What Are Parasomnias?

A parasomnia is any sleep disorder marked by disruptive, involuntary behavior that occurs at some point during the sleep cycle. Examples range from night terrors, sleepwalking, and sleep-related eating disorder to sleep paralysis, nightmare disorder, and exploding head syndrome. Persons experiencing a parasomnia are unaware of what they’re doing and will have little memory of it on waking. Parasomnias rob individuals of healthy sleep and occasionally pose a threat to their safety or to that of their bed partner.

Parasomnias can strike at any age and have a range of potential causes. If you or a loved one is suffering from some form of parasomnia, the sleep specialists at Baptist Health are available to help.

Triggers of Parasomnias

Parasomnias have a variety of triggers, either directly related to a sleep disorder or the result of an underlying medical issue. Included are:

• Anxiety: Parasomnias are more likely in individuals undergoing stressful life situations.
• Poor-quality sleep: An inability to sleep deeply or for long periods can be a source of parasomnia. This inability may have another medical cause, such as restless leg syndrome or sleep apnea.
• Sleep deprivation: A regular lack of sleep can also foster the development of a sleep disorder (which, in turn, makes it more difficult to achieve restful sleep).
• Genetic factors: Persons with a family history of parasomnias are more likely to experience them than those without.
• Medications: Several types of medication have been linked to sleep disorders, including certain antidepressants, asthma drugs, soporifics, and hypertension drugs.
• Neurological disorders: Neurological disorders, including dementia, Parkinson’s disease, and narcolepsy, have been connected to an increase in sleep disorders.
• Mental-health issues: Persons who have been diagnosed with psychological conditions such as depression or post-traumatic stress disorder (PTSD) have an elevated level of risk with regard to parasomnias.

There is evidence for a sex bias in some sleep disorders. Women are more prone to nightmares, while men are more frequently subject to unconscious sexual behaviors while sleeping (a condition called sexsomnia). Other disorders, including sleepwalking, occur at similar rates in both sexes.

Symptoms

Parasomnias disrupt the normal sleep cycle, reducing the likelihood of safe and healthy sleep. Evidence of sleep disorders includes:

• Troubled or interrupted sleep
• Disorientation on waking
• Daytime sleepiness or exhaustion
• Reduced ability to concentrate
• Strange nighttime behaviors observed by your bed partner but unremembered by you.

You may also discover cuts or contusions on your body, caused by unconscious acts undertaken while sleepwalking or during a related parasomnia.

Types of Parasomnias

There are three broad groups of parasomnias: non-rapid eye movement (REM) disorders, REM disorders, and a third, miscellaneous category. The first category, non-REM disorders, are those that occur during the first half of the sleep cycle, usually prior to the dreaming phase. Non-REM disorders include:

• Night (or sleep) terrors: If you suffer from night terrors, you’ll awake suddenly from sleep in an agitated or terrified state. Your arousal may be accompanied by moaning or screaming.
• Sleep bruxism: Grinding your teeth at night is called sleep bruxism. This disorder can result in serious dental problems by wearing down and damaging teeth.
• Confusional arousal: Confusional arousal is waking up in a baffled or disoriented state. You may sit up and even speak to your bed partner, but you won’t be fully conscious or aware of your surroundings.
• Sleepwalking: Sleepwalking literally means walking while you sleep. You rise from bed, open your eyes, and start moving around, but remain unconscious of what you’re doing. Sleepwalking can be dangerous; for example, a sleepwalker could fall down steps at night that he or she uses every day while awake.
• Sleep-related eating disorder: Another form of parasomnia involves eating and drinking while asleep. This can include items that aren’t a normal part of the diet, some of which are toxic or impossible to digest.
• Nocturnal paroxysmal dystonia (NPD): This is an epilepsy-like disorder that is marked by seizures during sleep.

