Parasomnias are a group of sleep disorders that involve unusual behaviors or experiences during sleep, such as movements, emotions, or perceptions. These events can occur while falling asleep, during sleep, or upon waking. Common types of parasomnias include sleepwalking, night terrors, REM Sleep Behavior Disorder (RBD), where people act out vivid dreams, and sleep paralysis, where a person wakes up unable to move or speak. While some episodes are harmless, others may signal underlying health issues and warrant medical attention.
Parasomnias can be a concern because they often involve unconscious behaviors that lead to injury, disrupt mental health, or signal serious medical conditions. People may have unknowingly fallen, started fights, wandered outside, or harmed loved ones while asleep.
Can You Get Physically Hurt During an Episode?
Parasomnias can be physically damaging. Sleepwalking, REM sleep behavior disorder (RBD), and sleep terrors often involve large, uncontrolled movements during sleep. That means the sleeper may fall down stairs, walk into traffic, cut themselves on sharp objects, hit walls or furniture, or flee the home in confusion
In RBD, the brain fails to paralyze the muscles during REM sleep, allowing people to “act out” vivid dreams. These dreams are often violent or defensive, leading to kicking, punching, or jumping out of bed. Nearly 60% of people with RBD experience self-injury, and around 16% accidentally injure a bed partner (1).
In children, sleep terrors can cause thrashing, screaming, or running into walls. While most grow out of it, these episodes can result in bruises or hazardous falls.
The bottom line is, if someone moves around in their sleep and doesn’t know what they’re doing, they can get hurt. And it actually happens a lot.
Is There a Link Between Parasomnia and Mental Health?
Many parasomnias either stem from or worsen existing mental health issues.
- Nightmare disorder is often triggered by trauma, anxiety, or depression. Veterans with PTSD, for example, have one of the highest rates of chronic nightmares.
- Sleep terrors and sleepwalking are more common in people with generalized anxiety disorder.
- Stress and emotional arousal can increase the frequency and intensity of parasomnia episodes.
And the connection goes both ways. Parasomnia disrupts sleep architecture, which directly affects emotional regulation. Fragmented sleep weakens your brain’s ability to process stress and emotions, worsening anxiety, depression, and even suicidal ideation.
Can Parasomnias Put Others in Trouble?
A person in the middle of a parasomnia episode may be completely unaware of their surroundings, including who’s in the room.
In RBD, a person might lash out during a vivid dream of being attacked. Their sleeping partner may wake up to a punch, slap, or shove. These aren’t signs of waking aggression. They’re the result of the dream being acted out in real time.
In other types of parasomnia, the risks are more environmental:
- A sleepwalker might turn on the stove or leave the door open with children inside.
- Someone in a confusional arousal might shout or push family members trying to help.
- In rare cases, parasomnia-related actions have led to legal consequences, including assault and property damage.
It’s not about intent. It’s about risk. The longer parasomnia goes untreated, the higher the likelihood that someone else could get hurt.
Can These Sleep Behaviors Be a Sign of Something Worse?
Sometimes, parasomnia is more than just a sleep behavior. It’s a symptom of an underlying neurological or medical issue.
REM sleep behavior disorder, for example, is considered one of the earliest signs of neurodegenerative diseases. Research shows that people with idiopathic REM sleep behavior disorder (RBD) have up to a 65% chance of developing Parkinson’s, Lewy body dementia, or multiple system atrophy within 10 years (2).
Other parasomnias may also signal:
- Obstructive sleep apnea – linked to arousals that trigger sleepwalking or confusional episodes.
- Nocturnal epilepsy – sometimes misdiagnosed as parasomnia due to similar movements.
- Medication reactions – certain antidepressants or sleep aids can trigger complex sleep behaviors, including eating, walking, or driving while asleep.
In short, recurring parasomnia isn’t something to brush off. It might be the first visible symptom of a more serious condition that requires immediate medical evaluation.
How Do These Disorders Affect Sleep Quality?
