Unusual Sleep Behaviors / Parasomnias

Parasomnias Sleep Disorder Specialist in Colorado

What are parasomnias?

Parasomnias are a group of sleep disorders that involve unwanted physical, verbal or emotional behaviors during sleep. These can occur when going to sleep, during sleep or while waking up. They often disrupt sleep quality and may cause distress or even harm to the affected person or bed partners.

Types of Parasomnias:

Sleepwalking (Sonambulism)

Walking or performing complex actions while asleep, often with no memory of the event. The patient appears to be awake but is still sleeping. Can occur at any age but is most common in children and tends to run in families. Sleepwalking often disappears when children grow older.

Sleep Talking

When an individual talks during sleep, anything from a few words to entire conversations. The sleeper typically does not recall the event.

Sleep Terrors (Night terrors)

Episodes characterized by intense fear, screaming, sweating and confusion. There is no response to soothing from others. The person is often difficult to wake and may not recall the episode. The patient is not fully awake, and once the episode passes, often returns to normal sleep without ever fully waking up. More common in children, but can occur at any age.

Confusional arousals

Episodes of disoriented behavior upon waking, often occurring in children. These typically occur in the first two hours of sleep when transitioning from a deep stage of sleep to a lighter stage of sleep. There is usually little to no recall of the event the following morning. More common in children although it can occur at any age.

Sleep-Related Eating Disorder

Eating food unconsciously while asleep, sometimes consuming unusual or harmful substances.

REM-Related Parasomnias

(Occur in Dream Sleep, more frequently in the last third of sleep):

REM Sleep Behavior Disorder (RBD)

Acting out vivid dreams, which may involve talking, shouting, punching or kicking. This can lead to injury to oneself or a partner. At the end of an episode, an individual may awaken and become quickly alert; they may even be able to recall a dream story. This disorder increases with age.

Nightmares

Intense, frightening dreams that cause awakenings and distress. If awakened during a nightmare, the sleeper can usually recount a detailed story of the dream. It often takes time to recover from the distress of nightmares and the person may have difficulty falling back to sleep. Nightmares are distinguished from sleep terrors based upon timing during the night and whether dream content can be recalled. PTSD can trigger frequent nightmares.

Sleep Paralysis

Temporary inability to move or speak upon waking up or falling asleep, often associated with hallucinations. Sleep paralysis is normal during REM sleep however is considered to be a disorder when it occurs outside of REM sleep. Sleep paralysis can last for several seconds to minutes. Episodes that last longer tend to cause a panic response. Sleep paralysis can occur in normal sleepers and is a surprisingly common occurrence.

Causes and Risk Factors

  • Stress, anxiety or sleep deprivation
  • Sleep disorders like sleep apnea
  • Medications or substance abuse
  • Genetic predisposition (family history)
  • Neurological conditions (Parkinson’s disease, Lewy Body Dementia, or Multiple System Atrophy for REM Sleep Behavior Disorder)

Diagnosis

  • Medical history and sleep diary to track symptoms.
  • Sleep Study to monitor brain and body activity during sleep.
  • Video recording to observe unusual movements or behaviors

Treatments Offered:

Many parasomnias are unable to be fully treated but can improve with the below recommendations.

Improve Sleep Hygiene:

Maintain a regular sleep schedule, avoid caffeine/alcohol before bed, and create a relaxing bedtime routine.

Safety Measures:

Remove dangerous objects, use bed barriers and secure doors/windows.

Cognitive Behavioral Therapy:

Can help with stress-related parasomnias.

Medications:

May occasionally use medication including melatonin, clonazepam, or antidepressants for specific cases.

Treat Underlying Conditions:

Managing sleep apnea, stress, or neurological disorders may reduce symptoms.

Frequently Asked Questions

When should I seek medical care for parasomnias?

  • If parasomnias cause injury or significant sleep disruption.
  • If episodes are frequent, severe, or progressively worsening.
  • If they start suddenly in adulthood without a prior history.
  • If you wake up confused.
  • If you are toilet trained but started to wet the bed often.