The Definition of Parasomnia

Parasomnia is a type of sleep disorder that causes people to engage in various abnormal activities while sleeping. It is listed as a sleep disorder in the DSM (Diagnostic and Statistical Manual of Mental Disorders), and it includes a variety of behaviors. Some examples of parasomnias include sleepwalking, night terrors, sleep paralysis and nocturnal epilepsy.

Insomnia and sleep apnea, both which are classified as dyssomnias, are quite well known. Not that many people, however, know the meaning of parasomnia, which is less common. Yet parasomnias are not that rare either, especially among children. In many cases, people will ignore such incidents out of fear or embarrassment, when a better understanding of them would be much more helpful.

Facts About Parasomnia

While symptoms of parasomnia, such as night terrors, sleepwalking and talking in one’s sleep have long been recognized by doctors, researchers and the general public, not much was known about them until recently. Today, there is a great deal of research being conducted on parasomnia.

You can now find quite a bit of literature on parasomnia, both on and offline. There are books, articles in medical journals and even documentaries on the subject. Researchers are finding links between parasomnia and other conditions, such as ADHD, Parkinson’s Disease and even respiratory ailments that obstruct breathing during sleep.

There are certain guidelines and precautions people suffering from parasomnia -and those who live with them- should follow. A person with such a condition should not sleep on a top bunk or any other place where falling could cause a serious injury. This includes, of course, near a window that can easily be opened. Any objects that could cause injury, such as anything sharp, should also be removed from the area.

For those who may be near a person experiencing an episode of parasomnia, it’s not a good idea to try to awaken them abruptly. This could provoke an aggressive response, as the person may be experiencing something frightening. It’s best to try to gently guide them back to bed using a soft voice.

Effects of Parasomnia

Parasomnias can have a variety of effects, some of them strange but harmless, others bizarre and frightening. In some cases, parasomnia can cause a person to commit crimes in their sleep, even killings. While violence committed during sleep is relatively rare, it does happen and the victim can be oneself or another.

Pseudo-suicide refers to cases where a person’s behavior during sleep results in death. It’s often considered a suicide, but since there was no conscious intent to commit the act, it’s actually pseudo-suicide. At other times, a person may commit parasomnia homicide, killing another person while asleep.

Most parasomnias are less dramatic than this, but they can still be serious and disturbing. Sleep paralysis, for example, can make it impossible to move as you’re starting to fall asleep or when you wake up. These incidents are sometimes connected to disturbing dreams. Violent dreams and other types of nightmares are also common among people who suffer from parasomnias.

Like other sleep disorders, one of the most potentially harmful effects of parasomnia is sleep deprivation. Both children and adults who frequently experience parasomnia often get much less sleep than they need. Even when they do sleep, it’s often not very restful.

Lack of sleep can bring about many physical and psychological problems. For this reason alone, you should seek medical advice for any type of parasomnia that occurs regularly.

Types of Parasomnia

Parasomnia can come in many forms. Some of the more common types include:

  • Night Terrors or sleep terrors

  • Bruxism -grinding of the teeth while sleeping

  • Restless leg syndrome

  • Confusional Arousals

  • Sexomnia or sleep sex

  • Non-REM parasomnia

  • Parasomnia RBD

  • Parasomnia enuresis or bedwetting

  • NPD -Nocturnal Paroxysmal Dysonia

Night terrors can be especially upsetting, and these are more common among children. These are more serious than nightmares, as with bad dreams, the person is usually no longer afraid once they wake up. With night or sleep terrors, though, the fear persists even when you’re awake.

Confusional arousals refer to any type of parasomnia where the person demonstrates confusion or disorientation. This may involve sleepwalking, talking while asleep or any number of activities that the person isn’t consciously aware of. These usually occur during the deeper, delta phase of sleep rather than the REM phase.

Restless legs syndrome is something that can occur when you’re awake or as a parasomnia. Some people move their legs around while sleeping, and there are a variety of causes for this disorder.

Sleep sex, or sexomnia is when people engage in sexual behaviors while asleep. While this is quite rare, it does occur on occasion. In some cases this can be a sensitive issue, as this disorder has sometimes been used as a defense in criminal cases involving sexually based crimes.

One of the most common types of paraxomnia is bruxism, which is grinding your teeth in your sleep. This can be more serious than it sounds at first. Over time, this can not only wear down the enamel of your teeth, it can cause headaches and disorders of the jaw such as TMJ.

Parasomnia RBD or rapid eye movement behavior disorder occurs when people have nightmares or night terrors during REM sleep. In these instances, they will often yell or scream as they wake up.

Enuresis refers to bedwetting in children over the age of 5. This is fairly common, and often runs in families. It’s upsetting for both children and their parents, who often have difficulty coming up with a solution. The obvious remedies of making sure that the child goes to the bathroom before bed and doesn’t drink too many fluids is often not enough to stop the problem. There are devices called bedwetting alarms that wake children up as they begin to urinate.

In the case of NPD, a person has seizures during non-REM sleep. This is believed by most medical researchers to be a form of epilepsy.

So the symptoms of parasomnia are quite varied and depend on the type that the person is experiencing. They can be fairly mild, such as talking in one’s sleep or quite a bit more dramatic and occasionally even violent.

