An Overview Of Parasomnias

Parasomnia is a sleep disorder that causes abnormal behavior while sleeping. The behavior can occur during any stage of sleep, including the transition from wakefulness to sleeping and vice versa.

If you have parasomnia, you might move around, talk, or do unusual things during sleep. Other people might think you’re awake, but you’re actually unconscious. You typically don’t remember the incident. In this article, we shall look at an overview of parasomnias.

Parasomnias is a term used to identify a group of unusual and undesirable experiences and behaviors people experience in their sleep. They are also known as disruptive sleep disorders.

They could occur just as you are about to fall asleep, while you are sleeping, or any other periods between when you are sleeping and awake. Most parasomnias are categorized into REM (rapid eye movement) or Non-REM parasomnias.

REM and Non-REM sleep are the stages of sleep your body cycles through every night—your body cycles through these stages about every 90 minutes.

Symptoms of Parasomnias

Symptoms of parasomnias vary depending on which form you have. However, some common symptoms most parasomnias share include:

• Difficulty sleeping
• Fatigue during the day
• Waking up disoriented
• Exhibiting unexplainable behaviors in your sleep
• Frequent nightmares
• Having bruises and injuries, you can’t explain

Diagnosing Parasomnias

A diagnosis of parasomnia has to be made by a sleep medicine specialist. In trying to diagnose and identify what type of parasomnia you have, you’ll be asked several questions. Questions about your medical history, any history of drug or alcohol abuse, and any medications you might be on are common.

If you sleep with a partner, they can also provide your doctor with valuable insight into your symptoms and the kind of behaviors you exhibit in your sleep. An MRI or CT scan might be ordered to rule out the possibility of any brain damage or neurodegenerative condition.

A sleep study is the best way to make a definite diagnosis of parasomnia. In a sleep study, you’ll be asked to sleep in a lab where you’ll be closely watched. A sleep study is also known as a polysomnogram.

Causes of Parasomnias

A variety of factors are responsible for causing parasomnias. These factors also vary from one parasomnia to the other. However, certain risk factors could make you more susceptible to developing parasomnia. They include:

• Having a family history of parasomnias
• Insomnia
• Taking certain medications such as antidepressants and antipsychotics
• Having certain medical conditions such as sleep apnea or restless leg syndrome
• Having a history of mental health disorders
• Having a neurodegenerative disease like Parkinson’s disease or Lewy body dementia
• Sleep deprivation
• Alcohol or substance abuse

Types of Parasomnias

Sleep parasomnia could occur at any point in your sleep. Sleep parasomnias are typically classified into those that happen in Non-REM sleep and those that occur in REM sleep. However, some parasomnias don’t fall under either category.

REM Parasomnias 

REM sleep is one of the stages of sleep you’ll experience whenever you fall asleep.

During this stage of your sleep, your body goes through specific physical changes. Your heart rate and breathing quicken, and your eyes move rapidly underneath its lids.

The most common parasomnias you could experience when your body is in REM sleep include:

• REM Sleep Behavior Disorder (RBD): RBD is characterized by sudden movements and vocalizations in your sleep. If you have RBD, you might find yourself suddenly swearing out loud in your sleep, sometimes in response to a dream or flapping your arms and legs around. RBD is more common in older male adults and linked with neurodegenerative conditions such as Lewy body dementia and Parkinson’s disease. A small 2013 study showed that older adult men who suddenly develop RBD develop either dementia or a form of Parkinson’s disease.5
• Recurrent Isolated Sleep Paralysis (RISP): During an episode of sleep paralysis, you’ll find yourself conscious but unable to move or speak. In some instances, you might even see things that aren’t there. You will feel like you are awake and should be able to move but will be unable to. Some research shows that about 7% of the population might experience an episode of sleep paralysis at least once. However, people who experience RISP have frequent and recurring bouts of sleep paralysis. People who have RISP might even develop a fear or anxiety related to falling asleep.
• Nightmare Disorder: If you have a nightmare disorder, you’ll experience graphic and recurrent nightmares that often cause sleep dysfunction. While it’s more likely to occur in adults, a small percentage of children who have experienced severe psychological stress could develop nightmare disorders. You’ll find yourself having very vivid and unpleasant dreams that leave you feeling terrified or anxious. It’s more likely to occur if you are highly stressed or have just experienced a traumatic event.

