Parasomnia is a type of sleep disorder that presents as unwanted experiences or events that occur while a person is falling asleep, asleep, or just waking up. They can include strange behaviors, perceptions, movements, emotions, or waking dreams. The comprehensive behaviors of parasomnias are vast and often complex, making them appear purposeful to others such as sleep partners. However, if you have ever been asleep during an event and have no memory of it, that may have been a parasomnia event. Many people with a parasomnia disorder have difficulty falling asleep or staying asleep throughout the night. This can sound quite a bit like insomnia, and in fact, insomnia can be a comorbidity of a variety of parasomnias.
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REM sleep behavior disorder (RBD)
RBD involves the acting out of vivid, often undesired, aggressive dreams with limb movements and vocal sounds. It is sometimes referred to as dream-enacting behavior. RBD is a serious sleep disorder as 96 percent of patients diagnosed with it will also develop Parkinson’s disease within 15 years. This is a fascinating disorder and like with any disorder it is best to catch and treat it as soon as possible to prevent any serious self-injury or injury to the bed partner. Only leading sleep specialists are typically aware of the link between RBD and Parkinson’s disease, Lewy Body Dementia, and Multiple System Atrophy. The Insomnia and Sleep Institute of Arizona is recognized as the Face of Sleep Medicine in the Phoenix area due in part to specializing in certain disorders such as RBD.
Sleep-Related Eating Disorder
Also known as SRED, this parasomnia presents as compulsive binge-eating and/or drinking while asleep. Many patients have a partial memory of these events, but many have none. Like all parasomnia events, it is difficult to wake up the sleeping person. SRED sufferers tend to seek out high-calorie foods, which can result in temporary illness, obesity, and may exacerbate other conditions such as diabetes.
Symptoms of parasomnia events can vary based on the actual disorder. Any parasomnia event may lead to engaging in high-risk behavior, injury to oneself or others, and daytime grogginess due to poor sleep. Ultimately, parasomnias can lead to a poorer quality of life, but treatments are available.
Also called somnambulism, the sleep walking form of parasomnia happens when a person gets out of bed and walks around while remaining asleep. Other activities might also be present, such as sitting up in bed, running, or acting as if they are desperately trying to escape. Some sleep walkers shout and most have their eyes open. Typical actions during sleep walking episodes are strange, crude, or inappropriate such as climbing out windows or being aggressive.
Also known as somniloquy, sleep talking occurs when a person speaks aloud while asleep. What is said may be sensical to onlookers or not. Most of the subject matter is harmless, although at times it can be offensive. The volume can range and can be irritating or disrespectful to sleep partners. Sleep talking can happen at any time of the NREM cycles, and during REM sleep it is known as dream vocalizations that can often be associated with RBD.
Also known as sleep terrors, this parasomnia event presents as a person sitting up in bed and screaming or shouting. The person may also thrash or kick about in bed. The person with night terrors often looks terrified and has a racing heart. They may be sweating, tense, or breathing heavily. In some cases, night terrors can overlap with sleep walking as the person quickly exits the bed. Night terrors usually are not calmed by someone else talking to them and these patients are typically difficult to wake up.
This sleep disorder makes a person act confused and strange as they wake up or soon after waking. They often act as if they don’t know where they are and can present with slow speech, poor memory, responses that are too blunt, and confused thinking. Many patients describe their mindset as foggy during this time, and confusional arousal is most common when someone else wakes a sleeping person up. Confusional arousals are common and generally harmless in children but can develop into sleep walking as a child grows older.
Also known as sexsomnia, this parasomnia event occurs when the brain is “caught” between sleep stages, which can make a person seem like they are awake when they are not. Sleep sex is not simply a sex dream, although sex-themed dreams during these episodes are not uncommon. Sexual behaviors are exhibited by the sleeping person, including fondling either themselves or a sleep partner, thrusting of the pelvis, orgasm, masturbation, or mimicry of intercourse. This is a very concerning sleep disorder secondary to the potential legal implications of having this disorder untreated.
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Parasomnia Disorders Treatment
The treatment approach for parasomnia disorders depends on whether the disorder is related to NREM or REM sleep cycles, both of which are typically secondary to an underlying sleep disorder. In order to address parasomnia behaviors, any underlying disorders such as sleep apnea or use of a medication triggering these events must be identified.
If a sleep study reveals the presence of an underlying disorder such as underlying obstructive sleep apnea (OSA) and/or periodic limb movement disorder (PLMD), the treatment for the parasomnia is actually treating the sleep disorder. Parasomnias are often the result of an arousal that is triggered by a sleep disorder such as sleep apnea.
REM parasomnia behaviors are often the result of poor-quality sleep, which would again require investigation to determine the cause of not obtaining enough REM sleep. REM sleep behavior disorder (RBD), however, is an independent sleep disorder that requires a sleep study for diagnosis, but can be linked with the future development of Parkinson’s disease, Lewy Body Dementia, and/or Multiple System Atrophy. RBD is typically treated by ensuring quality of sleep is as optimal as possible, timed-release melatonin, and/or clonazepam.
NREM parasomnia behaviors include:
- sleep talking
- sleep walking
- sleep terrors
- sleep sex
- sleep eating
- confusional arousals
The initial path in both children and adults with NREM parasomnia activity is to determine the source of what is causing the person to briefly be woken in what is called stage N3 sleep. Often underlying sleep apnea and/or periodic limb movement disorder are common causes of these events.
Parasomnia disorders are often individualized, leading to varying degrees of behaviors and symptoms. Fortunately, a number of effective treatments are available depending on the parasomnia disorder and the resulting behaviors and symptoms. Working with a sleep specialist is the first step in better sleep.
When possible and applicable, yes. Most parasomnia behaviors will require a sleep study to further determine the cause of the behavior, but reports from those who have witnessed the behaviors may also be helpful. However, you do not need to have had a witness in order to seek a diagnosis and treatment for parasomnia behaviors.
Nightmares are most often linked to traumatic incidents as well as comorbidities like depression, anxiety, and other mental disorders. Nightmares may also occur as a symptom of not getting an adequate quality of sleep.
Confusional arousal is relatively common in children, with 15 – 17 percent of children having experienced some degree of confusional arousal. The adult population incidence is smaller at 2 – 4 percent.
A relatively small percentage of the general population, about 0.5 – 1 percent, have RBD. It is more prevalent in adults, with 2 percent of older adults estimated to have RBD. That is 35 million possible patients worldwide.