Parasomnia

A disorder in which disruptive behaviors or events negatively affect your sleep is called parasomnia. When it occurs, people may walk, talk, or make physical movements to act out a dream. Some people may wake up in fear or be unable to move. In general, there are some treatment options available to address this condition and help you fall and stay asleep.

Furthermore, parasomnia is a type of sleep disorder that causes abnormal behaviors or experiences during sleep. Usually, people with parasomnia experience sleepwalking, nightmares, confusion when waking up, not remembering what they did during the night, and other problems. Sometimes, you may think you are awake when previous things occur, but you are actually asleep.

Types of Parasomnias

There are three primary groups of parasomnias that are based on the stage of sleep in which they happen. For example:

• Non-rapid eye movement (non-REM) sleep – Generally, non-REM sleep is the first 3 stages of sleep, including from falling asleep to about the first half of the night. Usually, non-REM sleep parasomnias cause physical and verbal activity.
• Rapid eye movement (REM) sleep – This stage of sleep occurs after all non-REM sleep stages. During this stage, eyes may rapidly move under the eyelids, and the heart rate, breathing, and blood pressure can increase. Usually, people see vivid dreams during this period. In such cases, parasomnias occur in the later part of the night.
• Other – There are some parasomnias that fall into this category because they do not fit into either a non-REM or REM sleep phase.

Non-REM Sleep Parasomnias

These include:

• Sleep terrors – This type occurs when you wake up scared. In some cases, you may scream or cry in fright. While it lasts mostly for 30 seconds, it may last up to a few minutes. You may also experience the following symptoms. For example, fast heartbeats, dilated pupils, fast breathing, and sweating.
• Sleepwalking (also called somnambulism) – In such cases, you may get out of bed and move about with eyes wide open, but you are still asleep. Some people may also perform complex activities (including playing a musical instrument or driving) or do strange things, such as peeing in areas without a toilet.
• Confusional arousal – This type causes you to feel confused and disoriented. You may also sit up, have your eyes open, or express emotions like crying. Some people may speak slowly or may not understand what other people say. While this episode can last several minutes, sometimes it may last a few hours. In most cases, confusional arousal occurs during childhood and tends to disappear over time.

REM Sleep Parasomnias

• Nightmare disorder – Generally, nightmares are vivid dreams that can cause fear, terror, or anxiety. When you wake up during a nightmare, you can describe it in detail. Therefore, it is usually difficult to fall asleep again after you wake up.
• Recurrent isolated sleep paralysis – This type of REM sleep parasomnia causes you to wake up with an inability to move your body. In most cases, it occurs when the muscles are relaxed (such as before you fall asleep or as you wake up). While these episodes can last a few seconds, some people may experience them for a few minutes. Some people may experience fear and panic during this period. However, if someone speaks or touches you, you may jolt out of paralysis.
• REM sleep behavior disorder (RSBD) – When it happens, you may act out, vocalize (talk, swear, laugh, or shout), or make aggressive movements (including punching, kicking, or grabbing) as a reaction to a violent dream. RSBD is considered a sleep disorder that commonly occurs among adults and people with neurodegenerative disorders. These include Parkinson’s disease, Lewy body dementia, or multiple system atrophy.

Other Parasomnias

The following types of parasomnia do not fit in any of the previous categories. Examples include:

• Sleep enuresis (bedwetting) – This type causes accidental release of urine (pee) during sleep. Commonly, parasomnia bedwetting occurs after age 5. It is considered that your child has sleep enuresis if it occurs at least 2 times per week for at least 3 months.
• Sleep-related groaning (catathrenia) – It occurs when you make repetitive moaning or groaning noises during sleep.
• Exploding head syndrome – In such cases, you will hear a loud noise or explosive crashing sound in the head as you are falling asleep or waking up. Sometimes, people may also see an imaginary flash of light or experience a sudden muscle jerk.
• Sleep-related hallucinations – People with this type of parasomnia can experience false perceptions when they are falling asleep or waking up. It means you can see, feel, or hear things that do not exist.
• Sleep-related eating disorder – It causes you to eat and drink during sleep. Moreover, some people may eat foods or food combinations you would not eat if you were awake (including uncooked chicken or a stick of butter). This type of parasomnia is dangerous because it may lead to eating inedible or toxic foods, choking, or injuries (such as cuts or burns).
• Sexsomnia – In such cases, you carry out sexual behaviors during sleep. It often includes intercourse, masturbation, sexual assault, touching your bed partner, or sexual vocalizations.

