Parasomnia

While some people are lucky enough to have a normal sleeping pattern with healthy sleep habits, others aren’t quite so fortunate. Parasomnia sufferers tend to experience abnormal movements, perceptions, dreams, behaviors, or emotions in their sleep. The term parasomnia essentially covers any unwanted experiences or events while sleeping, falling asleep, or waking up. 

To other people in the room the behaviors may seem complex and strange. However, people who suffer from parasomnia will normally wake up with no memory of what happened (except perhaps the knowledge that it was hard to sleep through the night).

Types of parasomnias 

To really get to grips with parasomnia we need to understand the types that exist. 

Sleepwalking

Sometimes known as ‘somnambulism’, sleepwalking is an unwanted event during sleep and therefore qualifies as  parasomnia. As well as getting out of bed and walking around while sleeping, this disorder can involve a series of other complex actions: 

• Sitting up in bed and looking around in confusion 
• Bolting up and running away 
• Talking or shouting (while walking) with glassy eyes
• Doing tasks that are not normally done at night.

Although there are many actions the disorder can manifest itself in, they’re all a little strange, crude, and seemingly out of place. Throughout history there have been stories of people climbing out of windows, urinating in trash cans, and moving furniture. 

Unfortunately not all sleepwalking is innocent and safe because some sufferers will involve themselves in sexual behaviors or exposure, others will get in the car and drive away, hallucinate, or eat while they sleepwalk. The problem? It can be notoriously hard to wake a sleepwalker up. Upon awakening they are often left confused and without memory of what occurred. Some people will recall particular parts of the episode, while an even lower number will remember everything. 

For men more than women there’s a risk of attacking others after being awoken. In some cases sleepwalking will end naturally and suddenly by itself (sometimes leaving an individual in an awkward location). In fact, some people return to their bed while asleep as if nothing had happened. 

When does sleepwalking occur?

Sleepwalking can occur during any long periods of sleep, but it most commonly takes place in the first third of the night; it happens in the slow-wave cycle of sleep. Though rare, some people will experience sleepwalking during a simple daytime nap. 

Every case is unique. Some sufferers will experience sleepwalking often, others will have it rarely. Either way there’s a risk of injury to an individual and their partners in the same bedroom, especially when sleepwalking happens multiple times per night or for a few nights in a row.

Sleepwalking in children

Sleepwalking in children isn’t normally something that raises concerns as it’s usually a fairly normal part of children’s early sleep patterns. They can walk to the parents’ bedroom or toward a light while sleeping. However, there are still some risks to consider because they can walk to windows/doors, go out, and more. On the whole, sleepwalking may become more active and vocal as they get older. 

When children sleepwalk, they may also experience sleep terrors and sleep talking. 

Confusional arousals 

Since this disorder involves unwanted experiences and events that occur while people are sleeping, falling asleep or waking up, it falls into the category of parasomnia. 

Just as the name suggests, this sleep disorder causes you to act confused and in a strange way upon waking up. Your speech may slow down, you may not know what you’re doing or where you are, you may have a bad memory of the day, or give blunt answers to people around you. Sufferers often report a foggy state of mind that occurs when they are physically awoken.

Waking from slow-wave sleep is more likely to cause confusional arousals. Much like sleepwalking, this disorder is common during the first third of the night or a daytime nap. 

While some people will experience this fogginess for a couple of minutes, others will have it for many hours. During this time they may sleepwalk, shout, and grind their teeth. Most sufferers of confusional arousals won’t remember what had happened when asked later. 

In severe cases confusional arousals can lead to aggressive and inappropriate behavior. Sadly this can affect relationships and lives. Fortunately most people will avoid these symptoms as these extreme episodes are quite rare. 

Confusional arousals in children

As you can probably imagine, seeing a child with confusional arousals can be stressful for parents. It’s often described as if the child is staring right through you with a confused look on his or her face. Children may also feel annoyed or irritated. Depending on the child, the episodes usually last from 5 to 15 minutes, but may last as long as 40 minutes. 

