Managing Parasomnias: Unusual Behaviors During Sleep

Parasomnias Overview

Most people have experienced some type of Parasomnia in their lifetime, whether it be talking in their sleep, nightmares, sleepwalking, or sleep apnea. Parasomnias are classified as unusual behaviors during sleep, which can cause distress or disruption to both the patient and those around them. In fact, 10 to 15 percent of adults experience Parasomnias at least the odd time. Prevalence of Parasomnias increases with age and primary care physicians often need to be aware of how to recognize and manage cases in their practice.

Parasomnias are disorders of arousal from either NREM or REM sleep, which can cause different physical movements, emotions, or sensations, and can have variable presentation, including fright, confusion and aggression. It is also important to note that the severity of the event can range from mild to severe. It is also possible for daytime problems, such as fatigue, poor attention, and memory difficulties, may also accompany Parasomnia.

Parasomnia Categories

The International Classification of Sleep Disorders classifies Parasomnias into four different categories. These categories include: Confusional Arousals, Sleep Talking (Somniloquy), Sleepwalking (Somnambulism), and Nightmare Disorder.

Confusional Arousals involve the patient experiencing feelings of confusion and a sense of disorientation after they wake up. This behavior usually occurs in the middle of the night and the person may act out by thrashing around their bed, shouting, and speaking incoherently.

Sleep Talking

Sleep Talking (Somniloquy) involves talking during sleep, sometimes accompanied by speaking in a foreign language or making strange noises. It can consist of mumbling or shouting words and is often quite difficult to understand. Sleep Talking can occur in any stage of sleep, is usually brief, and is considered to be generally harmless.

It is often caused by stress, psychological illness or physical illness and can also be triggered through a stressful event. People may experience sleep talking due to REM Sleep Behavior Disorder, a condition where people act out their dreams.

Sleep Talking generally does not need to be treated unless it becomes frequent and disruptive. In any case, if you or someone you know experiences it, it can be helpful to speak franky about your concerns to a qualified physician.

Sleepwalking

Sleepwalking (Somnambulism) is another Parasomnia where individuals perform activities while in a state of sleep. It typically occurs during a deep sleep stage and activities can range from getting out of bed and walking around to more complex activities, such as cooking or may become destructive, such as violence towards objects or other people.

Sleepwalking is most common in children, but can also occur in adults. It requires treatment if it is frequent, prolonged and disturbing. If it becomes persistent,patients should consult with a physician who can assess the underlying cause and provide appropriate treatment.

Nightmare Disorder

Nightmare Disorder is characterized by vivid, frightening dreams, which cause intense emotional reactions in the dreamer upon awakening. It is typically experienced in the rapid eye movement (REM) stage of sleep and can cause physical reactions, such as sweating and increased heart rate.

Nightmares can be caused by a number of factors, including anxiety, stress, depression or illness. It also can stem from trauma or life changes, such as job loss, divorce, death of a loved one or other major losses. Treatment may include talking therapy, medications or both.