Center for Sleep Medicine
Parasomnias
What Are Parasomnias?
Parasomnias are abnormal behaviors that occur during sleep. These involuntary actions may disrupt family life and cause considerable distress. Conditions such as sleepwalking, head banging, bed-wetting, and sleep terrors in the adolescent or young adult are sleep disorders that can be diagnosed and treated in our program. REM behavior disorder, a condition in which older adults may attempt to act out their dreams while asleep, can result in injury to the individual or their bed partner. Once diagnosed, this condition is manageable by medications.
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What Are the Different Types of Parasomnias?
Disorders of Arousal
The most common parasomnias are disorders of arousal, which include confusional arousals, sleepwalking (somnambulism), and sleep terrors. Experts believe the various types of arousal disorders are related and share some characteristics. Essentially, these arousals occur when a person is in a mixed state of being both asleep and awake or awakening from the deepest stage of nondreaming sleep. This means that a person is awake enough to act out complex behaviors but still asleep and not aware or able to remember these actions.
- Confusional Arousals. Confusional arousals often occur in infants and toddlers but may also be seen in adults. These episodes may begin with the person crying and thrashing around in bed. The individual may appear awake, confused and upset, yet resists attempts by others to comfort or console them. It is difficult to awaken a person who is having an episode of this parasomnia. These episodes, which may last up to half an hour, usually end with the person calming down, waking briefly, and only wanting to return to sleep.
- Sleep Terrors. Sleep terrors are the most extreme and dramatic form of the arousal disorders and are the most distressing to witness. A sleep terror episode often begins with a "bloodcurdling" scream or shout, and may produce signs that suggest extreme terror, such as dilated pupils, rapid breathing, racing heart, sweating, and extreme agitation. During a sleep terror, the victim may bolt out of bed and run around the room or even out of the house. During the frenzied event, victims can hurt themselves or others.
- Sleepwalking. Sleepwalking is commonly seen in older children. It ranges from simply getting up out of bed and walking around the room to prolonged and complex actions, including going to another part of the house or even outside to the yard or garage. The sleepwalker may return to bed or awaken in the morning in a different part of the house. Sleepwalkers might carry on conversations that are difficult to understand and make little or no sense. They are capable of acting out complicated behaviors (such as rearranging furniture), but these activities are usually purposeless, and injuries during sleepwalking are uncommon. In most cases, no treatment is necessary. The sleepwalker and family can be assured that these events rarely indicate any serious underlying medical or psychiatric problem. In children, the number of events tends to decrease with age. These events, however, can occasionally persist into adulthood or may even begin in adulthood.
- Nocturnal Seizures. These seizures, which occur only during sleep, can cause the victim to cry, scream, walk, run about, or curse. Like other seizures, these are usually treated with medication.
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Rapid Eye Movement (REM) Sleep Behavior Disorder
Muscles that allow us to sit and stand are normally paralyzed during REM sleep. In some people, typically older men, this paralysis is incomplete or absent, allowing the person to "act out" dreams. Such dream-related behavior might be violent and result in injury to the individual or bed partner. Unlike those who experience sleep terrors, the victim will recall vivid dreams. REM sleep behavior disorder can be controlled with medication.
Rhythmic-Movement Disorder
This condition is seen most frequently in young children but may also occur in adults. It takes the form of recurrent head banging, head rolling or body rocking. The individual also may moan or hum. These activities may occur just before falling asleep or during sleep. Medical or psychological problems are rarely associated with rhythmic-movement disorder. Behavior treatment may be effective in severe cases.
Sleep-Related Eating
A rare type of sleepwalking is "sleep-related eating". People with this disorder experience recurrent episodes of eating during sleep, without being aware of what they are doing. Sleep-related eating might occur often enough to result in significant weight gain. Although it can affect all ages and both sexes, it is more common in young women.
Sleep Starts
Most people have experienced the common "motor" sleep start — a sudden, often violent, jerk of the entire body that occurs upon falling asleep. Other forms of sleep starts also occur just as sleep begins A "visual" sleep start is a sensation of blinding light coming from inside the eyes or head. An "auditory" sleep start is a loud snapping noise that seems to come from inside the head. Such occurrences can be frightening, but are harmless.
Somniloquy (Sleep Talking)
Somniloquy or sleep talking is a normal phenomenon and is of no medical or psychological importance.
Bruxism
Grinding teeth during sleep is a very common occurrence and little evidence suggests that teeth grinding is associated with any significant medical or psychological problems, though damage to teeth can occur. In severe cases, mouth devices may help prevent or reduce dental injury.
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How Do I Know if I Have a Parasomnia?
Doctors will base a diagnosis of a parasomnia on the patient’s symptoms, family history, physical exam, and test results. The symptoms people have are often distinct enough for doctors to diagnose a parasomnia. Laboratory tests are often needed to confirm the diagnosis and determine the best treatment. These tests may require the patient to visit a Sleep Center for an overnight evaluation.>
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Should I See a Sleep Specialist?
If your doctor suspects you have a parasomnia, he or she will likely suggest you see a Sleep Specialist who may recommend special sleep tests. The Sleep Specialist will confirm a diagnosis of a parasomnia, diagnose another sleep disorder, or rule out a specific sleep disorder as the cause of your symptoms, based on:
- Your symptoms
- Your sleep habits (as often recorded in a sleep diary)
- The results of your sleep study (polysomnogram)
Information provided courtesy of the American Academy of Sleep Medicine.
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