You’ve heard of sleepwalking, and maybe even done it yourself. But did you know it’s just one of the many sleep disorders that fall under a category called parasomnias?
Some parasomnias like sleepwalking are fairly common. But others are more rare, and they can be confusing and even troubling to experience. Some parasomnias can be managed by improving sleep hygiene or other sleep habits. But for others, you may need to work with a sleep expert to get you on the road to more restful sleep.
Read on to learn more about parasomnias, including types that can happen during specific stages of your sleep cycle, who they typically affect, risk factors and when it may be time see a sleep medicine doctor.
What parasomnias are and what they have to do with the sleep cycle
A parasomnia is a sleep disorder that can occur before, during and while you’re waking up from sleep. Sleep disorders can disturb your sleep cycle, and an uninterrupted sleep cycle is crucial for maintaining good physical and cognitive health.
Your sleep cycle consists of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep stages, which cause your body to experience varying levels of brain and physical activity. Some parasomnias can be experienced at any time during your sleep cycle, but certain types of parasomnias are usually limited to specific stages of the sleep cycle.
Symptoms of parasomnias differ depending on the type
The symptoms you experience differ based on what type of sleep disorder you are experiencing (you can find more on the symptoms for each disorder below). But there are symptoms you may experience with all parasomnia sleep disorders, including:
- Waking up confused or disoriented
- Daytime sleepiness due to poor quality sleep at night
- Difficulty sleeping at night
Parasomnias you can experience in non-REM sleep
There are three stages in the non-rapid eye movement (NREM) sleep cycle:
- Stage 1 NREM (N1): This is the lightest stage of sleep in your sleep cycle and the one you spend the least amount of time in, usually lasting just a few minutes before moving into the next stage.
- Stage 2 NREM (N2): This is still considered light sleep, but deeper than Stage 1, and accounts for around 45% of your sleep in the NREM cycle, which is the most of any stage.
- Stage 3 NREM (N3): Deeper than the previous stages, it makes up for around 25% of total sleep in adults, but babies and children typically need more sleep at this stage. It can be difficult to wake up from this stage.
Examples of sleep disorders that can occur during NREM sleep include:
These are most common in children up to the age of five, and instances tend to decrease as they age. While still in bed, they might sit up with their eyes open, and they may cry. This typically happens within the first two hours of falling asleep, and it may look like they’re partially awake, but internally they feel disoriented and confused.
SRED usually happens in the first few hours of sleep. It’s most common in women under 20, but can affect anyone at any age. It’s similar to binge-eating disorder, but you eat and drink while deeply asleep, and it can be difficult or impossible to be woken up.
Foods you might eat can include cooked or packaged foods, but it can also include raw foods and combinations of food you wouldn’t normally eat while awake.
Sleep-related eating disorder can be dangerous and cause long-term health issues due to the potential of eating raw or toxic food, being injured while using a stove or other appliances when you’re not fully awake, and overeating without knowing it.
This occurs during N3 sleep, so it most commonly occurs in children and young adults because as you age, your sleep cycle typically includes less of this deep sleep.
When you sleepwalk, you usually get out of bed and walk around while mumbling and sleep talking. Occasionally, your eyes may be wide open, which can give you the appearance of being awake.
Sleepwalking can be dangerous and lead to injuries, as you may do activities while asleep you wouldn’t normally do, like go to the bathroom in a closet.
Waking someone from sleepwalking technically isn’t dangerous to them or to you, but it can trigger a fight or flight response – they can lash out and hit you, or they could fall and injure themselves. So it’s best if you just let them sleep and gently direct them back into bed.
These are very common in young children between the ages of three and seven, and they tend to run in families. They usually occur during the first half of the night.
Also known as sleep terrors, they can cause you to:
- Wake up screaming or yelling
- Experience a rapid heart rate
- Sweat
- Sit up or jump out of bed
- Move around with violent motions
- Have dilated pupils
Parasomnias that can affect you during the REM cycle of sleep
The last stage of the sleep cycle is rapid eye movement sleep, or Stage 4 REM. It’s called rapid eye movement because of the way your eyes move behind your closed eyelids. This makes up about 25% of your sleep cycle, and it’s where most dreaming occurs. During REM sleep, your brain activity can look very similar to when you’re awake.
Examples of sleep disorders that can happen during REM sleep include:
It’s common to experience an occasional nightmare, but when it’s a parasomnia, it’s described as experiencing recurrent, intense nightmares. It’s most common in children 6-10 years old but can happen to both children and adults at any age.
Nightmares can be accompanied by strong emotions of anger or disgust. Also, people who have nightmare disorder usually have very vivid dreams, are able to recount their dreams easily, and have trouble going back to sleep.
