Use of safety measures for the patient and family by clearing the bedroom from obstacles, securing the windows, or installing locks or alarms. Medications are necessary if the patient is in danger from his or her behaviour. In this case, Imipramine or low-dose Clonazepam is beneficial. Epidemiology
The current prevalence of confusional arousals varies according to the year and the sample population and is approximately 4% (4.2% in 1999 in UK sample population, 6.1% (15–24 years old), 3.3% (25–34 y.o.) and 2% (35+ y.o.) in 2000 in UK, Germany and Italy sample population, 6.9% in 2010 in Norway sample population with a lifetime prevalence of 18.5%). The current prevalence of confusional arousals in children (3–13 y.o.) is higher and around 17.3%. Confusional arousals without a known cause or associated condition is uncommon (for about 1% of cases ).The contribution of genetics and family link is strong and episodes of confusional arousals can occur in several members of the same family. Risk factors
Some independent risk factors associated with confusional arousals have been identified. According to studies, they are shift work, hypnagogic hallucinations (also known as hypnagogia), excessive daytime sleepiness, insomnia and hypersomnia disorder, circadian rhythm sleep disorder, restless legs syndrome, obstructive sleep apnea syndrome (OSAS), bipolar disorder, daily smoking, and age of 15–24 years. These risk factors of confusional arousals are somehow related to mental disorders and medical conditions and affecting mostly younger subjects regardless of gender.
The wave travels down to the stomach even if the bolus of food descends at a greater rate than the wave itself, and continues even if for some reason the bolus gets stuck further up the esophagus. If the bolus gets stuck or moves slower than the primary peristaltic wave (as can happen when it is poorly lubricated), then stretch receptors in the esophageal lining are stimulated and a local reflex response causes a secondary peristaltic wave around the bolus, forcing it further down the esophagus, and these secondary waves continue indefinitely until the bolus enters the stomach. The process of peristalsis is controlled by the medulla oblongata. Esophageal peristalsis is typically assessed by performing an esophageal motility study. A third type of peristalsis, tertiary peristalsis, is dysfunctional and involves irregular, diffuse, simultaneous contractions. These contractions are suspect in esophageal dysmotility and present on a barium swallow as a "corkscrew esophagus".During vomiting, the propulsion of food up the esophagus and out the mouth comes from the contraction of the abdominal muscles; peristalsis does not reverse in the esophagus. Stomach
When a peristaltic wave reaches at the end of the esophagus, the cardiac sphincter (gastroesophageal sphincter) opens, allowing the passage of bolus into the stomach. The gastroesophageal sphincter normally remains closed and does not allow the stomachs food contents to move back. The churning movements of the stomachs thick muscular wall blend the food thoroughly with the acidic gastric juice, producing a mixture called the chyme.