This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a 24-year-old man who was admitted with the chief concern of abnormal breathing sounds during sleep for the past 5 years. Physical examination and vital signs were normal with a BMI of 28 kg/m2. His Epworth Sleepiness Scale score, for subjective assessment of excessive daytime somnolence, was 9. The patient entered sleep through NREM sleep stages, had recognizable NREM/ REM sleep alternations and physiological muscle atonia during REM sleep, with a total sleep time of 222 minutes. The groaning sounds lasted between 5 and 15 seconds and recurred in clusters, 16 minutes in net duration but spanning across 30 minutes. The overall clinical and polygraphic features in this patient were felt to be consistent with the diagnosis of catathrenia, a syndrome whose etiology remains unclear.

Four patients had a positive personal history for parasomnias and two- a positive family history. Personal history was positive for parasomnias in two patients. Family history was positive for parasomnias in two patients, for nocturnal groaning in one patient, and for sudden infant death syndrome in one patient. Eight patients were reporting a family history positive for parasomnias and three for nocturnal groaning. Catathrenia is associated with a positive personal or familial history for other parasomnias. There is no drug medication available for catathrenia. Empirical pharmacological treatments with dosulepine, trazodone, clonazepam, paroxetine, carbamazepine, gabapentin, and pramipexole have been unsuccessful or refused. The efficacy of the nCPAP ventilation is still debated. In particular, nCPAP treatment seems effective only when noisy breathing during sleep, diagnosed as catathrenia, is related to the co-existence of expiratory and inspiratory flow limitation with obstructive apneas or hypopneas and consequent intermittent hypoxia.

Parasomnias involve automatic behavior, i.e., seemingly goal-directed, complex purposeful behaviors enacted without the conscious awareness and volition of the individual, who cannot exercise conscious deliberate control over his or her behaviors and sleep-related experiences. It could be subdivided by taking into account the motoric versus autonomic/ sensory activation. This chapter deals with the most common disorders, covering the appropriate diagnostic and therapeutic strategies. Disorders of arousal include sleepwalking or somnambulism, sleep terrors, and confusional arousals. The pathophysiology of REM sleep behavior disorder (RBD) lies in a dysfunction of the brainstem structures modulating REM sleep. Enuresis consists of recurrent involuntary urination during sleep. It includes primary forms, where bladder control has never been achieved, and secondary variants occurring after a period of bladder control. Catathrenia, also known as nocturnal groaning or expiratory vocalization during sleep, consists of the emission of an unusual expiratory noise occurring in bursts without associated motor phenomena.