The REM phase of sleep follows the non-REM phase. This is the second half of the sleep cycle, during the period when most dreaming occurs. REM disorders include:

• Sleep paralysis: During sleep paralysis, you’re unable to move any part of your body. The period of immobility doesn’t last long but may not feel that way to the person experiencing it.
• Nightmare disorder: We all have nightmares on occasion, but if you have nightmare disorder, you’re having bad dreams of an intense nature on a regular basis. Waking up suddenly and remembering these dreams can lead to anxiety, restlessness, and a fear of going back to sleep.
• Sleep talking: Sleep talking is speaking while asleep. The speech isn’t directed at anyone and doesn’t always make sense. You won’t remember what you said after waking.
• REM sleep behavior disorder: This is another physically active parasomnia, similar to sleepwalking, except that it involves loud speech and aggressive behavior, possibly in response to an intense dream state. These behaviors may include swearing, screaming, punching, and kicking. REM sleep behavior disorder often occurs in tandem with certain neurological conditions and poses a potential health threat to both the sufferer and his or her bed partner.

There are several parasomnias that occur independently of the non-REM/REM sleep cycle. These are:

• Nighttime hallucinations: Hallucinations are imaginary perceptions mistaken for real. Sleep-related hallucinations tend to occur during transitional periods when you’re first falling asleep or waking up in the morning.
• Bedwetting (sleep enuresis): Sleep enuresis is not the bedwetting of young children. It is considered a parasomnia if it occurs regularly at night in children at least five years or older.
• Exploding head syndrome (EHS): EHS is a sleep disorder in which you fall asleep or wake up hearing loud noises variously described as explosions, gunshots, thunder, crashes, or something similar. These noises are imaginary and can’t be heard by anyone else.
• Sexsomnia: A person with sexsomnia acts out sexually while asleep. Sexsomnia encompasses a wide range of sexual behavior, including masturbation, groping, and intercourse with a bed partner, whether consensually or not.

Children under age 15 are often subject to parasomnias. The most common types are nightmares, sleep terrors, sleepwalking, and confusional arousal. Some infants under the age of one also exhibit rhythmic movement disorder. While sleeping, the child will rock back and forth sitting up or bang his or her head against the bed.

Diagnosing Parasomnias

If you’re experiencing the symptoms of a parasomnia on a regular basis, you should consult a physician who specializes in sleep disorders. He or she will diagnose your condition by:

• Asking about your episodes and the circumstances surrounding them
• Recording a complete list of symptoms
• Reviewing your personal and family medical history, including any sleep disorders that you’ve experienced
• Documenting what, if any, medications you’re taking

The major medical concern with any parasomnia is the impact it has on your ability to achieve sustained, healthful levels of sleep. Depending on the situation, your doctor may ask you to keep a sleep diary or a written record of your sleep experiences, typically for a period of two weeks. In more serious circumstances, he or she may order a sleep study. A sleep study involves sleeping overnight at a healthcare facility attached to monitoring technology, the data from which is used to determine any deeper, underlying medical causes for the parasomnia. Other possible diagnostic tests include an electroencephalogram (EEG) or an imaging test, such as a magnetic resonance imaging (MRI) scan.

Treatment

The wide array of parasomnias, with various degrees of severity, means that there is no standardized treatment procedure for every sleep disorder. In relatively minor cases, no treatment may be required at all. Your physician might suggest one or more of the following treatments to assist you in coping with a parasomnia that is hampering your sleep or that poses a more serious threat to your health or that of your bed partner:

• Improved sleep habits
• Psychological or therapeutic counseling
• Stress management and relaxation training
• Changes in medications

Certain conditions, such as sleepwalking or REM sleep behavior disorder, which involve physical forms of behavior, may require safety precautions. Padded or secured furniture can reduce the possibility of injury for a sleepwalker. For individuals who exhibit aggressive tendencies while sleeping, the bed partner may choose to sleep in another bed or in a different room.

When to See a Doctor for Parasomnia

Parasomnias are a group of disruptive sleep disorders that lower the quality of sleep and present additional health risks as well. Individuals with a sleep disorder are typically unaware of their behavior and have no recollection of what they’ve done after they awaken. If you think that you or a loved one may be suffering from a parasomnia with serious health consequences, call a sleep care specialist today!”