Parasomnias – What is it?

Parasomnias are sleep disorders in which strange or dangerous events occur that affect or intrude on sleep. These include nightmares, REM behavior disorder, confusional arousals, sleepwalking, sleep terrors, sleep eating disorder, sleep paralysis, sleep hallucinations, exploding head syndrome, and sleep talking. If you experience any of these parasomnias, then you usually will have no memory of the episodes as you remain asleep during the event. Parasomnias take place either as you are drifting into sleep, during sleep, or as you are waking up.

Confusional arousals

What is it?

Confusional arousal is a parasomnia that causes you to wake up feeling very confused and may even cause you to act very unusual and out of the norm for yourself as you are waking up or just after you wake up. You may not know where you are or what is going on around you and you could be experiencing:

• Slowed or confused speech
• Clouded thinking
• Memory loss
• Blunt responses to questions or requests

Many people appear to be awake when confusional arousal occurs and seem like they are in that morning foggy state of mind, but they are acting strange, and almost always do not remember the incident. Usually, an episode will begin with the need to be physically woken up by someone else. Behaviors like sleepwalking, shouting, and aggressive behavior are common during confusional arousal.

What causes it?

You are more likely to experience confusional arousals if you have a relative with this sleep disorder. Other factors that can increase your risk for confusion arousals include:

• Changing shift work
• Night shift work
• Other sleep disorders (hypersomnia, insomnia, circadian rhythm sleep disorders)
• Deprived or disturbed sleep
• Stress
• Bipolar and depressive disorders

Potential causes of this disorder include the following:

• Recovery from sleep deprivation
• Alcohol consumption
• Obstructive sleep apnea (OSA)
• Periodic limb movement disorder (PLMD)
• Psychotropic medication use
• Drug abuse

Possible Solutions

Cutting back on alcohol or eliminating its consumption may help lessen the severity of confusional arousals and even erase them. Also, it is very important that you get a full night of rest every night.

Some medications also help in treating confusional arousals. The most effective are antidepressants and sleeping pills.

Why get treatment?

If you discover that you suffer from these episodes, consulting a doctor about the best course of action for treatment is the next step. If medication is needed, then your doctor can discuss with you the most effective treatment plan and prescribe you the medication needed to combat this parasomnia.

Sleepwalking

What is it?

Sleepwalking is just like it sounds, you get up from bed and walk around even though you are still sleeping. You may even act out complex actions that you normally would do while awake; this could be as simple as walking downstairs to the kitchen, opening the fridge, and pouring yourself a bowl of cereal, or in rare cases, getting in your car and driving off. Some people talk or shout while they are walking about, and others jump out of bed and walk fast or even run as if they are trying to escape a threat, possibly one they are dreaming about as they sleepwalk.

Most often while sleepwalking, the person’s actions are very strange and involve things like urinating in a corner or trash can, rearranging furniture, or attempting to climb out of a window. Actions also can be much more hostile and violent than usual, and sleepwalkers’ eyes are usually open and glassed over with a confused look about them.

What causes it?

Sleepwalking can be caused by many different things including:

• Sleep deprivation
• Physical or emotional stress
• Obstructive sleep apnea (OSA)
• Travel
• Sleeping in unfamiliar surroundings
• Alcohol use and abuse

Possible Solutions

Some ways that you can help yourself and possibly prevent and stop yourself from sleepwalking are to:

• Get enough sleep.
• Stick to a regular and relaxing routine leading up to bedtime.
• Relief stress and avoid stressful situations leading up to bed.
• Avoid drinking alcohol at night.

Why get treatment?

An adult who either continues sleepwalking or starts sleepwalking is concerning because they are at a greater risk of injury than a child. At this point, it is advised that you consult with a Board Certified Sleep Physician to discuss your symptoms.

Sleep terrors (Night Terrors)

What is it?

Sleep terrors/night terrors occur in the first few hours of sleep during phase just before deep sleep called the slow-wave sleep phase. The terror is brought on when the person feels a deep sense of terror and fear that they cannot shake. Sleep terrors are more common in adults than children.