Parasomnia directly fragments sleep, even if the person doesn’t fully wake up. This disrupts both non-REM and REM cycles, which are critical for memory, healing, and emotional balance.
Consequences of disrupted sleep architecture include:
- Impaired concentration
- Mood swings or irritability
- Chronic fatigue
- Increased risk of heart disease and metabolic disorders
Even when episodes aren’t remembered, they create micro-awakenings, brief, repeated interruptions that pull the brain out of deeper sleep stages. This prevents full rest and leaves a person feeling drained, foggy, and emotionally dysregulated during the day.
The damage accumulates over time. Poor sleep quality doesn’t just lead to tiredness. It increases the risk for:
- High blood pressure
- Type 2 diabetes
- Depression and anxiety disorders
- Workplace or driving accidents
Adults need at least 7 hours of uninterrupted sleep per night. Parasomnia makes this almost impossible for many patients, whether or not they recall the episodes.
Do Children Grow Out of It, Or Is That a Myth?
Many children do grow out of parasomnias, but not all. Sleepwalking, night terrors, and confusional arousals are common in children aged 4 to 12, peaking around age 7. These episodes usually resolve on their own by adolescence as the brain’s sleep-wake regulation matures.
But some parasomnias persist or return, well into adulthood.
- Around 4% of adults experience sleepwalking (3).
- Childhood sleep terrors may evolve into adult panic-like awakenings or REM-related disorders.
- Persistent parasomnia in childhood may signal an underlying issue like obstructive sleep apnea or nocturnal epilepsy.
Are There Effective Treatments for Parasomnias?
Parasomnia is treatable, especially when a trained sleep specialist guides the process. Treatment depends on the type, cause, and severity of the episodes. Options include:
- Addressing underlying disorders – like sleep apnea or PTSD, which may eliminate parasomnia when treated
- Behavioral strategies – such as keeping a consistent sleep schedule, stress management, and avoiding triggers like alcohol or sleep deprivation
- Scheduled awakenings – waking the person shortly before their typical episode time, which is often effective for children with sleep terrors
- Medication – such as low-dose clonazepam or melatonin for REM-related parasomnias
Treatment also involves making the sleep environment safe by blocking stairways, locking doors, and removing sharp or hazardous items. But that’s only a first step. Long-term safety requires understanding and addressing the root cause.
Worried About Parasomnias? We’re Here to Help You Sleep Safely and Soundly
Parasomnias can put your health, safety, and peace of mind on the line. The Insomnia and Sleep Institute of Arizona understands how disruptive and difficult these episodes can be. We identify what’s really happening during sleep and why it’s happening in the first place.
Our board-certified sleep physicians have guided countless adults and children through complex cases, from violent dream enactment to unexplained sleepwalking. Many now sleep through the night without fear or confusion.
If your nights feel unpredictable or unsafe, contact us today or call 480 745-3547. We’re here to help you take control of your sleep and finally rest without worry.
References
- McCarter, S. J., St. Louis, E. K., Boswell, C. L., Dueffert, L. G., Slocumb, N., Boeve, B. F., Silber, M. H., Olson, E. J., Morgenthaler, T. I., & Tippmann-Peikert, M. (2014). Factors associated with injury in REM sleep behavior disorder. Sleep Medicine, 15(11), 1332–1338. https://doi.org/10.1016/j.sleep.2014.06.002
- Postuma, R. B., Gagnon, J.-F., & Montplaisir, J. Y. (2013). REM Sleep Behavior Disorder and Prodromal Neurodegeneration – Where Are We Headed? Tremor and Other Hyperkinetic Movements, 3(0), 03. https://doi.org/10.5334/tohm.171
- Jaslow, R. (2012, May 15). More than 8.4 million Americans sleepwalk each year, study finds. Cbsnews.com; CBS News. https://www.cbsnews.com/news/more-than-84-million-americans-sleepwalk-each-year-study-finds/
Disclaimer: The information provided in this blog post is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a licensed healthcare provider for recommendations specific to your individual health needs.
