Parasomnia: Meaning, Types, Symptoms, Causes, Diagnosis & Treatment

Do you often wake up with unexplainable scratches on your body or experience gut-wrenching hallucinations during your sleep?

This symptoms indicate toward one of the several sleep disorders called parasomnia. Like any other sleep-related condition, parasomnias are treatable as well as preventable.

Wondering how?

You first need to understand the meaning of parasomnia for that.

Parasomnia is an umbrella term that denotes all sorts of unusual activities that individuals engage in while sleeping, just before falling asleep, or in the period between sleep and wakefulness. Such activities or behaviours may include talking, eating, walking, etc.

Generally, parasomnias occur during the period in which a brain transitions in and out of sleep. These can also occur between sleep cycles of non-rapid eye movement (NREM) and rapid eye movement (REM).

Exhibiting such unusual behaviours during one’s sleep can often disrupt your sleep and can even prove to be dangerous since you are unaware of your surroundings. The worst part is that you appear to be awake to your bed partner or people near you while displaying such behaviours when you are actually asleep.

Now that you are acquainted with the definition of parasomnia, it is important to know about the types of this sleep disorder.

Parasomnias fall under 2 broad types.

Wondering what they are?

Here is a brief overview of these types of parasomnia, along with their subtypes

1. NREM-related Parasomnias

NREM or non-rapid eye movement sleep stages comprise the first 90 minutes of a sleep cycle. These constitute the first stage of a sleep cycle, when one’s sleep is shallow, and the following 3 stages when the sleep becomes deeper. The most common NREM-related parasomnias include disorders of arousal, of which the patients have little to no memory. 

Here is a list of some of them.

• Sleepwalking: Sleepwalking or somnambulism refers to the behaviours that an individual exhibits after getting out of bed during their sleep. These include episodes of walking and other complex actions, such as sorting clothes. In case you have experienced such incidents, you are most likely to not recall it after waking up.

This is because individuals are mostly unaware or unresponsive to their surroundings during sleepwalking, meaning these episodes can lead to injuries if a sufferer bumps into an object or loses balance.

• Confusional Arousal: Also called Elpenor syndrome, confusional arousals involve exhibitions of confusing behaviour or mental confusion while sleeping. 

Patients may display signs of autonomic arousals, such as sped-up heartbeat or tachycardia, excessive perspiration, crying, faster breathing (tachypnea), and dilated pupils or mydriasis.

• Sexsomnia: The meaning of parasomnia of this type can be understood from its colloquial terminology itself. Individuals experiencing this type of parasomnia generally exhibit unusual sexual behaviours during their sleep. 

These include engaging in masturbation, pelvic thrusting, initiating intercourse, fondling one’s bed partner, making carnal noises, and other behaviours mimicking intercourse, all the while displaying an empty and expressionless look in one’s eyes.

• Night Terrors: Night terrors or sleep terrors depict the episodes where a patient experiences extreme fear or panic, forcing them to wake up in a frightened or confused state.

Such episodes can last 30 seconds to 3 minutes, and individuals experiencing such parasomnias mostly do not remember the cause of such behaviours upon waking up.

• Sleep-related Eating Disorder (SRED): Individuals experiencing this type of parasomnia experience dysfunctional eating episodes during their sleep. There is little to no responsiveness on a patient’s part.

2. REM-related Parasomnias

The stages following the NREM stages in one’s sleep cycle constitute the REM or rapid eye movement sleep stages. As one can understand from its name, an individual’s eyes exhibit rapid movement beneath the eyelids during the REM stage while experiencing a rise in blood pressure, heart rate, and faster breathing.

Some parasomnias occurring during this phase are as follows.

• Nightmare Disorder: If your unpleasant dreams are no more limited to a few instances and have turned into a regular phenomenon, you may be suffering from a nightmare disorder. 

Such recurrent episodes constitute vivid dreams depicting threats to security and survival. Unlike night terrors, nightmares are remembered by an individual and are often a result of post-traumatic stress disorder (PTSD).

• Recurrent Isolated Sleep Paralysis: A fairly common occurrence, sleep paralysis depicts the episodes during which individuals experience complete bodily atrophy, i.e., being unable to make any sort of bodily movements.

Although such episodes only last for a few minutes, experiencing them can result in anxiety about falling asleep.

• REM Sleep Behaviour Disorder (RSBD): A common phenomenon among individuals aged 50 years and above, RSBD comprises unusual movements or vocalisations, primarily responses to dreams.

This type of parasomnia is more common among individuals on specific anti-depressants and anti-anxiety medications.

