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What is Parasomnia?

by BetterSleep
Sep 17 • 10 min read
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Parasomnias incorporate different sleep disorders that cause abnormal behavior while sleeping. They affect children and adults and can occur in any part of the sleep cycle.

Sleep stages include NREM sleep (non-rapid eye movement), REM sleep (rapid eye movement sleep), and the movement between awake and falling asleep. While parasomnias are more common in children, studies show that around 4% of the adult population continues to be affected.

What Are the Symptoms of Parasomnia?

While experiencing parasomnias, you might talk, move around or act unusually while asleep. Your bed partner might think you’re awake but unconscious and will not remember what happened the next day.

You might be sleep talking, sleepwalking, grinding your teeth, or experiencing night terrors thrashing around. This can make it hard for you and your bed partner to get a restful sleep.

Also, certain parasomnias can be dangerous, causing injury or psychological stress.

Alongside the unusual behavior, parasomnias may cause you to:

  • Feel fatigued during the day
  • Wake up disorientated or confused
  • Not remember what you’ve done
  • Find unusual cuts and bruises on your body
  • Difficulty sleeping the whole night through

What Causes Parasomnias?

Parasomnias have many different causes. Common triggers and factors that increase your risk of experiencing parasomnias include:

  • High-stress levels
  • Suffering from anxiety
  • PTSD (post-traumatic stress disorder)
  • Depression
  • Some medications
  • Substance abuse
  • Alcohol use disorder
  • Shift work
  • Sleep apnea
  • Insomnia
  • Other sleep disorders
  • Sleep deprivation
  • Neurological disorders (e.g., Parkinson’s)
  • Chronic pain conditions

Different Types of Parasomnias

Parasomnias can occur in any part of the sleep cycle, early during NREM sleep (non-rapid eye movement) and later during rem sleep (rapid eye movement sleep). The different types include:

Sleep Talking

One of the most common parasomnias is sleep talking. According to the Sleep Foundation, up to 66% of people experience sleep talking in their lifetime.

It can involve muttering, mumbling, or full-on conversations. Sleep talking can happen in any sleep stage, but words are easier to decipher in the lighter stages.

Sleep Walking

Sleepwalking is also known as somnambulism. During this parasomnia, a person will walk around and may even do daily activities such as driving or preparing food.

Sleepwalking most often happens early on in the night. And, if a person is woken, they may appear disoriented and not know what has gone on.

Sleep Bruxism

Sleep bruxism is the act of grinding or clenching the teeth while asleep. Past studies have concluded that around 13% of people are affected by this condition.

Without intervention, bruxism can lead to:

  • Headaches
  • Earaches
  • Jaw pain
  • Toothaches and sensitivity
  • Abnormal tooth wear

Sleep Terrors

Sleep or night terrors are when you get woken up by intense fear or panic, usually in the first part of the night. These are more common in children aged 3-7, with episodes lasting from 30 seconds to 20 minutes.

The symptoms of sleep terrors include:

  • Sweating
  • Crying
  • Screaming
  • Skin flushes
  • Dilated pupils
  • Rapid heartbeat and breathing rate

Confusional Arousals

Confusion arousal is also known as sleep drunkenness. When experiencing this parasomnia, you might not know what you’re doing or where you are.

You might also find yourself:

  • Crying
  • Shouting
  • Speaking slower than normal
  • Having a slow reaction time
  • Having poor memory and coordination

Experts believe that around 17% of children suffer from confusion arousal.

Bed Wetting

Bedwetting, or sleep enuresis, involves involuntary urination while asleep. This is common in kids under 6 years of age and often doesn’t have an underlying cause.

Bedwetting is usually only considered a parasomnia when a child is over 5 years of age.

This is a type of non-REM sleep parasomnia where you drink and binge eat while wholly or partly conscious.

Binge eating episodes can happen frequently, where you might consume unusual foods like uncooked meat or strange food combinations.

Sleep Paralysis

As you fall asleep, your muscles start to relax. You become still and relax even further during the REM sleep stage. This is also known as muscle atonia.

Sleep paralysis is a condition where you experience muscle atonia while still awake. Some also lose the ability to speak in the waking or falling asleep stage.

Other common symptoms of sleep paralysis include hallucinations and vivid dreams. Episodes can last for a few seconds or up to a few minutes.

Sleep-related groaning (catatonia) is when a person groans loudly while asleep. Groaning sounds can include roaring, high-pitched moaning, or long humming sounds.

Sleep-related groaning is often related to other parasomnias, with one study of women finding that 43% experienced another parasomnia as a child. Episodes last between 2 - 50 seconds on a prolonged exhale and most often happen in the rem sleep stage.

REM Sleep Behavior Disorder

You may act out your vivid dreams during REM sleep behavior disorder (RBD). This often happens during REM sleep; unlike sleepwalking, most people remember what they’ve done on waking.

REM sleep behavior disorder actions can include:

  • Kicking
  • Punching
  • Shouting
  • Grabbing
  • Flailing
  • Shouting
  • Swearing
  • Screaming
  • Leaping

Nightmare disorder

This sleep disorder causes disturbing dreams that can be extremely frightening. We all have a nightmare occasionally, but if it happens frequently and it starts to affect sleep quality, this is known as a nightmare disorder.