Non-REM Parasomnias 

Non-REM sleep is made up of the first three stages of sleep. During this stage of sleep, you can still be easily awakened. Parasomnias that occur during Non-REM sleep are also referred to as “Disorders of Arousal.”

The most common Non-REM parasomnias include:

• Sleepwalking: Sleepwalking is a type of parasomnia that causes a person to move around and sometimes speak while still asleep. You might have seen sleepwalking depicted in books and movies or might have even experienced it yourself. Sleepwalking is also known as somnambulism. A sleepwalker could get out of bed, walk several feet and even engage in activities such as moving furniture while still asleep. Some sleepwalkers can even perform activities like driving or getting dressed. Sleepwalking tends to recur, and it’s rare to find people who experience it one-off. People who sleepwalk also stand a risk of causing severe harm to themselves.7
• Sleep-related eating disorder (SRED): A person with SRED will find themselves consuming edible and sometimes non-edible items during a time they’d be typically asleep. They generally are not fully conscious of when this is happening. Taking certain medications such as antipsychotics have been linked to the development of SRED.
• Confusional Arousal: Confusional arousals are more common in children than adults. Confusional arousals cause a person to experience agitation or distress when asleep. People with this disorder are not conscious of the behaviors they are exhibiting. You’ll notice a person with confusional arousal showing signs of confusion or confused behavior when sleeping. They might mumble incoherently or look lost and afraid. An episode can last a few minutes or even hours.
• Sleep terrors: People who experience sleep terrors find themselves suddenly waking up in a state of terror for no apparent reason. You might find yourself screaming out or bursting into tears. Sleep terrors are also referred to as nighttime terrors.

Other Parasomnias

Some other parasomnias can neither be classified as REM nor Non-REM parasomnias. Most parasomnias in this category are typically rare. This category of parasomnias typically occurs in the period between sleep and wakefulness.

Some of the most common include:

• Sleep-related hallucinations: People with this parasomnia experience hallucinations when they are about to wake up or fall asleep. You might see or hear things that aren’t there, and may even get up from your bed to try and escape them.
• Exploding Head Syndrome: With exploding head syndrome, you’ll find yourself experiencing sudden flashes of light or loud sounds in the period in which you are either beginning to fall asleep or when you’re waking up. It’s a rare condition and is sometimes called episodic cranial sensory shock.
• Sexsomnia: This form of parasomnia causes a person to engage in sexual behavior and activities when they are asleep.
• Sleep Enuresis: This is more commonly known as bedwetting. It’s a phenomenon that causes a person to urinate in their sleep involuntarily. While this is common among young children, especially those who haven’t been toilet trained, for a diagnosis of sleep enuresis to be made, specific criteria have to be met. You have to be at least five years old and experience involuntary urination in your sleep at least twice a week. This should also have gone on for at least three months.

Treatment for Parasomnias

For parasomnia to be treated, your doctor will first need to correctly identify what type of parasomnia you have and what may be causing it. Any other medical conditions you may have will also be taken into consideration.

For REM sleep parasomnias, medication such as Clonazepam and melatonin may be prescribed to help improve the quality of your sleep. For Non-REM parasomnias, cognitive-behavioral therapy is an effective form of treatment.

Coping With Parasomnias

Whether you’ve been diagnosed with REM sleep parasomnia or Non-REM sleep parasomnia, some general coping techniques can help improve the quality of your life. Some great go-to tips are:

• Practice good sleep habits: Getting enough quality sleep every night and avoiding using electronics that emit blue light before bed is an excellent sleep habits to adapt.
• Cut out bad habits: Either cut down or stop consuming alcohol and caffeine
• Make a sleep schedule: Make an effort to go to bed and wake up at the same time every day. Having a regular sleep schedule will improve the quality of your sleep.
• Maintain your stress levels: Several parasomnias have been linked to high-stress levels. Finding ways to reduce your stress levels will help manage your parasomnia symptoms.

If you have parasomnia like sleepwalking, locking windows and doors before falling asleep is encouraged.

I hope you find this article helpful.