The term “parasomnia” refers to a wide variety of disruptive sleep-related events. These behaviors and experiences occur usually while sleeping, and most are often infrequent and mild. They may, however, happen often enough to become so bothersome that medical attention is required.
The most common type of parasomnias are “disorders of arousal,” which include confusional arousals, sleepwalking (somnambulism), and sleep terrors. Experts believe the various types of arousal disorders are related and share some characteristics. These arousals occur when a person is in a mixed state of being both asleep and awake, and usually coming from the deepest stage of nondreaming sleep.This means the person is awake enough to act out complex behaviors but still asleep and not aware or able to remember these actions.
Parasomnias are very common in young children and do not usually indicate significant psychiatric or psychological problems. Such disorders tend to run in families and might be made worse when a child is overly tired, has a fever, or is taking certain medications. They may occur during periods of stress and may increase and decrease with “good” and “bad” weeks.
CONFUSIONAL AROUSALS
Confusional arousals often occur in infants and toddlers, but may also be seen in adults.These episodes may begin with a person crying and thrashing around in bed. The individual may appear awake, confused and upset, yet resists attempts by others to comfort or console. It is also difficult to awaken a person having a parasomnia. The episodes may last up to half an hour and usually end with the person calming, waking briefly, and then only wanting to return to sleep.
SLEEPWALKING
Sleepwalking is commonly seen in older children. It ranges from simply getting up out of bed and walking around the room, to prolonged and complex actions, including going to another part of the house or yard. The sleepwalker may return to bed or awaken in the morning in a different part of the house. Sleepwalker might carry on conversations that are difficult to understand or make no sense at all. They are capable of carrying out complex behaviors such as rearranging the furniture (for no expainable purpose) and injuries during sleepwalking are uncommon. In most cases , no treatment is necessary. In children, the number of events tends to decrease with age.These events, however, can occasionally persist into adulthood or may even begin in adulthood.
SLEEP-RELATED EATING
A rare type of sleepwalking is “sleep-related eating.” People with this disorder experience episodes of eating during sleep, without being aware of what they are doing. Sleep-related eating may occur often enough to result in a sinificant weight gain. Although it can affect all ages and both sexes, it is more common in young females.
SLEEP TERRORS
Sleep terrors are the most extreme and dramatic form of arousal disorders and are the most distressing to witness. A sleep terror episode usually begins with a bloodcurdling scream or shout, and may produce signs that suggest extreme terror, such as dilated pupils, rapid breathing, racing heart, sweating, and extreme agitation. During a sleep terror, the person may bolt out of bed and run around the room or even out of the house. During a frenzied event the person can hurt themselves or others. As disturbing and frightening as sleep terrors are to an observer, individuals having them are usually totally unaware of what they are doing and do not remember the incident when they awaken. People who have sleep terrors do not recall vivid dream images, unlike people who have nightmares or bad dreams.
Because disorders of arousal are less common in older people, adults suffering from these disorders should seek evaluation. In some cases these events are triggered by other conditions such as sleep apnea, heartburn, or periodic limb movements during sleep. A sleep specialist should evaluate the person’s behavior and medical history.
In typical childhood occurences of arousal disorders, medical evaluation is rarely needed. However, you should contact your physician if a child experiences disturbed sleep that causes;
1) potentially dangerous behavior that is violent or may result in injury
2) extreme disturbances of other household members
3) excessive sleepiness during the day. In these cases, formal evaluation at a sleep center is warranted.
Using simple safety measures can prevent serious injury to those with arousal disorders. Clearing the bedroom of obstructions, securing the windows, sleeping on the first floor, and installing locks or alarms on windows and doors will add a degree of security for the individual and the family. In severe cases, medical intervention may be needed with prescription drugs, behavior modification through hypnosis or relaxation/mental imagery.
Other Parasomnias
HYOPNOGOGIC HALLUCINATIONS AND SLEEP PARALYSIS
This phenomenon refers to dreaming while awake and usually occurs just before falling asleep. These dreams can be frightening because the setting reflects reality (i.e., occuring in the bedroom) and the content of the dream is often threatening.
Sleep paralysis is the experience of waking up (usually form a dream) and feeling paralyzed, except for being able to breathe and move the eyes.Hypnogogic hallucinations and sleep paralysis may occur together. These conditions are common in people with narcolepsy but can also effect others, particularly people who are sleep-deprived. Although a pretty terrifying event, these events are not physically harmful.
NOCTURNAL SEIZURES
These seizures, which occur only during sleep, can cause the victim to cry, scream,walk, run about, or curse. Like other seizures, these are usually treated with medication.
RAPID EYE MOVEMENT (REM) BEHAVIORAL DISORDER
All body muscles (except those used in breathing) are normally paralyzed during REM sleep. In some people, usually older men, this paralysis is incomplete or absent, allowing the person to act out dreams. Such dream-related behavior may be violent and cause injury to the victim or bedpartner. Unlike those who experience sleep terrors, the victim will recall vivid dreams. REM sleep behavior disorder can be controlled with medication.
SLEEP STARTS
Most people have experience the common “motor” sleep start - a sudden, often violent, jerk of the entire body that occurs upon falling asleep. Other forms of sleep starts also occur just as sleep begins such as;
visual sleep start - usually a sensation of blinding light coming from inside the eyes or head
auditory sleep start - a loud snapping noise that seems to come from inside the head
The different types of sleep starts can be frightening, but these occurences are harmless.
TEETH GRINDING (BRUXISM)
Grinding teeth during sleep is a very common occurrence and little evidence suggests that teeth grinding is associated with any significant medical or psychological problems. However, severe bruxism may be associated with sleep disruption. A sleep study can determine the degree of disruption. In severe cases, mouth devices may help or reduce dental injury.
RHYTHMIC-MOVEMENT DISORDER
This condiion is seen most frequently in young children but may also occur in adults. It takes the form of recurrent headbanging, headrolling, or bodyrocking. The individual also may moan or hum. These activities may occur just before falling asleep or during sleep. Medical or psychological problems are rarely associated with rhythmic-movement disorder. Behavior treatment may be effective in severe cases.
SLEEP TALKING (SOMNILOQUY)
Sleep talking is a normal phenomenon and is of no medical or psychological importance.
*Information taken from ASDA patient info brochure.