Parasomnias (also called parasomnias, parasomnias) refer to a group of sleep disorders characterized by abnormal behaviors, movements, emotions, perceptions, or dreams during sleep or sleep-wake transitions. These conditions can disrupt sleep quality, leading to daytime fatigue, impaired function and potential safety risks. Most people will experience parasomnias during their lifetime.
Types of parasomnia
Although each parasomnia involves different symptoms, these behaviors can be divided into three categories:
- Non-rapid eye movement (NREM) sleep stage related,
- Rapid eye movement (REM) sleep stage related; and
Non-rapid eye movement sleep (NREM)-related parasomnias
Parasomnias associated with NREM occur during the first three stages of the sleep cycle and are collectively referred to as NREM sleep.
The most common NREM-related parasomnias are called "arousal disorders" and are characterized by:
- incomplete awakening
- Limited response to others trying to intervene or redirect the sleeper
- Limited consciousness during seizure
Most people who experience sexual arousal disorder have little memory of their experience.
- Disorganized Arousal: During a disorganized arousal, the sleeper will appear disoriented and may sit up and look around but will not leave the bed.
- Sleepwalking: An episode of walking or performing complex behaviors during sleep, often with impaired consciousness and little memory afterwards.
- Night Terrors (Sleep Terrors): Sudden awakening from sleep with intense fear, screaming, sweating, and increased heart rate, often with limited or no memory of the event afterwards.
- Sleep-related parasomnias: Colloquially known as "somnophilia," this type of parasomnia is characterized by sexual behaviors during sleep, such as masturbation, initiation of intercourse, and sexual noises.
- Sleep-related eating disorders are characterized by the onset of disordered eating after awakening from sleep. Most people with this disorder show limited reactions during eating and have little memory of these events.
Rapid eye movement sleep (REM)-related parasomnias
Parasomnias during rapid eye movement sleep.
During normal REM sleep, the brain is particularly active, the eyes move rapidly, and the muscles are temporarily paralyzed. Most dreams occur during REM sleep.
People with REM-related parasomnias experience abnormalities in the normal functioning of REM sleep, such as muscle paralysis. There are several common parasomnias associated with REM sleep.
- REM sleep behavior disorder (RBD): Vivid and often violent dreams during REM sleep that may cause harm to yourself or your sleeping partner. RBD is characterized by abnormal sounds or movements made during REM sleep in an attempt to act out dreams. These behaviors are often related to self-defense and may include punching, kicking, or yelling. RBD is common in people with Parkinson's disease.
- Sleep paralysis: People with sleep paralysis briefly lose the ability to move their bodies when falling asleep or waking up. Temporary inability to move or speak when waking or falling asleep, often accompanied by hallucinations or a sense of impending danger. Sleep paralysis is not dangerous, but it can cause anxiety or distress while falling asleep.
- Nightmaresia: Disturbing and vivid dreams that cause feelings of fear, anxiety, or distress, typically occurring during REM sleep.
The "Other" category of parasomnias specifically addresses behaviors that occur during the transition between sleep or wakefulness, as well as behaviors that may occur during non-rapid eye movement sleep and rapid eye movement sleep.
- Exploding Head Syndrome: People with Exploding Head Syndrome wake up hearing loud noises or feeling like their head is exploding. They may also perceive imaginary flashes of light when they wake up. This sensation can leave the sleeper with lingering feelings of palpitations, fear, and anxiety. Some people may experience multiple attacks each night.
- Sleep-related hallucinations: This condition may involve hypnotic hallucinations when you wake up or hypnotic hallucinations when you fall asleep. Hallucinations may include vivid images, sounds, or other sensations. Hallucinations are sometimes associated with sleep paralysis. In extreme cases, the sleeper may leave the bed in an attempt to escape what they are experiencing.
- Bedwetting: Also known as sleep enuresis, bedwetting refers to involuntary urination during sleep. Bedwetting is common in young children. To be considered parasomnia, it must occur in a person 5 years or older and occur at least twice a week for three months.
- Somniloquy: Speech or vocalizations during sleep, ranging from simple sounds to coherent sentences. It occurs during NREM and REM sleep states.
Causes and risk factors
The underlying causes of parasomnias are multifactorial and may involve genetic, neurological, psychological, or environmental factors. Influencing factors include:
A family history of parasomnias or sleep disorders may increase the risk of parasomnias.
Irregular sleep schedules, poor sleep hygiene, and sleep deprivation can exacerbate parasomnia symptoms.
