What is a Parasomnia? 

A parasomnia is a sleep disorder where you experience unusual events or actions while sleeping. These can happen before sleep, during sleep, or when waking up. If you have parasomnia, you might move around, talk, show emotions, or behave strangely. You are asleep, even if someone else thinks you are awake. 

Are there different types of parasomnia? 

Yes. Parasomnias are classified based on the stage of sleep they occur in. There are two main stages of sleep: rapid eye movement (REM) sleep & non-rapid eye movement (non-REM) sleep. Some parasomnias fit into an "other" category. 

What is non-rapid eye movement (Non-REM) sleep? Which parasomnias happen during this stage? 

Non-rapid eye movement (Non-REM) sleep includes the first three stages of sleep, starting when you first fall asleep and lasting until about the middle of the night. Non-REM sleep disorders are also referred to as arousal disorders.

Non-REM parasomnias involve physical and verbal activity. You are not fully awake or alert during these events, do not respond to others who try to engage you, and typically do not recall or can only partially recall the event the following day. Non-REM parasomnias normally begin in patients between five and 25 years of age. Non-REM parasomnias frequently occur in individuals with a history of such parasomnias within their family.

Sleep parasomnias that are observed during non-REM sleep:

Dangers include:

• Eating inedible or poisonous foods.
• Consuming unhealthy or too much food.
• Injuries from handling or cooking foods.

What is rapid eye movement (REM) sleep? What parasomnias happen during this sleep stage?

Rapid eye movement sleep occurs after the sleep cycle's three stages of non-REM sleep. During REM sleep, your eyes dart quickly under your eyelids and your heart rate, breathing and blood pressure all increase. This stage is associated with intense dreaming. Your body goes through cycles of non-REM and REM sleep every 90 to 110 minutes. Parasomnias occur in the later part of the night. If you wake up during one of these events, you will likely remember part or the entire dream. Parasomnias that occur during REM sleep include:

• Nightmare disorder: These are intense dreams that induce fear, terror, and anxiety. You feel that your survival or security is being threatened. If you wake up during your nightmare, you could describe your dream in vivid detail. You often have trouble returning to sleep. You are more likely to experience this if you are stressed, have a traumatic event, are ill or have a fever, feel extremely tired, or drink alcohol.
• Recurrent isolated sleep paralysis: Individuals afflicted by this sleep disorder cannot move anybody or limb during sleep. Scientists surmise that REM sleep, a stage at which muscles are already in a relaxed state, is extended to cause paralysis either before falling asleep or while waking up. Episodes take up seconds to a few minutes and are terrifying, normally accompanied by anxiety or fear. Sleep paralysis can be halted if your bed partner speaks to or touches you.
• REM sleep behavior disorder (RSBD): You act out, make loud vocalizations such as talking, cursing, laughing or shouting; also aggressive movements toward a victim and make punching or kicking. REM sleep behavior disorder is associated mostly with older people. However, many sufferers of this sleep disorder already have neurodegenerative diseases or stroke, multiple system atrophy, or Lewy body dementia.

Other parasomnias include:

• Exploding head syndrome: If you experience this sleep disorder, you may hear a loud or crashing sound while falling asleep or waking up. You might also see a flash of light or feel a sudden muscle jerk.
• Sleep enuresis (bedwetting) is different from what young children experience. For it to be classified as a parasomnia, it must happen in children aged five years and older, occurring at least twice a week for three months or more.
• Sleep-related hallucinations involve seeing, hearing, feeling, or sensing things that are not real as you fall asleep or wake up. You might get out of bed to escape what you are experiencing.
• Sleep-related groaning (catathrenia) is when you make groaning noises during sleep, often involving long groans followed by sighs or grunts.
• Sexsomnia is when people engage in sexual behaviors while asleep. This can include intercourse, masturbation, rubbing a partner, or making sexual noises.

Are certain parasomnias more common in specific genders?

Nightmares occur more frequently in women. Sexsomnia is more common in men. REM sleep behavior disorder is usually diagnosed in men over 50. Sleep terrors, confusional arousals, and sleepwalking happen equally in men and women.

What are the symptoms of parasomnias?

Each of the parasomnias has many distinguishing characteristics and precipitating factors. Some of the more frequent symptoms include:

• Inability to sleep all night through.
• Waking up confused or disoriented.
• Being sleepy during the day.
• Finding lacerations and contusions on your body for which you do not know the origin.
• Having movements, facial expressions, vocalizations, or actions – according to your sleeping partner – for which you cannot remember.

What are the causes of parasomnias?

Parasomnias causes are classified into disturbances of sleep and other broad health-related disorders.

Disabilities of sleep:

• Incomplete transition from being awake to sleep.
• Abnormal sleep patterns and insufficient sleep, such as due to shift work or jet lag.
• Certain medications can affect sleep, including:
• Sleep aids (like zolpidem).
• Antidepressants (like amitriptyline, bupropion, paroxetine, mirtazapine).
• Medications for psychotic disorders (like quetiapine, olanzapine).
• High blood pressure treatments (like propranolol, metoprolol).
• Seizure medications (like topiramate).
• Asthma/allergy medications (like montelukast).
• Antibiotics (like fluoroquinolones).

Medical conditions that disrupt sleep, such as:

• Restless leg syndrome.
• Obstructive sleep apnea.
• Pain issues.
• Narcolepsy.
• Sleep deprivation.
• Circadian rhythm disorders.
• Disorder of periodic limb movement.