Besides the above primary categorisations, some other examples of parasomnia include bedwetting or Sleep Enuresis, Nocturnal Paroxysmal Dystonia or NPD, teeth grinding or Sleep Bruxism, sleep talking, and nocturnal leg cramps.

Now that you are aware of the meaning of parasomnia and its various stages and types, it is important to understand the various symptoms associated with such sleep disorders to identify its onset early on.

Individuals experiencing parasomnias may exhibit one or more f the following symptoms.

• Unexplainable and unusual behaviours during sleep
• Difficulty speaking or moving when falling asleep or immediately after waking up
• Inability to stay asleep
• Waking up in a disoriented state
• Experiencing nightmares frequently
• Feeling excessively tired during the day
• Having unexplainable cuts, bruises, and other injuries
• Experiencing hallucinations during transitions between sleep and wakefulness

If you or a loved one is acquainted with the above symptoms, it is important to under the underlying causes to get comprehensive treatment.

Some of the common reasons why individuals may be experiencing parasomnias are as follows.

• Excessive stress
• Sleep deprivation and non-uniform sleep schedules, for instance, due to changes in work shift
• Specific medications, including antipsychotic drugs and anti-depressants
• Substance or alcohol abuse

Besides the above causes, individuals who are victims of specific pre-existing conditions are at an increased risk of developing this sleep disorder.

If you find yourself acquainted with any of the following conditions, you may be more likely to develop and suffer from parasomnias.

• Pre-existing medical conditions, such as Parkinson’s disease
• Mental health disorders, such as anxiety, depression, and PTSD
• Other sleep-related disorders, such as sleep apnoea, insomnia, and restless leg syndrome
• Genetic history of parasomnia among other family members

Now that you have detailed knowledge about parasomnia, it is essential that you get a professional diagnosis in case you have observed any of the discussed symptoms.

Healthcare professionals generally use the following methods to provide a proper diagnosis of parasomnia.

• Examination of pre-existing health conditions: The foremost thing a healthcare professional will do is perform a basic check of your vital signs and ask you about your medical history, lifestyle habits, and genetic history. This may include a history of substance abuse, and medications, among others.
• Recording sleep pattern: Your doctor may also ask you to maintain a sleep diary to help monitor your behavioural pattern during sleep. In case you reside with a partner, he/she can also enter inputs about the behaviours you exhibit during sleep in this sleep diary.
• CT or MRI scan: Healthcare professionals may ask you to undergo tests, such as an MRI or CT scan, in order to point out any neurodegenerative condition or any other sort of brain damage that may be a contributing cause of parasomnias.
• Polysomnogram: This is a test specifically conducted to diagnose parasomnias. In this test, patients need to sleep overnight in a laboratory, where specialists will observe and note their heart rate, brain waves, and respiratory pattern to arrive at a conclusion.

Once you get a proper diagnosis of parasomnia, healthcare professionals may ask you to adopt any of the following modes of treatment to help allay the discomfort associated with this sleep disorder.

• Lifestyle changes: Doctors may ask you to follow a specific wake time by scheduling an alarm or asking your partner to wake you up 15-30 minutes prior to the usual time you wake up.

Additionally, you made need to remove specific items from your bedroom and make it a safer place in case you experience the trouble of sleepwalking.

• Medications: In case you are suffering from recurrent episodes of parasomnia, your physician may prescribe you specific medications to help relieve your symptoms. These include antidepressants, dopamine agonists, topiramate, benzodiazepines, melatonin, and levodopa.

In case your sleep disorders are a result of any specific medication, doctors will prescribe you effective copulations to combat the same, without you needing to stop consuming the former.

• Cognitive Behavioural Therapy or CBT: In case an individual is suffering from mental health conditions, such as anxiety and stress, resulting in parasomnia, healthcare professionals may prescribe cognitive behavioural therapy or CBT.

This form of treatment includes hypnosis, psychotherapy, and relaxation therapy.

Besides getting the applicable treatment, you must also note the ways in which you can prevent this sleep disorder from setting in, in the first place.

Here are some tips which can help you minimise the chances of developing parasomnias.

• Abide by a fixed sleep schedule.
• Make sure you are getting at least 7-8 hours of sleep every night.
• Avoid smoking and consumption of alcohol and drugs.
• Use sleeping pills strictly adhering to your doctor’s prescription and directions of use.
• In case you work in rotational shifts, make necessary adjustments to reduce the chances of sleep disruption.

Hopefully, the above discussion on the meaning of parasomnia, its types, symptoms, causes, and treatments will help you identify this sleep disorder, if prevalent, and get the necessary help to overcome the same. However, when seeking treatment, make sure to strictly abide by your physician’s advice and prescriptions to avoid unnecessarily aggravating the situation.