You dream during REM sleep, but your dreams don’t typically cause you to move your arms and legs. REM sleep behavior disorder can cause you to physically act out your dreams – it can happen occasionally or several times a night, and tends to worsen over time.
RSBD is most common in men over 50, with an average onset at age 61. However, it’s becoming more commonly diagnosed in women, and both male and female young adults and children. Common behaviors associated with RSBD include:
- Ability to recall your dreams if you wake up during an episode
- Making noises, including talking, laughing, shouting and crying out in reaction to your dreams
- Movement like kicking, flailing your arms and even jumping out of bed due to vivid or action-filled dreams
This is just as it sounds – you’re unable to move or open your eyes, and it usually happens right when you’re falling asleep or waking up. Episodes of paralysis can last for a few seconds to a few minutes, but it can be stopped if someone touches or speaks to you. Doctors think sleep paralysis happens because it’s an extension of REM sleep, where you’re already in a relaxed state, but there are other potential causes as well.
Sleep paralysis can cause you to feel fear, panic and helplessness due to your inability to move or speak. You may have the sensation of pressure on your chest or experience hallucinations, and these can cause you to feel sleepy during the day due to poor quality of sleep at night.
Sleep paralysis can happen to anyone at any age, but symptoms usually start in childhood and episodes can happen more frequently in people in their 20s and 30s.
Other types of parasomnias you may experience
Some sleep disorders aren’t specifically related to your sleep cycle, and they can develop in anyone at any age, including:
Parasomnia-associated bedwetting, also known as enuresis, is different than bedwetting that young children can experience and eventually grow out of. It’s considered a sleep disorder if it happens at least twice a week in a child who’s five years old or older.
It can take the form of primary enuresis, which runs in families and is when a child has never had bladder control at night. But it can also be secondary enuresis, where a child previously had bladder control, but starts wetting the bed at least twice a week for at least three months after already successfully being nighttime potty trained.
It’s most common in children and occurrences usually decrease with age, but adults can develop secondary enuresis at any age.
This disorder is most common with women of college age, but it can happen to anyone. With exploding head syndrome, you may hear a loud crashing sound or noise in your head as you’re falling asleep or waking up. You may also see a flash of light or your muscles may jerk involuntarily. It can be frightening and cause people to experience symptoms of panic or anxiety, including:
- Sweating
- Difficulty breathing
- Heart palpitations
This is a very rare sleep disorder where someone engages in sexual activity or movement during sleep. People often don’t remember it when they wake and it primarily affects adult men, but it’s becoming more commonly diagnosed in women.
A dissociative state is when a person disconnects from their thoughts, memories and feelings. When it’s related to a sleep disorder, it happens near the sleep-wake transitions of your sleep cycle, either when falling asleep or when transitioning from one stage of the sleep cycle to another. Behaviors of dissociative disorders, which can look similar to sleep disorders like narcolepsy or RSBD, usually start in childhood, but it most commonly affects middle-aged women.
This is where someone repeatedly makes groaning noises, occasionally followed by grunting or sighing, during sleep. It can affect any age or gender, but men are slightly more likely to develop it than women.
Hallucinations occur when you see, hear or feel things that don’t exist, and they typically happen when you’re awake. But they’re considered a parasomnia when they occur while you’re falling asleep or waking up.
They can be so vivid that they may be disturbing, causing you to leave your bed to stop experiencing them. They occur more often in women, teens and young adults, but they can affect men as well.
Sleep disorders that aren’t parasomnias
How sleep disorders have been categorized over the years has changed, but they’re typically categorized based on symptoms people experience, how they affect a person, and what part of the body is affected. Parasomnias are abnormal verbal and physical expressions in sleep. But other sleep disorders are in categories of their own and include:
- Circadian rhythm sleep-wake disorder, when your body’s internal clock is out of sync with its environment
- Hypersomnia causes excessive daytime sleepiness, even if you feel you got plenty of sleep overnight
- Insomnia can make it difficult to fall and stay asleep
- Restless legs syndrome is a prickly or pulling feeling in your legs that can make it difficult to sleep
- Sleep apnea causes breathing issues during sleep and can be serious
Possible risk factors and causes of parasomnias
Since sleep disorders can happen to anyone at any age, it’s important to know the risk factors that make you more likely to experience specific sleep disorders. These include:
- Brain immaturity – Some parasomnias that occur most commonly in children are due to brain immaturity and because children are still developing their sleep-wake cycles. These include sleepwalking, night terrors, nightmares, confusional arousals and bedwetting.
- Genetics – In general, parasomnias tend to be genetic and run in families. They also co-occur, meaning you can experience more than one type. Examples include sleep-related eating disorder (SRED), nightmare disorder, confusional arousals and sleepwalking.
