professor of Neurology, MayoClinic
College of Medicine, andConsultant
inNeurology andMedicine at Mayo
ClinicRochester. He previously co-
directed theMarshfieldClinic and
University of IowaComprehensive
EpilepsyPrograms for ten years. He
was educatedat St. Olaf College, the
Medical CollegeofWisconsin, Mayo
ClinicRochester, andTheUniversity
of Iowa. He is board certified by the
AmericanBoards of Psychiatry and
Neurology (Adult Neurology, with
additional Certifications inSleep
andClinical Neurophysiology),
SleepMedicine, andClinical
Neurophysiology (EEG/Epilepsy
Monitoring). Hewas renamed in
2013 to theBest Doctors inAmerica,
selectedas aFellow of theAmerican
Academy of Neurology, and serves
on theABRETBoard of Directors
andAANContinuumandFrontiers in
EpilepsyEditorial Boards. ■
often referred to in thepopularmedia
as
“Sexsomnia”
or
“SleepSex”,
as awell-
recognized clinical or pathologic subtype
ofDOA should facilitate the acceptance
of this condition in the courtroom arena,
particularlywithin theprosecutorial realm
whichoftenviews this conditionwithgreat
skepticism. Sleep-related eatingdisorder
(SRED) inmanywaysmay likewisebe
considered tobe a clinical or pathologic
subtypeofDOA; however, SREDhas
manydistinctive features - such as its
associationwith restless legs syndrome and
greater potential to retain awareness - that
diverge from thoseofDOA. Alongwith
greater understanding in terms of essential
features, demographics, predisposing and
precipitating factors and clinical course,
the importanceof SRED is reflected in the
presentationof its owndiagnostic criteria
and is situatedunder its ownheading in
ICSD-3- between sections ofNREM-
related andREM-relatedparasomnias.
A significant changewithin the ICSD-
3parasomnias section is the transfer
of catathrenia to the sleep-related
breathingdisorder section. Since ICSD-
2, continued researchhas revealed that
catathreniahasmore in commonwith
sleepdisorderedbreathing anddoesnot
appear tomechanisticallyfitwithin the state
dissociationparadigm. Similarly, enuresis,
a rather poorlyunderstood condition,
also appears tonot adhere to the state
dissociationparadigm.However, enuresis
was retainedwithin theparasomnias
sectiongiven its overall clinical significance
and that it conforms to the conventional
definition as an “undesirablephysical event
or experiencewithin sleep”. Last but not
least, it has longbeenheld that alcohol
has been identified as apotential trigger
for sleepwalking.More recent evidence-
based reviews have foundno compelling
relationshipbetween alcohol andDOA.
This undoubtedlywill have significant
diagnostic,management, and forensic
implications. It isnow explicitly stated in
the ICSD-3 that
“Disorders ofArousal should
not be diagnosed in the presence of alcohol
intoxication”
as thebehavior of the alcohol-
intoxicated individualmay superficially
mimic that of a sleepwalker.
Inviewof (1) the largenumber of neural
networks, neurotransmitters, andother
state-determining substances thatmust
be recruited synchronously for full state
declaration, and (2) the frequent transitions
among states during thewake/sleep cycle,
it isnot surprising that errors in state
declaration canoccur as frequently as
theydo. The ICSD-3 reflects this growing
fundof knowledge inparasomnias as
demonstratedbynotable refinements in
diagnostic criteria, clinical updates, and
bibliographic revisions toDOA, REM sleep
behavior disorder (RBD), andnightmare
disorder.Theparasomnias sectionof the
ICSD-3 aims to enhanceour understanding
of these conditions through the state
dissociationparadigm, provide current and
up-to-date clinical information aswell as
guidance, and set standards for on-going
and future research.
MichelA.CramerBornemann,MD