Luckily the majority of confusional arousals in children won’t cause harm and they tend to reduce once the child reaches five years of age. In recent years experts have drawn a correlation between confusional arousals in young children and sleepwalking once they become teenagers. 

Severe morning sleep inertia

As a variation of confusional arousals, sleep inertia has similar symptoms, but they occur in the morning when you are waking up. Affecting both adults and teens, it has been referred to as ‘sleep drunkenness’ and has very similar symptoms.

Severe morning sleep inertia can last years and in some cases happen every morning. This means that sufferers can be late for school or work and hostile towards their partners. If an individual doesn’t snap out of the morning sleep inertia quickly enough, it can also lead to car accidents and injuries at work. 

Sleep-Related Eating Disorder (SRED)

As a form of parasomnia, SRED consists of repeated episodes where an individual will wake up at night and compulsively eat or drink. During these episodes sufferers normally have no control over their actions because they’re in a partially awake state. Afterwards they either remember only parts of what happened or nothing at all. However, some people will remember much of the event in the morning, because they tend to be alert as they eat. 

As we’ve seen before, waking a sufferer up during an episode can be very difficult. If you try to stop an individual with SRED from eating and drinking, it will often be met with anger and frustration. 

Interestingly, feelings of thirst or hunger are usually absent when episodes occur. Even after a full day of eating hearty meals people with SRED may experience an episode and eat even more. Episodes can occur at any time of the night and multiple times per night for some unlucky sufferers. 

Problems with SRED

Of course, there are plenty of dangers that come with eating during sleep. Firstly, from the point of view of health, it’s rare that somebody will reach for the nearest apple. Instead it’s normally sugary foods such as syrup and peanut butter. SRED leads people to eating meals during sleep which they wouldn’t necessarily choose by day. 

Not only are the foods and drinks high in calories, but they’re also eaten rather quickly (an episode can end in under ten minutes). Since sufferers can wake up, eat, and go back to bed in very little time, it’s a problem that can go unnoticed for some time.

Depending on the food chosen during an episode, potential dangers include: 

• fires while cooking 
• poor preparation of cold/hot foods
• messy kitchen 
• burns and cuts
• sloppy food handling.

We should note that it’s rare for individuals to drink alcohol while in this state. A messy kitchen can spark reminders that an episode occurred. 

Long-term issues

Each case of SRED is unique. Some people will develop it slowly over a period of weeks while others will have heavy binge eating sessions from the start. Unfortunately this disorder doesn’t seem to go away by itself and can be a factor causing depression. 

We wake up, see the mess in the kitchen, and feel a sense of guilt, shame, and embarrassment that we can’t control the disorder. As a result of eating at night some SRED sufferers can stop eating during the day and overexercise to prevent gaining weight. 

Common side effects and problems with SRED include: 

• no appetite the next day 
• eating food despite allergies 
• eating raw foods, coffee grounds, and other unusual foods 
• injury
• weight gain 
• stomachache
• drinking toilet cleaners and other toxic substances 
• experiencing insomnia due to sleep disruption
• fear of sleep 
• high cholesterol 
• broken relationships.

Sleep terrors 

Also called ‘night terrors’, this disorder is a form of parasomnia as it involves unwanted events during sleep. A typical episode often looks like a scene from a horror movie because it can result in the sufferer sitting up in bed and screaming at the top of their lungs. Along with the scream sufferers may experience thrashing, kicking, and other characteristics: 

• a look of fear in the eyes
• heavy breathing and sweating 
• slurred speech or indistinguishable language 
• tense limbs.

Most commonly in adults, severe cases will run around the house and act violently. To make the problem worse, others will have trouble waking sufferers up. (individuals having an episode of sleep terrors are unlikely to respond to voices). When they do wake up, they may feel very confused and won’t remember what happened. 

Sufferers might remember brief parts of a dream which is often steeped in fear and danger. Whether you’ve experienced it yourself or have had to comfort a loved one, you’ll know that it takes some time to calm down after night terrors. 