People who have sleep terrors experience intense episodes of sitting up and screaming in the middle of the night. These episodes can also involve kicking and thrashing while screaming, all done with an intense look of fear on their face. Sufferers may run around the house and usually have their eyes wide open and are very difficult to wake up. They will not respond to voices and are prone to violent behavior during an episode. Unlike with nightmares, once the sufferer does wake up, they will be very confused and most often will only not be able to remember anything. When they wake they will be experiencing extreme fear, and it can take a long to comfort them after an episode.

What causes it?

The major causes of sleep terrors include:

• Sleep deprivation
• Physical or emotional stress
• Obstructive sleep apnea (OSA)
• Travel
• Sleeping in unfamiliar surroundings
• Alcohol use and abuse
• Certain mental illnesses

You’ll notice that these are the same causes as for sleepwalking. These two parasomnias are very similar in their cause, those most at risk, and their treatment.

Possible Solutions

Finding a solution for your sleep terrors often requires a multi-faceted approach. Some effective approaches include:

• Practice Good Sleep Hygiene – Reduce the potential for sleep terrors by making sure you are getting adequate sleep and aren’t experiencing fatigue, follow a regular bedtime routine, and create a comfortable, safe sleeping environment.
• Minimize Stress – You can try minimizing the amount of stress in your life using methods such as meditation, yoga, relaxation therapy, hypnosis, biofeedback, or cognitive behavioral therapies.
• Anticipatory Awakening – If your sleep terrors occur at about the same time every night, try setting an alarm 10-30 minutes before you usually experience the episode to interrupt the cycle.
• Resolve Underlying Conditions – Sleep terrors are often accompanied by other sleep disorders or mental health conditions. Treating those conditions can effectively resolve the sleep terrors.

Why get treatment?

Sleep terrors require treatment when they pose a risk to the safety to the sufferer or those around them, cause routine sleep disruptions resulting in excessive daytime sleepiness, or increase in frequency. Following up with a sleep specialist can help address the underlying cause of the sleep terrors or minimize the dangers of them.

If you are experiencing night terrors due to certain mental illnesses, like PTSD, then it is important to speak with a doctor who may want to prescribe medication to treat the PTSD, which can help treat sleep terrors.

Sleep eating disorder

What is it?

Repeated instances of compulsive binge eating and drinking while in a semi-awake state is considered sleep eating disorder. When it happens, you typically have no memory of the event, and it is very difficult to wake up from an episode fully. Usually, people eat recklessly and have little or no control and become very angry and resistant if another person tries to wake them and stop them.

Most people with SRED will experience an eating episode every night, and some eat more than once in a night even though they do not feel hungry or thirsty. Episodes may occur at any time during the night and usually does not last long. A typical episode may last ten minutes in its entirety. Typically sugary, fatty, and foods high in calories are eaten when on this binge. Oddly enough, preferred foods during these episodes are usually not foods that the individual chooses to eat when awake during the day and sometimes eating foods they are allergic too.

What causes it?

It is very common to have had another sleep disorder before developing SRED; the most common is sleepwalking as a child. Some of the other most common ones are:

• Restless legs syndrome
• Periodic limb movement disorder
• Obstructive sleep apnea
• Irregular sleep-wake rhythm

Other found causes of SRED include:

• Ending the habit of smoking
• Ending the abuse of alcohol or drugs
• Stress
• Dieting during the day
• Daytime eating disorders
• Narcolepsy

Possible Solutions

In treating SRED it is important to get enough sleep, sleep deprivation may cause these episodes to increase in frequency and severity. However, it has been shown that those suffering from SRED respond well to medication.

Why get treatment?

SRED is treatable with medication, but a sleep test is a good way to determine if your SRED developed from as a result of another sleep disorder and get proper treatment for that as well. Try to make the path to the kitchen as free from obstacles and as safe as possible to prevent injury during potential episodes while receiving treatment.  We also recommend you get an appropriate amount of sleep as sleep deprecation can increase the likelihood of another episode.

