Parasomnia refers to all the abnormal things that occur to people while they sleep — excluding sleep apnea. A parasomnia is characterized by unusual behavior and undesirable experiences that disrupt sleep. If you have a parasomnia, you may experience abnormal movements, sleep talking, or odd expressions.

Some examples are sleep-related eating disorders, sleepwalking, sleep terrors, nightmares, sleep paralysis, REM sleep behavior disorder, and sleep aggression. Parasomnias can have negative effects on people during the daytime, including daytime sleepiness.

When do parasomnias occur?

Parasomnias can occur as a person is falling asleep or at any point in the sleep cycle. If they occur while falling asleep, a person may experience disturbing hallucinations or sleep paralysis, where the body is unable to move for several seconds or minutes. Sleep paralysis can be quite frightening, especially in concurrence with hallucinations.

Types of Parasomnias

There are three general types of parasomnias: non-rapid eye movement parasomnia, rapid eye movement parasomnia, and others.

Non-REM Related Parasomnias

There are parasomnias that occur during the shallow stages of sleep or during arousal. The most common non-REM parasomnias cause a person to incompletely awake. These parasomnias typically occur in the younger population, and its prevalence decreases with age.

The following are considered non-REM parasomnias:

• Confusional arousals: Confusional arousals typically occur when waking from a deep sleep. You may experience difficulty or slowness when waking up, dilated pupils, accelerated heartbeat, or fast breathing.
• Sleepwalking: Sleepwalking, or somnambulism, occurs when you arise from bed while still asleep. Sleepwalkers exhibit limited awareness of their surroundings and unresponsiveness. These behaviors are not remembered the next day.
• Sleep terrors: Also referred to as night terrors, sleep terrors are similar to nightmares, but usually occur during deep sleep. Sleep terrors cause you to wake suddenly, and may cause you to scream. These episodes last from 30 seconds to three minutes.
• Sleep-related eating disorders: This disorder is characterized by dysfunctional eating habits after waking. Most people who have a sleep-related eating disorder have little to no memory of eating.
• Hallucinations: Sleep hallucinations are vivid experiences that typically occur as you are falling asleep or as you are waking. The hallucinations feel extremely realistic and tend to cause fear. These hallucinations are mainly visual.

REM-Sleep Related Parasomnias

Parasomnias that occur during sleep typically occur during the REM cycle of sleep. Common REM-related parasomnias include:

• REM Sleep Behavior Disorder (RBD): RBD often involves vigorous and harmful dream-enacting behaviors. RBD is a brain disorder that usually occurs in men over 50 years of age, but can affect people of any age who are taking certain medications such as antidepressants and people with neurologic disorders such as Parkinson’s disease, narcolepsy or stroke.
• Sleep paralysis: Sleep paralysis prevents you from moving your body or limbs during sleep. Experts believe sleep paralysis is an extension of REM sleep. These episodes can last from a few seconds to several minutes, and cause fear and anxiety.
• Nightmares: When a person has frequent and recurring vivid nightmares, this is considered nightmare disorder. This may cause trouble falling back asleep. Nightmare disorder causes fatigue, distress, reduced cognition, and daytime sleepiness.

Other Parasomnias

Other parasomnias that occur during sleep include bedwetting, exploding head syndrome, and sleep-related groaning, which can be loud and prevent a person’s bed partner from sleeping.

What causes a parasomnia?

Family history is likely a factor with parasomnias. Brain disorders may also be responsible, including REM Sleep Behavior Disorder. Parasomnias may also be triggered by other sleep disorders such as obstructive sleep apnea and various medications.

Other health issues that may cause a parasomnia include:

• Fever
• Stress
• Alcohol or substance abuse
• Pregnancy
• Depression, anxiety, or PTSD

Who is at risk for parasomnias?

Parasomnias affect one out of 10 Americans. They occur in people of all ages, but are more common in children. Children are particularly vulnerable because of brain immaturity. The most common parasomnias in children are confusional arousal, sleepwalking, sleep terrors, and nightmares. Parasomnias are not associated with negative health consequences and disappear as children mature.

Should a person be awakened during a parasomnia episode?

Trying to awaken a “parasomniac in action” — especially by shaking or shouting — may trigger an irritable, aggressive or violent response. Instead, gently redirect the person back to bed by guiding them by the elbow, while speaking softly.

What are the effects of parasomnias?

Parasomnias can cause negative effects while awake. These include:

• Anxiety and fear
• Embarrassment
• Sleep avoidance
• Insomnia and daytime sleepiness
• Depression
• Physical injuries

To prevent injuries, practice these tips:

• A person who suffers from parasomnias should not sleep on a top bunk or next to a window.
• Remove sharp objects from the bedside area.
• Make sure household members are aware of diagnosis and know how to react.
• During an episode, it’s safe to awaken a parasomnia sufferer with a door alarm.

How are parasomnias treated and at what point should someone with a parasomnia seek evaluation and possible treatment?

Many people who suffer from parasomnias enjoy improvements by adjusting sleep habits. Good sleep habits include keeping a regular sleep schedule, managing stress, having a relaxing bedtime routine, and getting enough sleep. Also, drug therapies and sleep medicine can control symptoms.

A person should seek treatment for parasomnia whenever there is risk for injury. It is also important to seek treatment if parasomnia disrupts a person’s own sleep or the sleep of the bed partner, if there is distress about the symptoms (e.g., nightmares), or if the frequency is high or escalating. An overnight sleep lab study may be needed to diagnose a parasomnia.

It is important to keep in mind that no matter how weird, bizarre, or violent, parasomnia behavior is rarely linked to psychiatric disorders. However, people who suffer from parasomnias may endure ridicule, confusion, and/or shame.

If you struggle with sleep over a long period of time, it’s time to consult a sleep specialist. Seeking a specialist could also be beneficial if you believe you are experiencing a parasomnia. We can help you develop a treatment plan. If you are looking to get quality sleep and improve your overall health, call Gwinnett Sleep at 678-582-1929 to schedule an appointment today.