Night terrors occur during slow-wave sleep and most commonly in the first third of the night. That being said, episodes can happen during other stages of the sleep cycle. Compared to children and teens, adults have a higher chance of remembering the associated dream. 

Serious and fatal injuries can occur as a result of night terrors as sufferers may try to fight and escape from bed. Otherwise it’s normally embarrassment that follows an episode which can potentially affect relationships. 

Sleep paralysis 

From one end of the scale to the other, sleep paralysis is a sleep disorder associated with not being able to move your body at all. Known as recurrent isolated sleep paralysis, it can occur at two times: when waking up from sleep (called postdormital or hypnopompic), or when attempting to sleep (called predormital or hypnagogic). 

The reason we’re able to feel refreshed after a normal night of sleep is that the brain causes our muscles to be still and relaxed throughout the night; this is known as atonia. According to experts sleep paralysis happens as a result of atonia as we’re awake. 

As you can imagine, this is a terrifying experience because you can’t talk or move your legs, arms, body, or head, and this episode can last minutes. All the while you’re aware of what’s occurring and can breathe as normal. Sometimes the episode will end as somebody speaks to you or touches you. Otherwise it will end naturally or when you make an intense effort to move. 

When we’re unable to move, the natural reaction is to panic. You may also hallucinate during the experience; you’ll hear, see, or feel things that aren’t present.

For most people sleep paralysis first starts in the teenage years. As we enter our 20s and 30s, it becomes more prominent and may continue into later years. 

However, sleep paralysis is not a serious issue for your health. It could be a symptom of narcolepsy; other signs include falling asleep suddenly during the day and disturbed sleep at night. In most cases sleep paralysis as an isolated incident won’t cause disturbances to sleep. 

Bedwetting

When it comes to parasomnia in children, perhaps the most universally common form is bedwetting. Known as sleep enuresis, bedwetting is a sleep disorder occurring when a person urinates by accident while sleeping. 

As adults a full bladder will wake us up, and we will go to the bathroom. However, these are skills that we develop as we grow. Smaller children may not wake up when they need to visit the bathroom or be in control of bladder contractions. 

If you’re a parent, know that there’s no magical answer to when children will learn this skill. For the first 18 months urinating is a reflex that occurs whether they’re awake, asleep, playing, trying to walk, or even having their diaper changed. 

From this point the child is taught to recognize a full bladder and delay urination while awake. Eventually this skill will pass across to their sleep too. The more advanced children are in their development, the more likely they are to succeed in this area. 

By the time children reach five years they can usually control their bladder while awake and asleep. With this in mind we cannot consider bedwetting a sleep disorder unless it occurs at least twice per week in a person who is at least five years old. If it’s the odd occasion, these are small accidents that will eventually disappear. 

There are two types of bedwetting: 

• Primary - the child has never been able to control their body and hasn’t yet accumulated six consecutive dry months 
• Secondary - the child (or adult) has been dry for at least six consecutive months. Now he or she started wetting the bed at least twice a week for a minimum of three months. 

Why don’t we always need to urinate while sleeping? The pituitary gland produces vasopressin as we sleep, and this hormone reduces the production of urine by the kidneys. During the early years some children with primary bedwetting lack this vasopressin production during sleep. So if they don’t wake up in time, they will urinate in bed. 

As well as the continual washing of sheets, bedwetting affects the child too because it hurts their confidence and self-esteem. Therefore one of the most important factors with primary bedwetting is how parents deal with the issue. According to research encouragement is the way to go because we can improve a child’s self-esteem and help with their bedwetting. 

REM Sleep Behavior Disorder (RBD)

This disorder occurs when you act out vivid dreams during sleep. Especially with action-packed or even violent dreams, we can be found: 

• flailing 
• jumping 
• shouting
• grabbing 
• punching 
• leaping 
• swearing 
• kicking.