Sleep paralysis

What is it?

When sleep paralysis occurs you are unable to move your body either:

• When falling asleep (hypnagogic or predormital form)
• When waking up from sleep (hypnopompic or postdormital form)

Everyone experiences temporary paralysis while they sleep. Your brain tells your muscles to relax, so you aren’t moving around, injuring yourself or others. However, sleep paralysis occurs while you are awake. You may not be able to move any part of your body or be able to speak, all while being able to breathe and being fully cognizant of what is going on. Episodes can last from a few seconds too many minutes. These are quite frightening episodes because, unlike other parasomnias, you are awake and fully aware that you are unable to move your body.

What causes it?

Sleep paralysis typically surfaces in the teen years and occurs during most people’s 20s and 30s. It is not a serious medical risk, and reoccurrences do not disturb your sleep.

Possible Solutions

Treating sleep paralysis is aimed more at what causes the paralysis to occur, which, typically, is sleep deprivation. However, people with psychiatric issues may experience sleep paralysis as well. In such a case, an antidepressant is a normal treatment.

Why get treatment?

Pursuing treatment options and discussing them with a sleep physician or your own doctor is important because you may find that your sleep paralysis is caused by another sleeping disorder. This will provide you with a better understanding of why you are having these episodes and how best to prevent them through proper treatment, directly or indirectly.

Sleep hallucinations

What is it?

Sleep-related hallucinations are easily confused with dreams because they are imagined events that seem very real, but are not dreams because they occur when you are awake; typically, just as you are waking up or just as you are falling asleep. The images, sounds, smells, and touch you experience during sleep hallucinations may last up to several minutes and usually cause fear, much like a nightmare.

What causes it?

Sleep hallucinations can be a result of another sleep disorder, a side effect of certain medications, a mental health disorder, such as bipolar disorder, or substance abuse. Other common factors that can cause sleep hallucinations are:

• Drug use (past or present)
• Heavy alcohol use (past or present)
• Anxiety
• Mood disorders
• Insomnia

Possible Solutions

Normally, sleep hallucinations gradually decrease over time and will go away on their own. The most effective aid to relieve yourself of sleep hallucinations is to:

• Get an appropriate amount of sleep
• Establish a regular sleeping schedule
• Avoid the consumption of alcohol and drug use

If further treatment is needed, doctors usually will prescribe an anti-depressant.

Why get treatment?

If your dreams and hallucinations are causing major sleep disruptions due to extreme fear and anxiety, then a doctor may want to prescribe medication, typically anti-depressant and anxiety medications.

Exploding head syndrome

What is it?

Exploding head syndrome is an imagined loud noise heard just before one falls asleep sounding like:

• A loud bang
• Cymbals crashing
• A bomb exploding
• Constant violent crashing

Episodes are undeterminable and may happen every night, multiple times a night, or infrequently. Exploding head syndrome is typically more annoying than painful. The imagined sounds disturb sleep by keeping you up, but usually, pain is not associated with the sounds. What causes exploding head syndrome is unknown, but it is thought to occur more with high levels of stress.

What causes it?

The specific causes of exploding head syndrome are not known, but it does seem to decrease over time.

Possible Solutions

Treatment most often involves getting adequate sleep at night as episodes typically occur when one is sleep deprived. If stress is believed to be a triggering factor, then establishing a relaxing routine, such as yoga or a hot bath, before bed is recommended.

Some studies have shown that clomipramine may help to treat some symptoms of exploding head syndrome.

Why get treatment?

If you believe medication is needed for treatment, talk to our Board Certified Sleep Physician or your personal physician.

Sleep talking

What is it?

Sleep talking is talk that occurs while people are asleep and for the most part is nonsensical babble, though it can involve quite complicated conversations, that they sleep talker is unaware of doing. It may be harmless talk referring to a dream one is having, or it can be very vulgar and offensive language.
It is not generally admissible in court as it is accepted by science and the law that sleep talk is not a product of the conscious or rational mind. Approximately 5% of adults experience sleep talking. Sleep talking typically does not disrupt your own sleep but may be disruptive to that of your sleeping partner.

