Parasomnias

  The term parasomnia refers to general sleep disruptions from the REM (rapid eye movement) sleep cycle and non-REM sleep cycles. These disruptions can occur on a regular basis, or very rarely depending on the person. The disruptive events by them self may cause the affected person to wake up or partially wake, although during the actual event, one remains asleep. There are several types of sleep disruptions that fall under the umbrella-term parasomnias. The most recognized parasomnias are talking while asleep, sleepwalking, night terrors and nightmares. These events are more common in children, but can occur in adults as well.

 

Confusional Arousals

  Confusional arousals are far more common in children than in adults. The affected person may cry out or thrash around in bed. Sometimes this condition is referred to as sleep drunkenness because the affected person reacts very slowly to stimulation or has a hard time understanding what is happening around them. Attempts to calm the person can go unnoticed because it is very hard to wake a person in one of these states. These events can last up to half an hour. After the arousal is over, the affected person wakes very briefly, calms and returns to sleep. Most people who have one of these events have no memory of it the next day.

 

Sleep Walking

  Sleepwalking or somnambulism is probably the most well known arousal disorder. Sleepwalking is most commonly seen in children, although it can be seen in adults and the elderly. Boys are more likely to be sleepwalkers than girls are, and the disorder usually runs its course before the teen years. The rates of the occurrences can vary from person to person, some may only sleep walk once a month, while others may sleep walk nightly.

  The actions during a sleepwalking event can vary as well. Some people may only sit up in bed, or walk around the room while others may walk around the house or leave the house. Other events during sleepwalking may include open eyes with a blank expression, unintelligible talking, or use of language not typical to the person. While injury from sleepwalking is rare, they affected person can put them self in danger, like going outside in bed cloths during the winter. In most cases, no treatment is necessary for the sleepwalker, as the number of events will decrease as the child ages.

 

  As the sleepwalker is unaware of their environment there are some common sense steps one can take to insure safety for the sleepwalker. Be sure there no large objects near the bedside; make sure there is not anything on the floor that could be tripped over. If one is concerned the sleepwalker will try to go outside, close and lock bedroom windows at night and lock doors to the house.

 

  Despite popular myths, it is not dangerous to wake a sleepwalker. However, upon waking them, they will probably be confused or disoriented, so it is best to speak to them gently and encourage them to return to bed.

 

REM Behavior Disorder (RBD)

  People who have REM Behavior Disorder, or RBD often act out their dreams during sleep. Typically, during REM sleep ones body will experience atonia, which is paralysis of all voluntary muscles. This sleep paralysis is a normal self-defense mechanism, preventing us from acting out our dreams.

 

  Sleep paralysis is nonexistent or insufficient for people who have RBD. This allows them to “act out” their dreams, which can cause them or their bed partners’ injury. When people with RBD experience an episode they often remain in bed, moan, and thrash around as they dream. In extreme cases, some people have actually gotten out of bed. Men over the age of 50 are most at risk for RBD, although it can occur in at any age and in women as well. RBD is different from “sleep terrors” and sleep walking as people with RBD can easily be awakened during an event. The affected person will usually be able to recall their dream, but they had no idea they were moving about during their dream. Many people who have RBD report that intense or violent dreams trigger their episodes.

 

  There is treatment available for RBD. Most physicians will want a person to have sleep study done to confirm the diagnosis of RBD. After which treatment will be decided on; most treatments include medication or behavioral therapy.

 

Sleep Terrors

  Sleep terrors are more common in children than in adults, although adults may have them occasionally. Despite their appearance, sleep terrors are not nightmares. Nightmares are vivid dreams that occur during REM sleep, and most people can recall most or all of their nightmares. On the other hand, sleep terrors occur during the deepest stages of sleep when dreaming does not occur. Commonly one who has a sleep terror cannot recall what was so frightening to them. It is typical during a sleep terror for a person to scream, sweat, have a rapid pulse and sit up in bed. The person having a sleep terror may appear to be awake, but are unable to communicate. During a sleep terror the person will not respond to soothing words or comfort, they may try to run away. This event will last 20 minutes or less, at which time the person will lie down and return to sleep.  

 

  Stress, some medications and possibly sleep apnea are thought to be triggers of sleep terrors. These evens will lesson as a child grows, and usually taper off completely by age 5. Until then, be sure to keep the bedroom a safe place. Make sure there is not anything on the floor that can be tripped over and move any large objects away from the bedside. There is no need to restrain a person having a sleep terror unless they are putting them self in danger.

 

Nightmares

  Nightmares are vivid, frightening dreams that we all experience at one time or another. People have little difficulty recalling their nightmares as they are usually filled with feelings of fear, terror and foreboding. It is not uncommon to have a problem returning to sleep after a nightmare, especially for children.  Nightmares occur more often in children than in adults, and it is a normal development process for children to go through. These frightening dreams can start as early as eighteen months of age. Children will benefit from comfort and reassurance after a nightmare as they move through this development stage.

 

  Adults have far fewer nightmares than children do. Often nightmares for adults are brought on by emotional stress, anxiety or illness. Some medications disturb REM sleep and these may trigger nightmares as well.

 

When to Seek Treatment

  Typically, any of the sleep disruptions listed above are not signs of anything physically or psychologically wrong with a child. Most of these behaviors will self correct as a child ages. However, one should contact a health care provider if a child experiences excessive sleepiness during the day, if the child puts them self in danger, or if the events are making it difficult for your family to function. In these cases, it is possible the health care provider will want to evaluate your child or have them see a sleep specialist.

 

  The sleep disruptions listed above are not typical for an adult; they actually may be indicators of other sleep related disorders like apnea or periodic limb movement disorder. See a health care provider to find the cause of the sleep disturbances. The health care provider may refer one to a sleep specialist or a sleep center for an evaluation.

 

Other Parasomnia Events

  Other parasomnias can be just as taxing and frightening as the events listed above. Some of the more common of these are listed below.

 

Teeth Grinding (Bruxism): Grinding ones teeth while sleeping could be an indicator of stress and can be damaging to your teeth.

 

Sleep Talking:  This is a very common event, there is no need to worry if one talks during their sleep; it is not a sign of anything physically or mentally amiss.  

Sleep Starts:  Many people often experience the sensation of their body “jerking” or a limb jerking just as they fall asleep. Theses sleep starts can be visual as well, in the form of a bright light inside ones eyes. Another type of sleep start is auditory, it will sound like loud bang or snap that seems to emanate from inside ones head. These occurrences can be startling and annoying, but are harmless.

 

 Nocturnal Seizures:  These seizures occur only while asleep, and may resemble a confusional arousal event. One having a nocturnal seizure may cry out, fall out of bed or thrash their limbs. This seizure disorder will need to be properly evaluated by a health care provider. As with most seizure disorders it may be treated with medication. 

 

Who to see.

  Most primary care physicians will be able to evaluate someone who is having sleep disturbances. However, if they conclude the disturbance is complex they may refer a person to sleep specialist or a sleep center for further evaluation.

  Reviewed September, 2007

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