For how we live.
Grinding and clenching in sleep is common, and in healthy people experts now class it as a behaviour rather than a disorder. But the evidence on how common it is, and what causes it, is thinner than you would expect.
For a few seconds to a couple of minutes you are awake but frozen, sometimes with a sense of a presence in the room. It is REM sleep intruding into wakefulness — common, frightening and, on its own, harmless.
Nightmare disorder affects about 4% of adults. The treatment with the clearest backing is not a drug but a rehearsal technique that rewrites the dream while you are awake.
Childhood sleepwalking is usually harmless and outgrown. In adults it is rarer but a different proposition — one clinic series found most had done something violent during an episode and one in six had been injured.
The 2024 American Academy of Sleep Medicine guideline strongly backs intravenous iron and gabapentinoids, and now suggests against the dopamine agonists that were first-line for two decades.
The 2024 AASM guideline now advises against routinely using the dopamine agonists that were once standard, because over time they often make the condition worse — and puts anticonvulsants and iron first.
The old antidepressant is prescribed at low doses for insomnia far more than its evidence supports. A Cochrane review found only a modest, low-certainty effect on subjective sleep and none on measured sleep efficiency.
Two trials of oveporexton, an orexin receptor agonist for narcolepsy type 1, met their wakefulness endpoint and cut cataplexy sharply. Side effects were near-universal.
Orzeyful replaces signaling from the brain chemical narcolepsy patients lack, rather than stimulating wakefulness around the gap. Two-thirds of patients on the higher dose had trouble sleeping.
The comparison group matters: against veterans with unspecified narcolepsy diagnoses, the mortality gap widened to 140% higher odds. The study can't yet say what's driving the excess deaths.
For years the disorder was treated off-label. A phase 3 randomised-withdrawal trial won lower-sodium oxybate the first US approval for it — but its design measures what is lost on stopping.