What causes it?

Sleep talking often runs in families, though it can be brought on by sleep deprivation, depression, stress, alcohol, and even a fever. Many people often have another sleep condition, mental illness, or medical illness who experience it as adults. Some of these conditions include:

• Confusional Arousals
• Nocturnal Seizures
• Obstructive Sleep Apnea Syndrome
• Psychiatric Disorders
• REM Sleep Behavior Disorder
• Sleep Terrors
• Sleepwalking

It is not generally a cause for concern as it tends to resolve on its own for most people.

Possible Solutions

The best way to combat sleep talking is to establish healthy sleep hygiene practices. Start by getting a good amount of sleep. Establish a relaxing wind down leading up to your bedtime and avoid consuming caffeine, nicotine, and alcohol before bed. Also, stop blue light exposure in the hour leading up to when you go to bed and read instead. Getting the most restful sleep possible is the best way to prevent sleep talking.

Why get treatment?

Sleep talking is not considered to be a serious sleep disorder but may be a result of one or multiple more serious sleep disorders. Treatment for sleep talking is usually unnecessary, that being said, if you suddenly start talking in your sleep as an adult, if it is accompanied by intense actions or sounds, or severe sleep talking persists and is consistently detrimental to a quality night’s sleep, then you may have another sleep disorder. In that case, you should speak with our Board Certified Sleep Physician or your personal physician. They may want to start treatment for any other diagnosed sleep disorder; treating these will, in turn, treat your sleep talking.

Nightmare disorder

What is it?

Nightmare disorder is referred to by doctors as a parasomnia — a type of sleep disorder that involves undesirable experiences that occur while you’re falling asleep, during sleep or when you’re waking up that impacts about 4% of adults. Nightmares usually occur during the stage of sleep known as rapid eye movement (REM).

Nightmare disorder has been known to cause excessive daytime drowsiness, leading to problems at school or work and even making common daily tasks difficult, like concentrating and driving. Lack of sleep and frightening dreams can cause difficulties with mood, resulting in agitation and anxiety from the dream content, which can lead to difficulty falling asleep and complete resistance to sleeping at night from the fear of nightmares.

What causes it?

The exact cause of nightmares is not known. However, there are many factors that can induce nightmares such as:

• Stress and anxiety
• Traumatic events
• Sleep deprivation
• Substance abuse

Possible Solutions

Treatment for nightmare disorder isn’t usually necessary. Some strategies to help combat nightmare disorder include:

• Practice good sleep hygiene – Reduce the potential for nightmares by making sure your are getting adequate sleep and aren’t experiencing fatigue, follow a regular bedtime routine, and create a comfortable, safe sleeping environment.
• Avoid fear-inducing media – Watching thrilling, suspenseful, or scary movies, shows, or news can result in residual anxiety and stress that sets the stage for nightmares.
• Talk about it – Share the details of your nightmare with someone else to help you process that it wasn’t real and can’t hurt you.
• Put stress in its place – If stress or anxiety is an issue, talk about it. Practice some simple stress-relief activities, such as deep breathing or relaxation. A mental health professional can help if needed.

Why get treatment?

Having a nightmare disorder can have serious quality of life impacts and cause you to avoid sleep which results in sleep deprivation. The result of which is an increase in the intensity of your nightmares. It can also lead to insomnia, daytime sleepiness, and fatigue. Your physician will try and treat the underlying medical condition that is causing the nightmares as well as any stress or anxiety you have if they are found to be associated with your nightmare disorder. Your physician may also suggest stress-reducing techniques to try before bed and throughout the day. Medication may also be prescribed for nightmares caused by PDSD.

People who have their nightmares successfully treated appear to have better sleep quality, feel more rested on awakening, and report less daytime fatigue and sleepiness, and improvement in their symptoms of insomnia.