Nightmares often happen in REM sleep and can happen multiple times a night. This can seriously disrupt sleep patterns and may need behavioral therapy or relaxation therapy to help minimize their occurrence.

Exploding Head Syndrome

Exploding head syndrome (EHS) is a sleep disorder where you imagine loud noises or explosions in your head, especially when trying to fall asleep.

You may see light flashes and feel involuntary muscle jerks and loud noises. Not enough research has been done to know why EHS episodes happen.

However, some sufferers report feeling stressed and anxious before it happens.

Other Less Common Parasomnias

Sleep Texting

Sleep texting is when a person sends or replies to phone messages while sleeping. It generally doesn’t happen independently and can be grouped alongside other parasomnias. For example, a person may be sleepwalking when they’re sleep texting.

Sleep Driving

Sleep driving is operating a vehicle without being fully alert and awake. It most often happens after a period of sleepwalking and can have dangerous consequences.

Sleep Scratching

Sleep-related scratching is a type of parasomnia where a person wakes up with bleeding scratches or cuts on the body. This is more prevalent in those with pre-existing skin conditions but can also present as a stand-alone sleep disorder.

Hallucinations while falling asleep or waking up are quite common. You may see or hear things or even feel a sensation in your body in some circumstances. Sleep-related hallucinations are often experienced with other parasomnias, such as sleep paralysis.

Those who suffer from narcolepsy, a sleep disorder causing excessive daytime sleepiness, are more likely to suffer from sleep-related hallucinations.

What Are Non-REM Parasomnias?

Non-REM sleep is the first stage in the sleep cycle. Parasomnias in this early stage are often called arousal sleep disorders and involve verbal and physical activity.

During non-REM parasomnias, most people won’t remember what happened the next day. These sleep disorders happen more frequently between the ages of 5 - 25. Common non-REM parasomnias include:

  • Sleepwalking
  • Sleep terrors
  • Confusional arousals
  • Sleep-related eating disorder

What Are REM Parasomnias?

Rapid eye movement REM comes after the non-REM part of the sleep cycle. In this stage, your eyes move rapidly, and breathing, heart rate, and blood pressure all increase.

This is a time when vivid dreaming may occur, and if you experience parasomnias, you may be able to recall all or part of the dream. Common REM parasomnias include:

  • REM sleep behavior disorder
  • Nightmare disorder
  • Recurrent isolated sleep paralysis

How Are Parasomnias Diagnosed?

Your local GP can diagnose parasomnias. They may send you to a sleep specialist, who will assess your sleep behavior, including your sleep-wake cycle, abnormal movements, and any sleep disturbances.

The steps to a diagnosis include:

Sleep History

Your doctor will ask about your sleep hygiene habits and sleep patterns. This might include keeping a sleep diary or having your bed partner report details of how you sleep.

Medical History

Discuss with your doctor any medications you’re taking and what underlying medical conditions you have. They will also want to know about your lifestyle habits and family medical history that could be of relevance.

Polysomnogram

This is a type of sleep study where you sleep in an observation center so an expert can observe your behavior. Your breathing, heart rate, and brain waves will all be analyzed to help reach a diagnosis.

How Do You Stop Parasomnias?

Treatment for parasomnias will vary depending on the type and seriousness. After identifying the type of parasomnia and any underlying health issues, your doctor might recommend a plan to improve sleep hygiene, such as:

  • Maintaining a regular sleep-wake schedule.
  • Improving your sleep environment.
  • Limit, or don’t use, coffee, alcohol, or recreational drugs near bedtime.

For severe parasomnias, your doctor may recommend treatment like:

Medication

If you experience frequent parasomnias, medication could be a way forward. Some medications used to manage parasomnias include:

  • Melatonin
  • Anti-depressants
  • Topiramate
  • Dopamine agonists
  • Benzodiazepines
  • Levodopa

If a medication causes parasomnia symptoms, your doctor may offer a different dose or an alternative. Always talk with your GP before making any changes to medications.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral treatments are often used to treat parasomnias. This is because sleep disorders are sometimes linked to mental health conditions, such as anxiety and stress.

Your GP may recommend CBT alongside:

  • Hypnosis
  • Psychotherapy
  • Relaxation therapy

Are Parasomnias Seen More in Males or Females?

Some parasomnias are more frequent in one gender than the other. For example, females seem to suffer nightmares more than males. Sexsomnia more often happens in males, and REM sleep behavior disorder is more common in males over 50.

Sleepwalking, night terrors, and confusional arousal disorders seem to happen equally in males and females.

Do Parasomnias Occur in Children?

Yes, parasomnias are seen more often in children than adults. Parasomnias common in children under 15 years old include:

  • Nightmares
  • Sleep terrors
  • Sleepwalking
  • Confusion arousal

How Are Parasomnias Treated in Children?

Non-REM sleep parasomnias are common and usually end without any intervention. Sometimes, all a child needs are comforting reassurance from a parent or loved one.

