Sleep Disorders : Parasomnias

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Q:	What are parasomnias?
A:	Parasomnias are disorders resulting in abnormal events during the night, such as sleep-walking, night terrors, bruxism (tooth-grinding), nocturnal groaning, enuresis (bedwetting), rhythmic rocking movement disorder, and sleep-talking. Most can be divided into disorders that affect either REM or NREM sleep. Some parasomnias are not confined to any particular sleep stage.

Q:	What can trigger an abnormal event during sleep?
A:	A number of factors can trigger a parasomnia or make it occur more frequently. These factors include fever, alcohol, prior sleep deprivation, strenuous physical activity, emotional stress, and various medications. Parasomnias can also be made worse by pregnancy or menstruation, and sleep-disordered breathing. Genetic and environmental factors often interact to cause parasomnias.

Q:	When should medical help be sought with a parasomnia?
A:	Bizarre, sleep-related activities may occasionally be experienced by normal people and usually do not warrant further investigation or treatment. However, you may need to seek medical advice if the affected person’s behavior is violent/injurious, disruptive, results in excessive daytime sleepiness, or is associated with medical, psychiatric, or neurological symptoms and findings.

Q:	How is a parasomnia diagnosed?
A:	A history of the person’s unusual behavior is noted. It is helpful if family members can recount behavior they’ve witnessed. The disorder may be investigated further with the person spending a night in a sleep center and undergoing PSG with video recording.

What is sleep-walking?

Sleep-walking consists of a series of complex behaviors that are initiated in NREM slow wave sleep and result in walking during sleep. It is also called somnambulism or noctambulism. Sleep-walking may terminate spontaneously or the sleep-walker may return to bed, oblivious to the fact that they left it in the first place. Occasionally, there is also inappropriate behavior. Falls and injuries may occur if the person walks into dangerous situations, like out of a door and into the street or through a window. Rarely, aggressive behavior occurs, especially as a response to attempts to restrict the sleep-walker’s mobility; homicide or suicide have also been reported. Contrary to popular belief, it is not dangerous to wake a sleep-walker.

Q:	How common is sleep-walking?
A:	Sleep-walking occurs regularly in 1–3 in 100 children, and occurs occasionally in about 1 in 4. It usually disappears after adolescence. Sleep-walking occurs regularly in 1–6 in 1,000 adults and occasionally in 1–3 in 100. Sleep-walking is hereditary and about 85 in 100 adults who do sleep-walk have had the condition since childhood.

What are night terrors?

Also known as pavor nocturnus (in children) or incubus (in adults), night terrors are characterized by a sudden arousal from NREM slow wave sleep with a piercing scream or cry, accompanied by manifestations of intense fear. The attacks usually end spontaneously. Night terrors occur regularly in 3 in 100 children and occasionally in about 10 in 100 children. They usually end during adolescence and less than 1 in 100 adults experience them.

What is sleep-talking?

Sleep-talking is the utterance of speech or sounds during sleep without the person being aware of the event. No one knows why people talk in their sleep, although there may be a link with an anxiety disorder or a fever. Sleep-talking is usually brief, infrequent, and devoid of signs of emotional stress. Some sleep-talkers seem to be able to hold conversations, while most just moan, say the odd word, or make unintelligible sounds. Sleep-talking occurs regularly in 4–14 in 100 children, and occasionally in more than 1 in 4. Sleep-talking occurs regularly in 1 in 20 adults, and occasionally in about 1 in 3.

Q:	Is there any treatment for sleep-talking, sleep-walking, and night terrors?
A:	Treatment should be discussed with a medical expert. If the behaviors occur infrequently, then no specific treatment is usually necessary. If the behaviors are causing problems, then several medications can be used to treat them. Occasionally, psychotherapy, progressive relaxation, and hypnosis can be useful.

What is REM-behavior disorder?

This is a disorder that can occur at any age, but is more common in middle-aged to older men. It occurs during REM sleep when a person tries to act out their dreams, usually in a violent or disturbing manner. Instead of the body being paralyzed, as is normal in REM sleep, it is able to act out the dream. People with REM-behavior disorder can often injure themselves and their partners, sometimes seriously. REM-behavior disorder can occur spontaneously, as part of another sleep disorder, such as narcolepsy, or as the first sign of other neurological disorders, such as Parkinson’s disease. The disorder can be treated but should always be diagnosed and managed by a sleep specialist.

Normal and Abnormal Events During Sleep

Some events that occur during both NREM and REM sleep are considered normal, while other events are thought to be abnormal (see here ). Medical advice should always be sought if you are unsure about the symptoms you are experiencing. It is helpful if someone in your household can also describe the behavior that you are experiencing. If the behavior is disruptive to you or to others, it should be investigated.