 A child's immature sleep-wake cycle may contribute to sleepwalking or other sleep problems. Other medical conditions can also impact sleep:

• A fever.
• Stress.
• Abuse of drugs or alcohol.
• A head injury.
• Menstruation or pregnancy.
• A hereditary history of sleep issues in the family.
• Inflammatory conditions (such as encephalitis).
• Mental health conditions (such as PTSD, anxiety, and depression).

Some neurological diseases that can affect sleep include:

• Parkinson's disease.
• Lewy body dementia.
• Stroke
• Multiple system atrophy.
• Multiple sclerosis.
• Brain tumors.
• Migraines.
• Spinocerebellar ataxia types three.

What is the diagnosis for parasomnias?

The sleep medicine specialist will interview you and your bed partner about your symptoms of sleep. You will also be asked about your medical history, family history, alcohol use and other substance abuse. You will be asked about your current medications. You could be asked to keep a diary of your sleep, and your bed partner could be asked to follow your sleep events.

Other tests for sleep disorders include:

Sleep Study: Polysomnogram

This is a sleep lab where your sleep will be monitored. While you sleep, we will record your brain waves, heart rate, eye movements, and breathing. We will also capture video of your movements and behavior. Some sleep studies can be done at home, but we recommend in-lab studies if we suspect parasomnia.

Video EEG or Sleep EEG

These tests help your doctor see and record your brain activity during a brain event.

Neurologic Exam, CT, or MRI Scan 

These tests check for brain degeneration or other possible causes of your symptoms.

How is Parasomnias Treated?

Treatment starts by identifying and managing other sleep problems and health issues. We will also review any medications that might trigger the parasomnia.

General Management Strategies

For both Non-REM and REM sleep disorders, follow these guidelines:

Practice Good Sleep Hygiene:

• Aim for 7-9 hours of sleep each night.
• Turn off lights, the TV, and electronic devices.
• Keep your room cool and avoid caffeine and strenuous exercise before bedtime.
• Maintain a regular sleep-wake schedule. Go to bed and wake up at the same time each day.
• Limit or not use alcohol or recreational drugs.
• Take all prescribed medications as recommended by your healthcare provider.

Other treatments for non-REM sleep disorders:

Medications are not typically employed for non-REM parasomnias. When they are used, though, benzodiazepines are the drugs of choice for parasomnias that are prolonged and potentially dangerous. Tricyclic antidepressants are also sometimes attempted. Psychological approaches like hypnosis, relaxation therapy or cognitive behavioral therapy, psychotherapy are also taken.

Other treatments for REM sleep disorders:

The commonly prescribed medications to control REM sleep disorders are clonazepam and melatonin.

Your doctor will also advise on the most suitable treatments – medications and/or psychological treatments – for your particular parasomnia based on your medical background and medical conditions.

Safety Precautions

Other advice you will get from your doctor, alongside yours, is safety precautions while sleeping. Tips are:

• Lock or take away any hazardous or sharp objects from the bedroom.
• Install table side lamps.
• Use floor pads to prevent and cushion falls
• Put cushions on the edges of bedside furniture.
• If you plan to drink water near your bed, use plastic cups and bottles.
• Install door and window alarms for sleepwalkers.
• Sleep in separate beds in case the afflicted child with parasomnia displays aggressive activities such as punching or kicking.

How are parasomnias among children treated?

Non-REM parasomnias are most common in childhood and end in adolescence. Usually, all that's required is some calming reassurance by the parents that everything will be okay. Medication is rarely required, but when it is, it's for only three to six weeks. Some of the medications that are typically considered include benzodiazepines or anti-anxiety medication.

Can you prevent parasomnias?

Some types of parasomnias, like those caused by neurological diseases, mental health problems, or genetics, are harder to prevent. However, you can take steps to avoid others. To avoid parasomnias, get seven to nine hours of sleep each night. To maintain a regular sleep routine, sleep and wake up simultaneously every day. Also, try to limit alcohol and recreational drug use.

Since some medications can interfere with sleep, discuss your existing medications with your doctor. If needed, they might suggest different options.

Do children experience parasomnias?

Children are more likely to have parasomnias than adults. Compared to REM sleep disorders, non-REM sleep disorders are more common in children. The following are the most prevalent parasomnias in children under the age of 15:

• Confusional arousal
• Sleepwalking
• Sleep terror
• Nightmares

Parasomnias occur more frequently in children with neurologic or psychiatric comorbidity including epilepsy, ADHD or developmental problems.

When should I contact my physician about sleep disorders?

Discuss the situation with your doctor when you or your family member undergoes any abnormal sleep behaviors associated with trauma or sleep interference.

Why choose Tender Palm Super-Speciality Hospital for Parasomnia treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital offers advanced Parasomnia treatment in Lucknow, India, at an affordable cost. We have a team of experienced neurologists and sleep disorder specialists. Our experts provide accurate diagnoses and personalized medical care, including advanced treatment plans such as polysomnography, sleep behavior evaluations, medication management, and long-term sleep monitoring and support. Our Neurology and Sleep Medicine team has decades of experience in successfully treating Parasomnia in Lucknow, India.

To seek an Expert Consultation for Parasomnia Treatment in Lucknow, India:

Call us at +91-9076972161
Email at care@tenderpalm.com

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