How Common Are Parasomnias?

According to some studies, between 4% and 67% of adults around the world have experienced parasomnias during their lifetime.

Symptoms

Usually, the symptoms appear differently among people with parasomnias because they depend on several factors. For example, the type and severity of the condition, overall health, and age. Check some general symptoms of parasomnia:

• Strong emotions when waking up (such as fear, anxiety, or stress)
• Daytime tiredness
• Bad dreams
• Doing strange things that you would not typically do when you are awake
• Difficulty falling and staying asleep
• Wakeful movements during sleep (including grabbing objects, walking, and others)
• Vocalizations (such as talking or yelling) during sleep
• Confusion or disorientation when waking up

If any of the previous symptoms occur, do not hesitate to visit a doctor.

Causes

There are multiple reasons that can cause parasomnias. Usually, symptoms occur when something interferes with the ability to sleep through the night. For example:

• Irregular sleep-wake schedule (including jet lag or shift work)
• It is challenging for the body to transition from being awake to falling asleep
• Genetic predisposition
• Lack of sleep-wake cycle maturity (usually in children)

Furthermore, there are some medicines and health conditions that may also cause or contribute to parasomnias. For example:

Medicines

The following medicines can disrupt your sleep cycle, which eventually leads to parasomnia. For example:

• Antibiotics (such as Fluoroquinolones)
• Antidepressants (including Amitriptyline, Bupropion, Paroxetine, or Mirtazapine)
• Medications to treat seizures (such as Topiramate)
• Antipsychotics (for example, Quetiapine, Olanzapine, and others)
• Asthma/allergy medicines (including Montelukast)
• Medicines used to treat hypertension (such as Propranolol, Metoprolol, and others)
• Sedatives (including Zolpidem, Benzodiazepines, and others)

Disorders

The following disorders can cause parasomnia. Examples include:

• Chronic pain
• Narcolepsy
• Circadian rhythm disorders
• Periodic limb movement disorder
• Restless legs syndrome
• Obstructive sleep apnea
• Alcohol and substance use disorder
• Encephalitis (inflammatory disease)
• Mental disorders (such as depression, anxiety, post-traumatic stress disorder)
• Neurological conditions (for example, Parkinson’s disease, Lewy body dementia, stroke, multiple system atrophy, multiple sclerosis, brain tumors, migraines, and others)
• Pregnancy
• Traumatic brain injury (TBI)

Risk Factors and Triggers

Healthcare providers have identified some factors that could cause the condition and things that make the symptoms happen (also called triggers). Check below some factors that could increase your risk of parasomnias:

• Age – Children and young adults between the ages of 5 and 25 are more likely to develop non-REM parasomnias.
• Health conditions – The risk of parasomnias significantly increases in children with neurologic or psychiatric disorders, including epilepsy, attention-deficit/hyperactivity disorder (ADHD), or developmental difficulties. In addition, REM parasomnias often affect adults with underlying neurological or degenerative brain disorders.
• A family history – If you have a parent or sibling with non-REM parasomnias, your risk of developing them increases.

There are some things that trigger the symptoms in people with parasomnias. Check some examples below:

• Fever
• Some medicines
• Drinking alcohol before bed
• Hearing certain noises
• Sleep deprivation (not getting enough sleep)
• Physical touch
• Stress

What Are The Potential Complications of Parasomnia?