Parasomnia Statistics

While parasomnia only affects a minority of the population, it’s more common than many people believe.

  • Parasomnias occur in about 2% of adults

  • Approximately 5% of all children engage in sleepwalking at some point

  • About 5% of children and 1% of adults experience night terrors

  • Up to 10% of the population has restless leg syndrome

  • 25% of the population engages in bruxism or teeth clenching

  • 95% of all sleep disorders remain undiagnosed

Because of the latter statistic, that the vast majority of sleep disorders are never even diagnosed, it’s difficult to know the actual extent of parasomnia. Yet, this will hopefully change as more people recognize that these conditions can be serious and that there are effective ways to treat them.

Parasomnia affects many more children than adults. Researchers believe that this has to do with the brains of children not being fully mature. In the majority of cases, these sleep disturbances begin to stop as the child gets older. This doesn’t mean, however, that they should be ignored. Although most parasomnia in children doesn’t have harmful consequences to physical health, they can be quite traumatic, so treatment should be sought whenever distressing symptoms are present.

Causes and Diagnosis

Since parasomnia refers to many different behaviors, there is no single cause. In children, there is often a connection between night terrors and other sleep disorders and ADD or ADHD. Kids who have difficulty concentrating in school and have other symptoms of Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) often have parasomnia symptoms as well. In some cases, treatments such as medication that are directed at treated ADD or ADHD may help to curb the nighttime disorders as well.

There’s evidence that parasomnia RBD, which involves frightening dreams during REM sleep, is often an early sign of Parkinson’s Disease. Researchers aren’t sure why these are linked, but studies have shown that people who exhibit RBD symptoms often develop Parkinson’s Disease later on.

In some cases, alcohol or drugs may be connected with parasomnia. This is usually in cases where a person has ingested large quantities of alcohol, and some alcoholics and drug addicts will frequently have paraomnias.

Another possible cause of parasomnia is PTSD or post -traumatic stress disorder. When a person has undergone an extremely traumatic incident, such as a crime, war or disaster, they may have long term symptoms of anxiety and even panic. Sometimes this occurs during sleep, and causes various types of parasomnias.

Both children and adults with bipolar disorder are more likely to experience nightmares, night terrors, bruxism and other types of parasomnias. In such cases, the treatment the patient is receiving for bipolar disorder, such as medication, may be helpful at controlling these symptoms that occur during sleep.

There’s evidence that parasomnia tends to run in families. This isn’t surprising, as there is a genetic component to a large number of both physical and psychiatric disorders.

Other possible causes of parasomnia include brain disorders, side effects of medications and other sleep disorders, such as sleep apnea. In children, it’s been noted that respiratory ailments that obstruct breathing can cause symptoms such as night terrors.

Diagnosis of parasomnia is often based on the accounts of the person suffering from it, and in some cases people in the same house who witness their behavior during sleep. Patients may be given a quiz or questionnaire to pinpoint their symptoms and connect them with any other medical issues they might have.

If you suffer from paraomnia, it might be advisable for you to undergo a sleep study. This is something you have to discuss with your doctor, who can advise you where the nearest sleep laboratory is. This is a detailed study of your sleep habits, where your brain, eye movement, breathing and other factors are carefully measured to determine how you are sleeping and what might be causing your symptoms.

Many hospitals have sleep labs. Yet it’s also possible to conduct a sleep study at home, if you have the right equipment. Your doctor may be able to help you gain access to portable devices that can allow you to conduct your own sleep study.

Treatment

Although all instances of parasomnia are considered sleep disorders, some types are obviously more serious than others. When is it advisable to seek medical help for parasomnia?

  • When the symptoms present a danger to the sufferer or others

  • When making changes in sleep patterns and other lifestyle adjustments don’t help

  • When the symptoms cause chronic sleep deprivation

While there is no simple cure for parasomnia, as it comes in so many varieties, there are many treatments that can help to manage and sometimes overcome the condition. In some cases, medications are used to alleviate the symptoms of parasomnia.

Some of the medications that are often prescribed include benzodiazpines such as Lorazepam and Klnopin, which are both used to treat seizures and panic attacks. Non-benzodiazpines are also sometimes given, especially sedatives or hypnotics such as Zopidem and Zopiclone, both which are often prescribed for insomnia.

Medication isn’t the only way to treat parasomnia, of course. Doctors and therapists might also recommend various actions and lifestyle changes, including:

  • Hypnosis and relaxation techniques

  • Exercise and a healthy diet to aid in sleep

  • Avoidance of violent movies, books, computer games, etc.

  • Removing tonsils (not recommended) in children often stops sleep terrors by making it easier for them to breathe while sleeping

  • Following a more regular sleep schedule

Aside from these treatments, patients suffering from parasomnia can also find help with support groups. There are parasomnia organizations that can offer you information on support groups as well as online forums. These groups can provide you with the latest findings in this field, and also allow you to meet others who are experiencing similar symptoms.

Parasomnia can be a difficult condition to live with, and it’s sometimes even hard for doctors to diagnose it. Yet, as more research is done and public awareness about this sleep disorder grows, there are now more resources to help you cope with parasomnia.