Other sleep disorders may also trigger parasomnias, such as obstructive sleep apnea
stress and anxiety
Emotional stress or traumatic experiences may trigger parasomnia episodes, such as nightmares or sleep terrors.
Certain medications, including antidepressants, antipsychotics, and sleep aids, may disrupt sleep architecture and cause parasomnias.
Symptoms and diagnosis
A sleep medicine specialist will usually ask you to complete a sleep diary for two weeks. This will give the expert clues as to what may be causing your problem.
You can also use the Epworth Sleepiness Scale to assess your sleep.
A sleep medicine specialist will need to know your complete medical history. Be sure to tell your doctor about any medications you have taken in the past or currently and if you have ever had any other sleep disorders. A sleep medicine specialist will try to determine if there are other causes of your parasomnias or making your symptoms worse, such as:
- another sleep disorder
- Physical conditions
- drug use
- mental health disorders
- substance abuse
A sleep medicine specialist may want to check your sleep with a laboratory sleep study. A sleep study, also called a polysomnogram, records your brain waves, heartbeat, and breathing while you sleep. It also watches how your arms and legs move and records your actions during sleep via video. This will help show if you got up and did anything unusual during the sleep study.
You should seek treatment whenever parasomnias pose a risk of harm to you or others.
It's also important to seek treatment if parasomnias are disrupting your sleep or that of your bed partner or roommate, if your symptoms are distressing, or if the parasomnias are frequent or escalating. An overnight sleep laboratory study may be necessary.
It's important to know that parasomnias are rarely associated with mental illness, no matter how unusual or violent the behavior may be. However, people with parasomnias may experience ridicule, confusion, and/or shame because of their symptoms. In many cases, seeking help from a therapist or support group can help you and those around you cope with these issues. You should see your specialist if you:
- Frequent disturbing dreams and nightmares
- Repeated feelings of numbness when falling asleep and waking up
- act out of dreams
- Sleepwalking or waking up in other rooms of the house or apartment and not remembering how you got there
- Unexplained bruises and injuries in the morning
- Someone tells you that you are waking up, looking frightened and screaming loudly
- In the morning, I found that I had finished eating without realizing it.
- Things seen, heard or felt during the transition from sleep to wakefulness are not real
management and treatment
Treatment strategies for parasomnias aim to reduce symptoms, improve sleep quality, and address underlying factors that contribute to the disorder. Many people with parasomnias see improvements in their symptoms simply by improving their sleep habits. Good sleep habits include maintaining a regular sleep schedule, managing stress, having a relaxing bedtime and getting enough sleep. There are also drug therapies used to control symptoms.
General management options may include
- Sleep Hygiene Habits: Establish a consistent sleep schedule, create a relaxing bedtime, and optimize your sleep environment.
- Medications: In some cases, medications such as benzodiazepines or antidepressants may be prescribed to control the symptoms of parasomnias.
- Behavioral therapy: Cognitive behavioral therapy (CBT) or relaxation techniques may help reduce the stress and anxiety associated with parasomnias.
- Safety Measures: Implement safety precautions such as securing the sleeping environment, installing alarms or locks, and avoiding potentially hazardous activities during sleep.
A sleep medicine specialist will recommend treatments based on the diagnosis of parasomnias.
Sleepwalking – Management and Treatment Approaches
If you sleepwalk or suffer from parasomnias that cause you to wake up, you can take the following steps to make your home safer:
- Add new locks or alarms to doors and windows
- Sleep on the first floor
- Clear your bedroom of items that could cause you to trip or fall
Obstructive sleep apnea – management and treatment options
If you have been diagnosed with obstructive sleep apnea, using CPAP (continuous positive airway pressure) therapy or alternative treatments may improve symptoms of related parasomnias. You may also be instructed to follow these tips to minimize symptoms:
- Have a good sleep every night
- Maintain a regular sleep/wake schedule
- If you use sleeping pills, use the medicine as directed
- If you are a shift worker, adjust your work schedule
- Avoid alcohol and drugs
Parasomnias encompass a variety of sleep disorders that can have a significant impact on overall health and well-being. Although these conditions may disrupt sleep and impact daytime functioning, effective management strategies and interventions can help individuals cope with parasomnias and improve sleep quality. By understanding the symptoms, causes, and treatment options for parasomnias, individuals can take proactive steps to address the sleep disorder and achieve restful and restorative sleep.