A 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 a 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.
Parasomnias include a wide range of abnormal behaviors, such as walking or talking during sleep. Parasomnias can occur during any sleep stage.
There are two general sleep phases:
• NREM(Non rapid eye movement)sleep, consisting of three different stages
• REM(Rapid eye movement) sleep
The body usually cycles through these sleep stages 4–6 timesduring the night. Each sleep phase involves different types of brain wave activity and physiological changes.
▪︎ NREM sleep
NREM sleep, also known as quiescent sleep, has three stages:
• Stage 1: This includes the transition from wakefulness to sleep. Brain wave activity begins slowing down during this sleep stage.
• Stage 2: This is a period of light sleep in which a person’s heart rate and breathing slow down, their body temperature drops, their muscles relax, and their eye movements stop.
• Stage 3: This involves deep, restorative sleep. This sleep phase occurs during the first half of the night.
▪︎ REM sleep
REM sleep begins about one and a half hours after a person falls asleep. The REM sleep phase involves rapid side-to-side eye movements, increased brain wave activity, and irregular breathing.
☆ NREM parasomnias
Examples of parasomnias that occur in the first sleep phase include:
Sleepwalking, also known as somnambulism, is an arousal disorder in which a person gets up and walks around while asleep.
Sleepwalking can also involve sleep talking or performing routine activities, such as preparing food or driving.
If a person wakes up in the middle of a sleepwalking episode, they may appear confused or disoriented.
▪︎ Sleep bruxism
Sleep bruxism is a type of movement disorder that involves clenching or grinding the teeth during sleep. Over time, bruxism can lead to headaches, earaches, jaw pain, and abnormal tooth wear.
▪︎ Confusional arousal
Confusional arousal happens when a person wakes up in a state of confusion. The individual may not know where they are or what they are doing. Other symptoms of confusional arousal include:
• speaking slower than usual
• slower reaction time
• poor memory
• poor coordination
Confusion arousal occurs in about 17% of children. Episodes can last anywhere from a few minutes to several hours.
▪︎ Sleep terrors
Sleep, or night, terrors are when a person experiences intense feelings of panic or fear during the first third of the night. Sleep terrors occur most often in children between the ages of 3–7 years old.
Sleep terror symptoms include:
• screaming or thrashing around
• rapid heartbeat
• abnormally fast breathing
• dilated pupils
Episodes last between 10–20 minutes. Most children return to sleep afterward and do not remember having a sleep terror.
☆ REM parasomnias
REM parasomnias occur during the last sleep stage, which involves heightened brain activity, muscle paralysis, and increased heart rate and breathing.
▪︎ REM sleep behavior disorder
REM sleep behavior disorder (RBD) occurs when a person physically acts out vivid dreams. Under normal circumstances, the body enters a temporary state of paralysis during REM sleep. However, people with RBD have incomplete or absent paralysis.
RBD does not necessarily occur every night, but an exceptionally realistic, violent, or frightening dream can trigger symptoms. Multiple RBD episodes may occur throughout the night with each REM phase.
A person with RBD may exhibit the following symptoms while sleeping:
• talking, shouting, or screaming
• kicking, punching, or thrashing
• waking up easily
• clearly remembering dreams
Although RBD does not usually affect a person’s sleep, it can increase a person’s risk of injury.
Nightmares are vivid and disturbing dreams that can cause feelings of anxiety, fear, or terror. A person who frequently experiences nightmares or nightmares that significantly affect their sleep may have a nightmare disorder.
▪︎ Sleep paralysis
The body’s muscles relax as a person falls asleep. During REM sleep, the muscles relax even further and become still. Doctors know this as atonia. Sleep paralysis occurs when muscle atonia happens while a person is still awake.
Sleep paralysis episodes last seconds or minutes. Episodes usually resolve spontaneously, but a person can end an episode if they force themselves to move.
☆ Other parasomnias
• Bedwetting or sleep enuresis refers to involuntary urination that happens during sleep. Most children wet the bed occasionally. Controlling bladder function during sleep is one of the final stages of toilet training. Doctors do not consider frequent bedwetting to be a parasomnia unless the child is over 5 years oldTrusted Source.
• Exploding head syndrome (EHS) is a condition in which an individual imagines a loud noise, similar to an explosion, just before they drift off to sleep.
• Sleep-related hallucinations are unreal visual, auditory, or tactile experiences that occur during the transition between sleeping and waking.
Aside from the unusual behavior during sleep, parasomnia can cause other symptoms. You might:
• wake up confused or disoriented
• wake up wondering where you are
• not remember doing certain activities
• find unfamiliar cuts on your body
• have difficulty sleeping throughout the night
• feel daytime sleepiness or fatigue
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
• 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
Your primary care doctor can help diagnose parasomnia. They’ll likely have you see a sleep specialist, who can further examine your sleeping behavior.
Diagnosis often includes –
• Medical history. Your doctor will ask about underlying medical conditions, current medications, family history, and lifestyle.
• Sleep history. A sleep diary can show your sleep behavior patterns. If you live with someone, they can observe how you sleep.
• Polysomnogram. In a polysomnogram, you sleep in a lab overnight so a specialist can analyze your sleeping behavior. They’ll record your brain waves, breathing, and heart rate to make a diagnosis.
For a 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 habit 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
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