Clinical POEMs
Clinical question
What clinical approach is most appropriate for identifying and managing parasomnias in young adults?
Bottom line
Parasomnias in post-secondary students are strongly associated with insomnia, anxiety, and psychological distress, indicating that they should be managed using a comprehensive, multimodal approach. Clinically significant insomnia affects approximately one-third of students, and anxiety levels are elevated across the population. Effective management should include routine screening for parasomnias, assessment of comorbid conditions, and first-line behavioral interventions such as sleep hygiene and cognitive behavioral therapy for insomnia (CBT-I). Pharmacologic treatments may be considered based on parasomnia type, but management primarily focuses on symptom reduction and safety rather than cure. (LOE = 2)
Reference
Fichten CS, Havel A, Libman E, et al. Parasomnias, sleep and psychological adjustment among students with different disabilities. (Manuscript submitted).
Study design
Observational cross-sectional study with supporting literature
Funding source
Government (FRQ-S; FRQSC)
Setting
Post-secondary students (Canada)
Synopsis
Parasomnias are often overlooked in clinical practice and may be dismissed as benign or isolated sleep disturbances. However, findings from this study indicate that parasomnias frequently co-occur with significant sleep and psychological difficulties. Among 202 post-secondary students, approximately one-third met criteria for clinically significant insomnia, and about 40% demonstrated clinically significant anxiety. Students with mental health-related disabilities, particularly those with additional comorbid conditions, were at highest risk for both sleep and psychological impairment.
These findings emphasize that parasomnias rarely occur in isolation and should prompt clinicians to assess for comorbid insomnia and mental health conditions. Management should begin with low-risk behavioral interventions, including sleep hygiene education, stress reduction strategies, and CBT-I when insomnia is present. Safety precautions are also important, particularly for parasomnias involving complex behaviors such as sleepwalking.
Overall, a holistic and integrated approach to assessment and treatment is essential to improve patient outcomes in this population.
POEM 2
Clinical question
What practical interventions can clinicians use to manage parasomnias in post-secondary students?
Bottom line
Management of parasomnias in young adults should prioritize routine screening, identification of comorbid insomnia and mental health conditions, and implementation of low-risk behavioral interventions. Parasomnias are strongly associated with insomnia, anxiety, and psychological distress, particularly in individuals with mental health-related disabilities. First-line treatment should include sleep hygiene, stress reduction, and cognitive behavioral therapy for insomnia (CBT-I), with pharmacologic interventions considered when necessary. (LOE = 2)
Reference
Fichten CS, Havel A, Libman E, et al. Parasomnias, sleep and psychological adjustment among students with different disabilities. (Manuscript submitted).
Study design
Observational cross-sectional study with supporting literature
Funding source
Government (FRQ-S; FRQSC)
Setting
Post-secondary students (Canada)
Synopsis
Parasomnias are highly prevalent among post-secondary students and frequently co-occur with clinically significant sleep and psychological difficulties. Evidence from this study demonstrates that approximately one-third of students meet criteria for clinical insomnia, with elevated anxiety and depression particularly among those with mental health-related disabilities and comorbid conditions.
Given these associations, effective management requires a comprehensive approach. Clinicians should begin by screening for parasomnias and assessing related conditions such as insomnia, anxiety, and depression. Behavioral strategies should be prioritized as first-line interventions, including maintaining consistent sleep schedules, improving sleep hygiene, and addressing stress through cognitive and behavioral techniques. Cognitive Behavioral Therapy for Insomnia (CBT-I) is recommended when insomnia is present.
Safety measures are also important, particularly for parasomnias involving complex or potentially harmful behaviors. Pharmacologic treatments may be used selectively depending on the specific parasomnia, but overall management focuses on reducing symptom severity and improving sleep stability rather than achieving a cure.
POEM 3
Clinical question
Are parasomnias clinically meaningful indicators of sleep and mental health risk in post-secondary students?
Bottom line
Parasomnias are highly prevalent (>90%) in post-secondary students and are associated with significantly greater insomnia severity, poorer sleep quality, and increased psychological distress, particularly among individuals with mental health-related disabilities and comorbid conditions. Approximately one-third of students meet criteria for clinically significant insomnia, with the highest rates observed in those with both mental health and other disabilities. These findings suggest that parasomnias should be routinely screened for in clinical practice as a marker of broader sleep and psychological dysfunction. (LOE = 2)
Reference
Fichten CS, Havel A, Libman E, et al. Parasomnias, sleep and psychological adjustment among students with different disabilities. (Manuscript submitted).
Study design
Observational cross-sectional study
Funding source
Government (FRQ-S; FRQSC)
Setting
Post-secondary students (Canada)
Synopsis
Parasomnias are a group of sleep disorders involving abnormal behaviors or experiences during sleep, but their prevalence and clinical significance in post-secondary students—especially those with disabilities—remain underexplored. In this study, 202 students (125 with disabilities, 77 without) completed questionnaires assessing parasomnias, sleep quality, insomnia severity, and psychological functioning.
Results showed that parasomnias were extremely common, with over 90% of participants reporting at least one parasomnia in the past year. Students with mental health-related disabilities, particularly those with additional comorbid conditions, reported significantly higher parasomnia frequency and number of symptoms. This group also demonstrated worse sleep quality, higher insomnia severity, and greater daytime distress and psychological maladjustment. Approximately 32% of the total sample met criteria for clinically significant insomnia, with the highest proportion (59%) in those with both mental health and other disabilities.
These findings highlight parasomnias as a widespread and clinically relevant issue in young adults, particularly among those with mental health conditions. Routine screening for parasomnias may help identify individuals at increased risk for sleep and psychological difficulties.
SleepSomnia 