Parasomnia

• Parasomnias are disruptive sleep-related behaviors or experiences.
• They are categorized by the sleep stage in which they occur, such as NREM or REM sleep.
• Common types include sleepwalking, sleep terrors, and REM sleep behavior disorder.
• Causes can range from genetics and medications to stress and underlying health conditions.
• Diagnosis typically involves a medical history review and sometimes a sleep study, with treatment focusing on addressing triggers and managing symptoms.

What is Parasomnia and Its Symptoms

Parasomnia is a broad category of sleep disorders characterized by abnormal and undesirable physical events or experiences that happen during sleep. These events can occur during any stage of sleep, including the transition periods between wakefulness and sleep. While some parasomnias are relatively benign, others can be dangerous to the individual or others, or cause significant distress and impairment.

The symptoms of parasomnia vary widely depending on the specific type of disorder. They can include movements, behaviors, emotions, perceptions, and dreams that are not typically associated with sleep. Individuals may not remember these events upon waking, especially if they occur during deep sleep stages. Common manifestations can range from talking or yelling in sleep to more complex behaviors like walking, eating, or even driving while not fully awake.

Types of Parasomnia Sleep Disorders

There are numerous parasomnia sleep disorders, broadly categorized by the sleep stage in which they predominantly occur: Non-Rapid Eye Movement (NREM) parasomnias and Rapid Eye Movement (REM) parasomnias. Understanding these distinctions is crucial for proper diagnosis and management.

• NREM Parasomnias: These typically occur during deep sleep (stages N3 or slow-wave sleep). Examples include sleepwalking (somnambulism), sleep terrors (night terrors), and confusional arousals. Individuals experiencing NREM parasomnias may appear awake but are unresponsive and often have no memory of the event.
• REM Parasomnias: These occur during REM sleep, the stage where most dreaming happens. The most well-known is REM sleep behavior disorder (RBD), where individuals physically act out vivid, often violent, dreams due to the failure of normal muscle paralysis during REM sleep. Sleep paralysis, where a person is temporarily unable to move or speak upon waking or falling asleep, is also considered a REM parasomnia.
• Other Parasomnias: This category includes conditions that don’t fit neatly into NREM or REM, such as sleep-related eating disorder, sleep enuresis (bedwetting), and exploding head syndrome.

Causes, Diagnosis, and Treatment for Parasomnia

The causes for parasomnia are often multifactorial, involving a combination of genetic predisposition, environmental factors, and underlying health conditions. Factors such as sleep deprivation, stress, certain medications (e.g., sedatives, antidepressants), alcohol consumption, and other sleep disorders (like sleep apnea) can trigger or worsen parasomnias. Neurological conditions and fever, particularly in children, can also contribute.

Diagnosing parasomnia in adults and children typically begins with a thorough medical history and a detailed account of the sleep disturbances from the individual and any witnesses. A sleep diary can be helpful in tracking patterns. In many cases, a sleep specialist may recommend a polysomnography (PSG), an overnight sleep study conducted in a lab. This test monitors brain waves, oxygen levels, heart rate, breathing, and eye and leg movements during sleep, helping to identify specific sleep stage abnormalities and rule out other conditions.

The treatments for parasomnia aim to reduce the frequency and severity of episodes and ensure safety. This often involves addressing any underlying causes or triggers. For instance, improving sleep hygiene (consistent sleep schedule, comfortable sleep environment, avoiding caffeine/alcohol before bed) is a foundational step. Behavioral therapies, such as scheduled awakenings for NREM parasomnias, can be effective. In some cases, medication, such as benzodiazepines or antidepressants, may be prescribed, particularly for severe or dangerous forms like REM sleep behavior disorder. It is important to consult a healthcare professional for an accurate diagnosis and personalized treatment plan.