Parasomnias

The most common are “disorders of arousal” which include confusional arousals, sleepwalking (somnambulism) and night terrors. These occur when a person is in a mixed state, both asleep and awake, and often emerging from the deepest stage of non-dreaming sleep. The sleeper is awake enough to act out complex behaviors but is still asleep and not aware of or able to remember these activities.

What causes a parasomnia?

Parasomnias often run in families and so there is probably a genetic factor in many cases. Brain disorders may be responsible for some parasomnias, such as many cases of REM sleep behavior disorder. Parasomnias may also be triggered by other sleep disorders such as obstructive sleep apnea, and by various medications.

Who is at risk for parasomnias?

Parasomnias affect approximately 10% of Americans. They occur in people of all ages, but are more common in children. Children are particularly vulnerable because of brain immaturity. The good news is that they are usually not associated with negative health consequences and disappear as a child matures.

Should a person be awakened during a parasomnia episode

Trying to awaken a “parasomniac in action” - especially by shaking or shouting - can sometimes trigger an irritable, aggressive or violent response. Therefore, gently redirect the person back to bed by guiding him or her by the elbow and speaking softly.

How can a parasomnia sufferer be protected?

Door alarms can help by awakening a person during an episode. Also, a person who suffers from parasomnias should not sleep on a top bunk, or next to a window. It is important to remove sharp objects from the bedside area and to be sure roommates and household members are aware of the problem and what to do about it.

How are parasomnias treated and at what point should someone with a parasomnia seek evaluation and possible treatment?

Many people who suffer with parasomnias see an improvement in their symptoms simply by improving their sleep habits. Good sleep habits include keeping a regular sleep schedule, managing stress, having a relaxing bedtime routine, and getting enough sleep. There are also drug therapies that are used to control symptoms.

A person should seek treatment whenever there is risk for injury to oneself or another person from the parasomnia. It is also important to seek treatment if the parasomnia disrupts a person's own sleep or the sleep of the bed partner or roommate, of if there is distress about the symptoms (e.g., nightmares), or if the frequency is quite high or escalating. An overnight sleep lab study may be needed.

It is important to keep in mind that no matter how weird, bizarre, or violent the behavior, a parasomnia is rarely linked with a psychiatric disorder. However, people who suffer from parasomnias may endure ridicule, confusion, and/or shame about their symptoms. In addition, bed partners, family members, and roommates may suffer sleep loss as a result of the parasomnia. In many cases, seeking help from a therapist or support group can help people with parasomnias and the people close to them cope with these issues.