Have you ever had a nightmare? Maybe you wake up in the middle of the night not quite sure where you are or what is real. You go to the kitchen, get a drink of water, and calm yourself down enough to go back to bed. An occasional incident for some, others may have consistent problems with these behaviors that fall under the umbrella of “parasomnias.” Defined as unusual and undesirable physical events or experiences that disrupt your sleep, parasomnias can occur before or during sleep or during arousal from sleep.
While you sleep, your body goes through four different sleep stages, including one for rapid eye movement (REM) sleep and three that form non-REM (NREM) sleep. These stages blur and create incomplete awareness, leading to parasomnia. Parasomnias are categorized by the stage of sleep in which they happen into three general groups: NREM-related, REM-related, and “other.”
Non-rapid eye movement (NREM) sleep constitutes the time from initially falling asleep to about the first half of the night. NREM-related disorders, also called arousal disorders, involve physical and verbal activity. Insufficiently awake or aware, individuals experiencing arousal disorders are not responsive to attempts at interaction and may not remember the incident the next day.
- Confusional arousals: You may seem to be awake while exhibiting mental confusion or disorientation in bed
- Sleepwalking: Sleepwalking occurs when you get out of bed while still asleep but display limited awareness or responsiveness to your surroundings.
- Night terrors (or sleep terrors): When experiencing night terrors, you often scream in your sleep and wake up in a terrified state.
- Sleep-related sexual abnormal behaviors: This parasomnia is commonly known as “sexsomnia” and is characterized by unusual sexual behaviors during sleep.
- Sleep-related eating disorder: This disorder involves episodes of dysfunctional eating that occur while you are partially awake.
During the sleep cycle rapid eye movement (REM) sleep follows the three NREM stages. Your body cycles through and repeats NREM and REM sleep every 90 minutes for the rest of the night. Your eyes rapidly move under your eyelids during REM sleep, and there is an increase in your heart rate, breathing, and blood pressure.
Common REM-related parasomnias include
- REM sleep behavior disorder (RSBD): If you have this sleep disorder, you act out, vocalize, or make aggressive movements in reaction to a dream.
- Recurrent isolated sleep paralysis: With this condition, you cannot move your body or limbs during the period before you fall asleep or after you wake up. These episodes, ordinarily lasting only a few minutes, can lead to anxiety or distress about falling asleep.
- Nightmare disorder: A nightmare disorder diagnosis is the experiencing of recurrent, vivid dreams defined by threats to survival or security. These episodes result in fatigue, distress, reduced cognition, and other daytime impairments.
Nightmare disorder: A nightmare disorder diagnosis is the experiencing of recurrent, vivid dreams defined by threats to survival or security. These episodes result in fatigue, distress, reduced cognition, and other daytime impairments.
- Exploding head syndrome: Also known as sensory sleep starts, this condition involves hearing a loud noise or feeling an explosive sensation in your head upon waking. You may also imagine you see a flash of light.
- Sleep-related hallucinations: If you have this condition, you experience hallucinations either while falling asleep or upon waking. You may see, hear, and feel things or imagine a movement that doesn’t exist. In extreme cases, you may leave your bed to escape what you are experiencing.
- Sleep Enuresis (bedwetting): Sleep enuresis refers to involuntary urination during sleep. Although bedwetting is quite common in young children, to be considered parasomnia, it must occur in people ages five and older at least twice per week for at least three months.
Diagnosis and Treatment
Parasomnias can be caused by issues that disrupt sleep and other health problems. If you are concerned that you may be experiencing a sleep disorder, it is helpful to keep a sleep diary in order to track your sleep events. You will need to detail your medical history, family history, alcohol use, and substance abuse to your doctor along with current medications. You can also reach out to sleep centers and discuss a sleep study in which you will be monitored as you sleep to observe your movements and behavior. Other tests can examine your brain activity or detect degeneration to determine possible neurologic causes of your symptoms.
Once you have identified your sleep disorder and eliminated any other sleep problems or health issues, there are general management strategies that can aid in reducing the occurrences of parasomnias.
- Follow good sleep hygiene habits.
- Maintain your regular sleep-wake schedule.
- Limit, or don’t use, alcohol or recreational drugs.
- Take all prescribed medications as directed by your healthcare provider.
Parasomnias can be alarming, leading to anxiety and distress. An organization dedicated to helping you achieve restful sleep, the Comprehensive Sleep and Breathing Disorders Center is available to guide you toward a safe and rewarding night’s rest.