People who develop this condition may also experience some complications. These include:

• Depression
• Physical injuries to themselves and others
• Poor performance at school or work
• Sleep anxiety
• Stress

While it is very rare, some people may cause fatal physical injuries to themselves. This article does not contain a full list of complications. However, you can consult with your doctor about ways to reduce the risk of the previous complications.

How to Prevent Parasomnia?

Unfortunately, it is not possible to prevent all types of parasomnia (such as those caused by neurological diseases, mental health problems, or genetics). One sure way to reduce the risk of developing parasomnia is practicing good sleep hygiene. Furthermore, your doctor may recommend some tips to keep you safe if you experience parasomnias (including sleepwalking or REM sleep behavior disorder). For example:

• Sleep on the first floor
• Avoid sleeping in bunk beds or lofted beds
• Do not share your bed with someone else
• Move furniture and lamps away from the bed
• Use childproof doorknobs
• You can also install alarms on windows and doors
• Do not keep any weapons or dangerous items in your home

Diagnosis

Commonly, a parasomnia is diagnosed after a physical and neurological examination and testing. During these examinations, doctors will check for irregularities linked with the disease. They may also ask your bed partner or other people who have observed your behavior while you sleep. To learn more about the condition, physicians may evaluate your medical and family history. However, to confirm the condition, they can perform the following tests. For example:

• Polysomnogram (sleep study) – During this test, doctors will monitor as you sleep to record brain waves, heart rate, eye movements, and breathing.
• Video electroencephalogram (EEG) or sleep EEG – This test is used to record your brain activity during sleep.
• Imaging tests – The following tests are used to detect brain degeneration or other possible causes. Doctors usually perform CT (computed tomography) or MRI (magnetic resonance imaging) scans.

Treatment

The treatment is often different among people with parasomnia because it depends on several factors. However, doctors may prescribe any of the following options to address the symptoms and prevent serious complications. For example:

• Follow good sleep hygiene habits (such as getting to 9 hours of sleep per night, turning off lights and electronic devices, trying to keep the temperature cool, avoiding caffeine and strenuous physical exercises before bedtime, and others)
• Keep a regular sleep-wake schedule
• Limit or avoid alcoholic beverages and non-prescribed drugs or substances
• Administer the medicines exactly as recommended by your doctor to avoid adverse reactions and complications
• Cognitive behavioral therapy (CBT)

Medicines

The following medicines are often recommended by doctors for people with REM parasomnias. They can be used if you have non-REM parasomnias if they cause chronic or harmful effects. In general, these medications are not the first-line treatment, but they can manage your symptoms if you do not notice improvements with sleep hygiene and bedtime habits. Check some of them below:

• Clonazepam
• Melatonin
• Tricyclic antidepressants
• Benzodiazepines
• Selective serotonin reuptake inhibitors (SSRIs)

You may wonder how parasomnias are treated in children. However, some children do not need treatment because it goes away on its own when him/her get older. In any case, you should inform their pediatrician about how frequently episodes occur and what symptoms they experience. In severe cases, doctors may prescribe Benzodiazepines or anti-anxiety medicines.

Frequently Asked Questions

Is there a cure for parasomnia?

However, there is no single cure for all types of parasomnia. While some children get rid of this condition when they become older, others need treatment for the rest of their lives. Long-term treatment is often required by people who develop parasomnia due to neurodegenerative disorders, autoimmune conditions, or genetics.

How do you treat parasomnia?

In most cases, doctors recommend the following treatments to treat this disorder. For example, good sleep hygiene, medicines (including antidepressants and benzodiazepines), behavioral therapies, and environmental changes to prevent injuries. For more details, discuss it with your doctor.

What drugs cause parasomnia?

There are some medicines that may contribute to or even cause parasomnias. These include:

• Sedative-hypnotics (such as Zolpidem)
• Antidepressants (including SSRIs and other classes)
• Antipsychotics
• Beta-blockers
• Anticonvulsants
• Certain allergy/asthma medicines (including Montelukast) and others

This article does not contain a full list of medicines that may cause parasomnia. Ask your healthcare professional if you have additional questions.