If medication is needed, anti-anxiety drugs or benzodiazepines may be prescribed for 3 - 6 weeks.

Is Parasomnia Dangerous?

Parasomnias can become dangerous when you’re not aware of your surroundings. While acting out during a sleep behavior disorder, you may punch or kick something, causing injury.

Parasomnias have also been linked to psychological stress and are more prevalent in those with mental health conditions.

Tips to Make Your Sleeping Environment Safe if You Suffer Parasomnias

If you experience parasomnias frequently, your healthcare provider may suggest ensuring your sleeping environment is safe. Recommended safety precautions include:

  • Secure bedside lamps
  • Pad bedside furniture edges
  • Lock sharp and dangerous items out of the bedroom
  • Pad the floor next to your bed
  • If you sleepwalk, install alarms on the doors and windows
  • If you display aggressive parasomnia behavior, sleep in a separate room from your bed partner
  • Have water in a plastic cup or bottle next to the bed

What Brain Disorder Causes Parasomnias?

It’s often unclear why some people suffer from sleep disorders. Although, some are linked to mental health conditions such as PTSD, depression, anxiety, or neurodegenerative disorders such as Parkinson’s.

When to See a Doctor For Parasomnias?

If you occasionally have a bad night of sleep, this should not be a cause for concern. But, if it becomes a frequent occurrence, it could become a sleep disorder needing medical attention.

A doctor may recommend sleep medicine or that you visit a sleep specialist who will look for a root cause.

How Do You Go Back to Sleep After Waking Up?

Suffering from sleep disorders may mean you wake up often at night. Before agreeing to take sleep medicine, look at these simple tips to help you nod off naturally.

Avoid Bright Phone Screens

Bright phone and computer screens are well known to block melatonin that helps regulate your sleep cycle. The pineal gland makes melatonin, and when it’s released, this signals to your body that it’s time to sleep.

If you wake up at night, resist the temptation to check your phone. If you must look at it, ensure your screen is turned onto night mode, which changes the screen to a warmer color.

Get Out of Bed for a Few Minutes

If you cannot fall asleep within 20 minutes, get up and move to a new room for a little while.

This helps to distract the brain from constantly thinking about going back to sleep, which can be extremely stressful

Remove Lights or Sounds

After waking at night, have you noticed light streaming through the window? Or maybe loud sounds emanating through the wall?

If yes, this may stop you from falling back to sleep. Try to block the light and sound. Alternatively, use earplugs or listen to white noise, which effectively blocks background sounds.

Try Breathing Exercises or Meditating

Trying to fall back asleep once you wake up can increase feelings of anxiety. Try meditating or performing breathing exercises to calm the mind and slow down the breathing.

A few of the best breathing exercises for sleep include:

  • 4-7-8 breathing. Simply breathe through your nose for a count of 4, hold your breath for a count of 7 and exhale for a count of 8.
  • Diaphragmatic breathing. Take a deep breath through your nose, so your belly rises. Exhale through pursed lips and feel your belly lower. Repeat until you feel relaxed.

Relax With a Full Body Scan

A full body scan is one way to help yourself relax and prepare to go back to sleep. Follow this simple guide:

  • Lie down in a comfortable position
  • Close your eyes and take deep breaths
  • Start at the top of the head and mentally scan your way down your body, noticing any areas of discomfort
  • Bring awareness to the head and neck. Is there any pain or tension?
  • Repeat this process for the rest of your body parts, spending 20 - 30 seconds on each
  • When you notice areas of tension, send a breath to the area and visualize the pain leaving your body

Play Soothing Music

Relaxing music may help to distract your mind and block out any background chatter. Soothing nature sounds and binaural beats do a great job of calming the mind so it can sleep.

Research has shown that it’s important to choose sleep music according to personal preference. Try out a few different kinds to see which works for you.

Concentrate on Something Boring

When your brain is not stimulated, and you feel bored, this can often lead to sleepiness. To get back to sleep after waking up at night, focus on a boring task such as counting sheep or reading an uninteresting magazine article.

Download a Sleep App

Experts design sleep apps to help you relax and fall asleep quicker specifically. Many sleep apps offer guided meditations, bedtime stories, soothing sounds, and calming sleep music.

You can even combine sounds and music to create your personalized sleep soundscape. Using a sleep app can also help you create a healthy bedtime routine for yourself.

If you find yourself awake at night, try listening to a bedtime story or customized relaxation music on the BetterSleep app. Or, try out ASMR (auto sensory meridian response) sounds that are also available in the app.

This is known to activate calming regions of the brain, with 82% saying it helps them fall asleep at night.

Conclusion

If you are experiencing parasomnia, consult with your GP to discover treatment options and prevention tips. Often, parasomnias happen when you’re stressed or managing a certain condition.

While other times, parasomnias occur due to poor sleep hygiene. Always make sure you have a relaxing routine leading up to bedtime.

Have a warm bath, stretch out, read a book, limit screen time, meditate and calm racing thoughts with soothing sounds from the BetterSleep app.

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