It’s important not to confuse RBD with sleep terrors or sleepwalking. The major difference lies in the fact that an individual with RBD can easily be woken up. Once awake, they can normally recall the dream and what they were trying to achieve with their movements.

During the episode the movements will match the dream. Over time the issue tends to get worse. While it might start with small amounts of activity, the disorder can quickly escalate to violent episodes. In many cases the milder stages are ignored, and the problem only gets attention once a partner (or the sufferer) is hurt or the movements get particularly intense. 

For example, one of the most common RBD dreams contains sport. Whether it’s catching a ball in baseball or kicking in football, our movements will reflect the action. As the problem gets worse, we might think we’re being chased by an attacker which causes us to leave the bed and run away. Despite this, RBD sufferers rarely have their eyes open, walk, or leave the room – these are symptoms of sleepwalking. Unlike SRED, RBD sufferers also don’t eat or drink during the episode. There’s no bedwetting nor sexual activity. 

How does RBD work?

Since we’re dreaming, RBD occurs during the REM (rapid eye movement) stage of the sleep cycle. Every 90 -120 minutes we enter the REM stage where dreams can occur; normal sleep consists of five or six dream episodes every night. While RBD doesn’t necessarily occur in every REM cycle, it can still take place up to four times per night. In less severe cases episodes will only occur weekly or even monthly. An RBD episode tends to first appear at least 90 minutes after falling asleep and won’t normally happen during a daytime nap. 

RBD won’t usually cause fatigue the next day. However, this condition is normally coupled with other sleep disorders which do affect energy levels the next day. For example, RBD can be found along with periodic limb movement disorder, sleep apnea, and narcolepsy. 

It’s normally a partner that first alerts a sufferer to the problem. If you think you might have this form of parasomnia, know that it’s a medical problem. People with RBD are not more violent than nonsufferers when awake. RBD is not a psychiatric disorder as scientists have not found a link between RBD and other mental problems. 

Sleep hallucinations 

Sleep hallucinations are imagined events that seem real which occur while we sleep. Although mainly visual events, they can also involve smell, sound, motion, touch, and taste. 

What’s the difference between sleep hallucinations and dreaming? This is an interesting question, and it’s easy to confuse the two. There are similarities between hallucinations and nightmares, but you generally know that you’ve been asleep after a nightmare. However, even with complex visual sleep hallucinations with stationary images of people or animals, we don’t recall being in the middle of a dream after waking up. Fortunately these stationary image hallucinations are less common.

The danger of hallucinations often comes with the initial shock or terror. In the first few seconds we might think that the images are real and jump from our bed. Considering these images can be distorted in shape or size. They can stay in our minds for a number of minutes. Eventually the image will fade as we become more alert or when a light is turned on. 

Sleep hallucinations can happen as we’re about to fall asleep or just after waking up. If you’ve experienced hallucinations during the day, this suggests narcolepsy. When people have narcolepsy, they can have episodes of sleep paralysis, sleep attacks, and hypnagogic hallucinations at any time. 

For some people with sleep hallucinations a migraine is the cause and the pain will quickly follow the images. 

Nightmares

Whether we’re falling asleep, waking up, or in the middle of sleep, nightmares are never welcome. However, if nightmares occur frequently and wake you up in the middle of the night, they are considered a sleep disorder.

While the odd nightmare is common, it starts to become a problem when we fear going to sleep at night. The more real the nightmare feels, the harder it is to get back to sleep. Suddenly we’re left pulling the covers up to our faces while staring at the ceiling. Sadly, this only starts a negative spiral because loss of sleep causes more nightmares and daytime fatigue. 

Perhaps the biggest issue with nightmares is that they can feel so real; as the episode progresses and becomes more alarming, we eventually wake up. Normally the nightmare will involve some form of imminent physical danger and commonly occurs towards the end of our sleep. When we should be resting, we’re sitting up feeling angry, anxious, scared, embarrassed, and even disgusted. 