- Being diagnosed with other sleep disorders – Things like narcolepsy, restless legs syndrome, periodic limb-movement disorder or sleep apnea can cause you to experience parasomnias, including sleep paralysis, sleep-related hallucinations, nightmare disorder, SRED, sleep terrors, confusional arousals, sleepwalking and REM sleep behavior disorder (RSBD).
- Neurological disorders – Parkinson’s disease, Lewy body dementia, multiple sclerosis, dementia and brain tumors can cause parasomnias. The most common is RSBD, but they can also cause sleepwalking, SRED, sleep terrors and confusional arousals.
- Mental health conditions – If you’re diagnosed with depression, anxiety or PTSD, you may be more likely to experience sleep terrors, nightmare disorder, sleep paralysis and RSBD.
- Changes in your sleep schedule – If you do shift work or travel that causes you to experience jet lag, you might experience parasomnias. The most common is sleep terrors, but changes in your sleep can also cause sleepwalking, SRED and RSBD.
- Medications – Certain medications like antidepressants and medications that treat high blood pressure can cause parasomnias like SRED, RSBD, sleepwalking, sleep terrors, sleep-related hallucinations and nightmare disorder.
- Health issues – Things like stress, fever, head injury or pregnancy can cause sleepwalking, night terrors, nightmare disorder, exploding head syndrome, sleep paralysis and RSBD.
- Sleep deprivation – When you consistently don’t get enough sleep, it can cause sleep terrors, sleepwalking and confusional arousals.
- Alcohol and substance use, abuse or withdrawal – These can all cause you to experience SRED, nightmare disorder, sleep terrors, sleep paralysis, sleepwalking, sleep-related hallucinations, RSBD and sexsomnia.
How parasomnias are diagnosed
When it comes to parasomnias, more often than not, you won’t need to see a doctor. But if the sleep disorder hasn’t resolved itself even after improving your sleep hygiene and making lifestyle changes, speaking to a sleep specialist can help you receive a diagnosis and a plan for treatment.
Your sleep medicine specialist will ask about your sleep and family history of sleep, your personal medical history and your symptoms. If you have a bed partner, they may be asked to keep track of your sleep.
Then, depending on what kind of disorder your doctor suspects, they may order sleep tests such as:
- Sleep study (polysomnogram) to monitor brain waves, body and eye movement, breathing and heart rate
- Video or sleep EEG to monitor your brain activity during sleep
- CT or MRI scan to determine if neurological disorders or brain health decline is the cause of your symptoms
Treatment for the different types of parasomnias
Typically, you grow out of parasomnias when you reach adolescence. But there are some that require treatment, like medication. It’s important to speak to your doctor if you’re experiencing problems with your sleep, so you can improve your sleep and avoid triggers of parasomnias when possible.
Practicing good sleep hygiene can improve your sleep
Sleep hygiene is a term that refers to healthy bedtime and bedroom habits that help you get good quality sleep, which is essential because it gives your body a chance to rest and repair.
- Try to get the amount of sleep per night that’s recommended for your age
- Avoid using electronics in bed, as blue light from screens can disrupt the sleep cycle
- Keep your bedroom at a cooler temperature
- Have a consistent wake up and bedtime
- Limit the use of caffeine, alcohol and drugs, especially close to bedtime
- Follow a bedtime routine to establish consistent sleep
Medication can help with the symptoms of a sleep disorder
Melatonin supplements are usually the first line of treatment for REM-related sleep disorders. But if they don’t seem to be helping your sleep, your doctor may prescribe clonazepam, a benzodiazepine drug typically used to treat things like epilepsy and panic disorders.
Non-REM sleep disorders are often treated with antidepressants and psychological approaches like cognitive behavioral therapy or hypnosis. But if your sleep disorder is harmful to you or has lasted a long time, your doctor may prescribe benzodiazepines.
Small lifestyle changes you can make to get better quality sleep
In addition to practicing good sleep hygiene, you can make small lifestyle changes to help your sleep. This can include:
- Getting regular, consistent exercise that’s not close to your bedtime
- Managing any stress in your life as best you can
- Trying cognitive behavioral therapy
When it may be time to see a sleep medicine expert
Some parasomnias are common and run their course with age or at-home treatments. If you’re experiencing mild parasomnia symptoms, make a primary care appointment. A primary care doctor can work with you to make sense of your symptoms and determine what treatments can help.
Other parasomnias can be upsetting or even dangerous to experience. If your symptoms are concerning or severely disrupting your sleep and quality of life, speak to a sleep medicine doctor. They can help you with treatment so you can stay safe while sleeping and get the ZZZs you need.
