Management of Non-REM parasomnias: A systematic review of evidence-based treatment approaches.

Non-rapid eye movement (NREM) parasomnias are sleep disorders characterized by abnormal, involuntary behaviours during partial arousals from slow-wave sleep. NREM parasomnias are common in childhood and usually remit, but a subset persist into or first emerge in adulthood, where they may cause significant morbidity. Evidence to guide treatment is limited, and no formal treatment guidelines exist. This review summarises evidence for behavioural, psychological, and pharmacological interventions. Ovid (Embase), the Cochrane Library, and PubMed were searched for English-language reports on the treatment of NREM parasomnias (confusional arousals, sleepwalking, sleep terrors, sexsomnia, sleep-related eating disorder) from January 2003 to 25 February 2026. The review followed PRISMA and was prospectively registered with PROSPERO (CRD420261327423). Risk of bias was assessed with RoB 2, ROBINS-I, and Joanna Briggs Institute tools, as appropriate; certainty of evidence was rated using GRADE. Heterogeneity precluded meta-analysis; findings were synthesized narratively. Fourteen studies were included, mostly retrospective and uncontrolled. Pharmacotherapy, particularly benzodiazepines, was the most studied modality; cognitive behavioural therapy was the leading non-drug intervention. Interventions also included melatonin, antidepressants, Z-drugs, topiramate for sleep-related eating disorder, serotonergic precursors in children, and hypnosis. Most interventions suggested benefit, but small samples, reliance on subjective outcomes, and the absence of comparators limited interpretation. Certainty was very low for most outcomes. High-quality trials with standardized and ideally objective measurements are needed to guide clinical practice.