Parasomnias

If you’ve ever been told that you walk, move violently, or talk loudly in your sleep, there’s a chance that you have experienced a parasomnia. However, most likely, you wouldn’t have realized this, which can make many parasomnias potentially disturbing to learn about.

Parasomnia is not one condition. Instead, the term parasomnias refers to a range of different issues that can occur during sleep or while one is falling asleep or waking up. These abnormal behaviors often occur during transitions between sleep stages and can take many different forms. While many adults experience parasomnias of some type, the frequency and impact of these can vary significantly.

In this guide, we’ll provide an overview of parasomnias including information about their definition, the most common types, the symptoms, health impacts, diagnosis, and treatment.

What Are Parasomnias?

Parasomnias are abnormal behaviors that arise during sleep. These can happen when someone is fully asleep or when they are transitioning between sleep stages, including when they are just falling asleep or are just waking up.

Sleep usually occurs in five stages. Each stage lasts from 5 to 15 minutes, creating a sleep cycle of around 100 minutes. The way the brain functions is different in each stage, but the brain is most active during the last stage, which is known as REM (rapid eye movement) sleep. The other stages are referred to as NREM sleep (non-REM). Dreams tend to be the most intense during REM sleep when the brain is most active.

Parasomnias can occur during any of these stages and are often classified based on whether they occur during REM or NREM sleep. With both types, it is common for someone to have no recollection of their parasomnia or their actions when they occur. For this reason, the person doesn’t feel “awake” at that moment even though by their actions they may very much appear to be awake. This inability to remember actions that occur during episodes of parasomnias can make them more difficult to diagnose.

Some parasomnias are very normal, and it is estimated that well over half of adults experience parasomnias during their adult lives. Many parasomnias are more common in children and young adults. Other parasomnias are more rare and may appear strange or surprising to people who have not experienced them. Some examples of parasomnias include:

  • Somnambulism (sleepwalking)
  • Night Terrors
  • Nightmares
  • REM Sleep Behavior Disorder (moving during REM sleep)
  • Sleep-Related Leg Cramps (usually calf and/or foot muscles)
  • Somniloquy (talking during sleep)
  • Sleep-Related Hallucinations (intense images during sleep)
  • Sleep Atonia (Sleep Paralysis; inability to move sometimes coupled with hallucinations)
  • Sleep-Related Eating Disorder (nocturnal eating; eating in large volumes while sleepwalking)
  • Exploding Head Syndrome (hallucinating loud noises)
  • Sleep Enuresis (wetting the bed)
  • Confusional Arousals (partial awakenings)

What Are the Symptoms of Parasomnias?

A person who experiences parasomnias may not be at all aware that they are happening. In many cases, they only become cognizant of their abnormal sleeping behaviors when they are noticed by a family member or partner.

Despite not knowing of their specific actions, a person may still feel certain symptoms related to parasomnias. For example, fatigue and excessive sleepiness during the day may be a result of poor sleep caused by parasomnias. This lack of sleep can also cause irritability and changes in mood as well as forgetfulness and cognitive challenges (such as loss of memory or concentration).

What Are the Causes of Parasomnias?

The exact causes of many parasomnias are not fully known or understood. Many occur without any identified cause. In some cases, the parasomnia may be traced to the use of a certain medication or may be tied to an underlying medical problem or mental distress.

Parasomnias do appear to occur more frequently in people who have other conditions or are taking specific medications. Examples include:

Health Conditions

  • Post-Traumatic Stress Disorder (PTSD)
  • Other mental distress
  • Central nervous system degenerative disorders (such as Parkinson or Alzheimer disease)
  • Sleep deprivation
  • Narcolepsy
  • Serious pain or chronic pain

Medications / Substances

  • Alcohol
  • Stimulants
  • Sedative hypnotics
  • Norepinephrine reuptake inhibitors
  • Neuroleptics
  • Oleptro (trazodone)
  • Ambien (zolpidem)

What Are the Health Risks of Parasomnias?

Generally, the health risks of parasomnias stem primarily from the way that a lack of sleep can affect the mind and body. For example, people with parasomnias often suffer from fatigue and daytime sleepiness, which can raise their risk of auto collisions or other accidental injuries (such as from falls).

Other risks may arise depending on the specific manifestation of the parasomnia. For example, people who sleepwalk can trip or fall or engage in otherwise risky behaviors, even driving, without being aware of what they are doing.

How Are Parasomnias Diagnosed?

Diagnosing parasomnia can be a challenge because it requires observing you while you sleep. A doctor will usually ask you questions about your sleep habits and may want to you track these habits in a sleep journal. The doctor may also want to ask questions of your family or partner to get more information about your sleep disruptions.

Because many people with parasomnias do not remember them, it may be necessary to conduct a sleep study. During a sleep study, which often takes place a a specialty clinic, you can be observed through the night. Equipment can also monitor things like your breathing, pulse, and brain waves over the course of the night. All of the details of a sleep study will be explained to you if your doctor believes it to be necessary to assess your situation.

How Are Parasomnias Treated?

The treatment for parasomnia can depend on many factors. In children, treatment may be limited since most parasomnias naturally go away as a child gets older.

If the parasomnia is believed to be related to underlying mental distress, then one of the ways of treating it may be talk therapy (such as cognitive behavioral therapy) to try to resolve this underlying distress. This can be a process that takes time and requires numerous visits with a trained mental health professional. In some cases, medications may be prescribed to help.

Treatment can also include harm mitigation strategies. For example, for people who have a tendency to sleepwalk, it may be necessary to keep dangerous items (such as lighters or knives) in locked drawers. Potential tripping hazards may be removed from the bedroom and common areas, and in extreme cases, a bed alarm can be used to wake someone up when they stand up from bed in the night.

What Medications Are Available for Parasomnias?

There are no medications that are universally used to treat parasomnias. Medications are always prescribed on a case-by-case basis and under the supervision and judgment of a health professional.

One type of drug that may be used is a benzodiazepine. These increase the amount of GABA, an inhibitory neurotransmitter in the brain, with the goal of sedating a person. For example, clonazepam (Klonopin) may be prescribed for certain parasomnias.

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