What are Parasomnias?

Parasomnias are sleep disorders that include undesirable physical events or experiences that occur while falling asleep, during sleep, or waking during sleep. Some of the more common parasomnias include:

• Sleep terrors
• Confusional arousals
• Sleepwalking
• Nightmare disorder
• REM sleep behavior disorder

Parasomnias can involve abnormal movements, behaviors, emotions, perceptions and dreams that can lead to disrupted sleep, anxiety, adverse health effects and even physical injury to the individual or their bed partner. The movements and behaviors seen are disconnected from conscious awareness – the individual has no intentional control.

Parasomnias are broadly divided into those that occur in non-dream sleep (NREM) and those that occur in dream sleep (REM). 

NREM parasomnias:

• Confusional arousals - awakening confused / disoriented with no recall.
• Sleepwalking
• Sleep terrors
• Sleep-related eating disorder – unconscious eating during sleep

REM-related parasomnias:

• REM sleep behavior disorder (RBD) – acting our dreams
• Nightmares
• Recurrent isolated sleep paralysis

Who gets parasomnias?

Parasomnias can occur in anyone though some are more common in children, some more common in adults, and all generally occur in less than 10-15% of the population.  Confusional arousals and sleep terrors are most common in children, while sleep-related eating disorder and RBD occur more in adults, with RBD most commonly seen in late middle age to elderly individuals. 

How do I know if I have parasomnia?

Any abnormal behaviors in sleep should be discussed with your Primary Care Provider. This should include a full description of the activity or behavior that has been seen.  It often requires a witness (spouse, family member) as most individuals with parasomnias are not aware of the activity in their sleep.

Certain risk factors may increase the likelihood of a parasomnia and include:

• Other sleep disorders (such as obstructive sleep apnea or lack of adequate sleep)
• Other medical disorders, particularly neurologic disorders
• Medications
• Post-traumatic stress disorder (PTSD)

Do I need to see a Sleep Specialist?

In many cases, parasomnias do not represent an underlying condition and, particularly in children, may resolve over time without requiring specific treatment.  In these instances, simple safety measures (as outlined below) may be all that is needed. However, in some cases referral to a Sleep Specialist for further history and possible testing are suggested to determine the exact nature of the condition and how best to treat it. An overnight sleep study may be ordered if the doctor suspects that you may have a primary sleep disorder contributing to the parasomnia.

How are parasomnias treated?

Many cases of parasomnia will respond to changes in sleep-related behaviors as mentioned in the sleep hygiene section.  Changing existing medications may also be helpful.  In all cases of parasomnias certain safety measures should be considered:

• Lowering the bed to the floor
• Consider sleeping in a sleeping bag
• Clear the bedroom of items that could cause one to trip
• Gates across stairwells
• Having the bedroom be on the first floor
• Latching windows and keeping doors locked / consider alarms

If an underlying sleep disorder is found that may be causing the parasomnia (such as sleep apnea), then treatment may be directed at that disorder as an initial step.  In addition, specific treatments are available for many of the parasomnias and mostly come in the form of medications and/or behavioral therapy.  A Sleep Specialist can help you decide which course of action would be best to manage these types of problems.  

Our Sleep Medicine team uses advanced technology to diagnose and treat sleep disorders at a variety of locations throughout the community. To schedule an appointment, call 216-778-5864.