Parasomnias consist of some of the weirdest and as yet unexplained sleep behaviors some of which are even more dramatic and unusual than sleepwalking. For instance have you ever heard of sleep driving, sleep-eating and or even sleep sleep-sex aka sexsomnia?
What is a parasomnia?
Parasomnias are a subset of sleep disorders that consist of abnormal or unusual behaviors, emotions, thoughts, or physical sensations relating to a person’s sleep.
Parasomnias are different from insomnia, a number of conditions that affect people’s abilities to fall asleep or stay asleep, and hypersomnia, conditions that cause extreme tiredness.
Researchers believe that genetics might contribute to parasomnias. Some families have more than one person with the same type of parasomnia and certain genes appear to be linked to sleepwalking. Researchers also believe that stress, anxiety, and nervous system malfunctions may contribute to parasomnias.
What are some common types of parasomnias?
There are many types of parasomnias that belong to different categories. According to the Bible of sleep disorders, the third edition of the International Classification of Sleep Disorders (ICSD-3), there are three categories of parasomnias: non-rapid eye movement (NREM) sleep, rapid eye movement (REM) sleep, and nonspecific conditions.
List of parasomnias (ICSD 3)
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Non-rapid eye movement (NREM) sleep disorders are often known as arousal disorders. They arouse people from normal states of sleep and often occur during a person’s early sleep.
NREM-related parasomnias include:
- Sleepwalking (also known as somnambulism and noctambulism). A condition affecting about four percent of adults, sleepwalking occurs when a person’s brain is partially awake and partially asleep. This disorder is not limited to walking; many other behaviors such as sleep-eating, sexsomnia (sleep-sex), sleep driving and even sleep-texting are becoming increasingly common
- Confusional arousal. Confusional arousal often occurs when people arouse other people from sleep. The newly awakened people could be confused and disoriented and experience memory and speech problems.
- Night terrors (also known as sleep terrors, sleep terror disorder, or pavor nocturnus). Fear, terror, disorientation, sweating, rapid heartbeat, screaming, and thrashing are just some of the frightening symptoms of night terrors. As with other parasomnias, children tend to experience night terrors more than adults.
Dreams occur during rapid eye movement (REM) sleep. Parasomnias can also occur then, a few of which include:
- REM sleep behavior disorder (RBD). People with REM sleep disorder can experience vivid dreams and try to mimic the behavior occurring in their dreams, even though they may be experiencing temporary muscle paralysis, a condition known as atonia.
- Nightmares. Frightening dreams are another form of parasomnia that is more common in children than adults.
- Night eating disorder. People who consume a majority of their daily calories after dinner at night, and even wake up to eat more, might have night eating disorder.
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Other parasomnias can occur during the transition from sleep to wakefulness:
- Myoclonus. This is the technical term for jerks, twitches, or seizures that can occur during this time.
- Nocturnal leg cramps. Muscle contractions sometimes cause nighttime cramping and pain, especially in older adults.
- Rhythmic movement disorder (RMD). Children who make repetitive movements and rock themselves to sleep might have RMD, a condition most children outgrow by the age of five. Children with this disorder might also bang or roll their heads while sleeping.
- Somniloquy. Not Hamlet’s famous “To be or not to be” speech (that’s a soliloquy), somniloquy occurs when people talk in their sleep. This talk can be eloquent or incoherent and is yet another parasomnia that is more common in children.
Other parasomnias do not fall into specific categories. Some of these parasomnias include:
- Hallucinations. People might experience hypnagogic hallucinations while falling asleep or hypnopomic hallucinations while waking up from sleep.
- Addiction-related parasomnia. Drugs and alcohol can affect people while they’re awake, so it’s no surprise that people who need drug addiction help sometimes experience sleep disorders.
- Medical-related parasomnia. Medical conditions can cause parasomnias and other sleep disorders.
- Sleep enuresis. This is a term for urinating while sleeping (bed-wetting), another parasomnia more common in children.
- Exploding head syndrome. People with this condition sometimes say it feels as if they have exploding bombs in or near their heads while they are trying to fall asleep. Exploding head syndrome is often related to insomnia, jet lag, emotional tension, and stress. It might be caused by the brain’s inability to shut down certain functions as people fall asleep.
- Bruxism. People with bruxism grind their teeth or clench their jaws. Excess stress might contribute to this condition.
How do parasomnias affect people?
Given the sheer number and variety of parasomnias, perhaps it is not surprising that a number of people have had them. Their experiences illustrate how parasomnia can affect people’s lives.
These effects can be medical. Bruxism can cause pain or even damage the teeth and jaws if people repeatedly clench their teeth and grind their jaws.
Socially, people who experience sleep enuresis may be afraid to travel and stay at new places because they’re afraid they’ll wet their beds and be teased for their actions. But, worrying about bed-wetting can create stress and anxiety that might make enuresis and other parasomnias worse.
As with people with other sleep disorders, people with parasomnias may dread or even fear going to sleep because they’ll experience parasomnias, which could lead to even more stress and parasomnia.
Children who might not understand their condition or have the life experience needed to cope effectively with parasomnias might struggle with them as well. But, luckily, many parasomnias disappear on their own as children grow up and grow out of parasomnias such as sleepwalking and night terrors.
Of course, many parasomnias affect more than the person experiencing them. People who share beds with parasomniacs are firsthand witnesses to the condition. For example, this not-safe-for-work recording features audio recordings of somniloquy, or sleep talking. It gives a sense of what parasomniacs’ partners might witness on a regular basis.
Furthermore, the partners of parasomniacs might worry about their partners’ health and safety. They might also worry about their own. People with parasomnias might behave violently or thrash out in their sleep, so they might unintentionally hurt themselves or others. A 2016 case report describes an adult woman who fractured her arm, herniated a bulging disc in her spinal cord, and suffered other injuries during different night terror incidents. She also became embarrassed about her behavior during her night terror incidents.
Even if not violent, parasomniac behaviors can disrupt the sleep of parasomniacs and the sleep of their partners, and inadequate sleep can contribute to a host of physical and psychological disorders. This is why properly diagnosing and addressing parasomnias can be helpful.
Can you treat parasomnias?
But diagnosing and addressing parasomnias might be difficult. Like so many matters relating to sleep, parasomnias are complex and not fully understood. But, like other matters, researchers are working to understand parasomnias and develop ways to treat them.
Of course, sometimes people choose not to treat parasomnias at all. Many are not inherently harmful by themselves and disappear as people become older. If parasomnias persist, partners and family members of parasomniacs might choose to create safe environments for their loved ones. For example, talking to sleepwalkers and guiding them gently back to bed could help sleepwalkers deal with the symptoms of their condition.
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People who do decide treat parasomnias have a number of options. The woman in the case study who struggled with night terrors used a number of prescription medications to help her sleep. Medications are common ways to treat parasomnias, but they are not the only options.
Treatments for parasomnia-related bruxism illustrates the range of different approaches used to treat parasomnia. Some people who experience bruxism wear mouthguards to reduce the impact of their teeth grinding.
Others may participate in hypnotherapy that uses visualization techniques, or be encouraged to exercise and participate in activities that release physical and mental tension that can contribute to teeth grinding and jaw clenching. Still others receive Botox injections in their jaws, weakening their jaw muscles and thus releasing tension.
Sometimes, people do not treat parasomnias because the conditions have not been properly diagnosed as parasomnias. Some parasomnias, such as exploding head syndrome, are so rare that some physicians have never seen the condition or have even heard of it in the first place.
Parasomnias demonstrate the complexity of the human brain and body. They illustrate the complicated interaction between the two and what can happen when they slip from alignment.