For a dream to be classed as a nightmare, there’s one important factor; it needs to wake us up. When we don’t wake up, this is actually just a bad dream. For people who have experienced multiple nightmares in the same night, often with similar themes, this is yet another reason why it’s so hard to get back to sleep (they don’t want to go through it again). 

It’s thought that a quarter of our sleep is spent in the REM stage and this is where nightmares tend to happen. As we go through the stages of the sleep cycle, the REM stage gets longer and longer. By the end of the night it may last around an hour which is why nightmares normally occur close to the morning. 

For people with PTSD and other trauma related problems nightmares can come earlier in the night and at other stages of the sleep cycle. 

Sleep talking 

We’ve referenced sleep talking a few times, so let’s look into this form of parasomnia in more detail. The medical term for sleep talking is somniloquy as the words can be understood in some cases (and not in others). 

For the most part, sleep talking is harmless and those listening will get a good laugh. In rare cases the subject matter can be offensive or violent. However, sleep talking can disrupt the sleep of a partner or a roommate as it might be quite loud and occur many times during the night.

People with sleep talking can experience an episode in any stage of the sleep cycle including NREM sleep and REM sleep.

Nearly half of all young children talk in their sleep. In adults this decreases to one in twenty. Furthermore we know the following; 

• Sleep talking can run in families 
• Men and women are equally affected by sleep talking 
• Experts aren’t sure whether sleep talking is connected to particular dreams 

Exploding Head Syndrome 

The term is used to describe a sudden loud burst of noise that you imagine just as you’re drifting off to sleep. It can sound like a huge bomb or the crashing of a building demolition. As well as early in the night, this loud sound can occur as we wake up in the morning. 

Of course, such episodes can cause all sorts of problems because we are half asleep and unsure of what’s going on. Was the sound real? Has something happened outside? With the fear that follows, some people even feel as if they were having a stroke. 

Annoyingly, the exploding head syndrome can occur more than once per night. And the more episodes we experience, the more disturbed our sleep becomes. If you’re attacked by a cluster of these exploding sounds, it’s difficult to sleep because you may fear that they will happen again. 

But what is important is that there’s no pain associated with the noise. That being said, some people with the exploding head syndrome will experience a jerk, muscle twitch, or flash of light simultaneously. 

Why does this syndrome happen? Scientists would love to know. So far we’ve learned that people who are stressed and extremely tired are more likely to experience the sounds. It tends to be a problem that diminishes over time. 

Finally, we shouldn’t confuse the exploding head syndrome with other headache conditions because the latter normally come with pain. 

Treatment of parasomnia

Now that we know all about the different types of parasomnia, you’re probably wondering how they’re treated. Especially if you recognize the symptoms of one of them, these are problems that, as well as the risk of injury, are a nuisance more than anything else.

First and foremost, prevention will always be better than cure and this is why doctors will suggest improving sleep habits before anything else. Here are some tips:

• Go to bed earlier 
• Get between seven and eight hours of sleep each night 
• Reduce stress (try meditation or reading before bed) 
• Introduce a regular sleep schedule. 

If there’s a real risk to your health or the health of people around you, we recommend speaking to a medical professional. With extreme symptoms you may receive a prescription for drug therapy. Either way, intervention is important when your sleeping pattern is disturbed. For the sake of your relationship we also recommend visiting a professional when your partner is having their sleep disturbed too. 

Otherwise seek help if the problem gets more frequent or more severe. In some cases you may need to attend an overnight sleep lab. Don’t feel ashamed about your condition no matter how strange or bizarre the symptoms may seem. Even with violent behavior parasomnia is rarely linked to a psychiatric disorder. 

To prevent suffering of you and your roommates, family, or partners it’s always better to find a resolution early. In our experience support groups and therapy sessions have a fantastic reputation for sleep related issues. Even conversations with people in the same boat relieve the tension and help you understand that this is just a medical condition that needs resolving. 

By dealing with the issue you can get closer to your loved ones and resume a sleeping pattern that allows for a healthy life!