PARASOMNIA: (Causes, Symptoms & Treatments)

This article will revolve around a commonly faced disorder, that is, Parasomnia.

Moreover, this guide will reflect upon the psychological effects of Parasomnia, and available medications too. 

Parasomnia is a class of sleep disorder characterized by unwanted events or experiences that occur while falling asleep, during sleep, or while waking up.

It manifests behaviours like sleepwalking, sleep terrors, sleepwalking associated with partial arousal.

A person may experience some abnormal movements, behaviour, perception, and dreams.

Some of the actions may seem intentional or purposeful to others, but actually, those are due to parasomnia.

Parasomnia results in distressful sleep for the patient as well as their bed partners.

The consequences of parasomnia include psychological disorders or poor health conditions.

STAGES OF SLEEP

Sleep has two steps non-rapid eye movement (NREM), which includes levels 1, 2, and 3, followed by the fourth stage known as rapid eye movement (REM).

During Stage one of NREM, a person is in the state of drowsiness and can be woken up quickly and may last for 5 to 10 minutes.

Stage two is the state of light sleep, or it is when the body is getting for deep sleep while in step three, the person goes into a deep sleep stage, and it is difficult to wake them up.

REM is also known to be a dreaming stage.

In this stage, eye movements are rapid, including side to side movements. Awakening is more natural during this stage.

Parasomnia may occur in any of the above stages.

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Types Of NREM Parasomnias

Sleep terrors: 

these are considered to be a type of arousal disorders.

The person wakes up in a terrifying state accompanied by screaming trembling or crying with increased heart rate, breathing, and sweating.

They may be brief but can last up to 30 to 40 minutes.

The person becomes confused, agitated, and may find difficulty in talking and coming out of the state of terror.

Sleep terrors are relatively standard in children from 4 to 12 years of age, but adults might experience them due to specific traumas or stress.

The use of alcohol also contributes to the cause of night terrors in adults.

Sleepwalking: 

it is another type of arousal disorder. The person walks around and appears to be awake, but in actual, he is asleep.

Sleepwalkers may wake up in the middle of the episode and have no clue or memory of their action and head back to bed in a confused state.

However, sleepwalking can occur in young or adults, but most commonly, it is reported in children age 5 to 15 years.

Sleepwalking is dangerous; the person has no idea about his or her surroundings.

Confusional arousals: 

it occurs when the person awakes from a deep sleep in the middle of the night.

He might sit up confused about his surroundings looking here and there with fear and might start crying for no reason. 

This condition is also known as decreased sleep inertia or sleep drunkenness as the person responds slowly to the commands or the questions asked to him.

He might become inconsolable in that condition. Besides, a person with confusional arousal often has a problem of short term memory, which means that he would have no memory of his arousal the following day. 

Rhythmic movement disorder: 

Although rhythmic movement disorders are most common in children, some adults might show persistent or emergent rhythmic movements.

Rhythmic movement disorder is also known to be headbanging or body rocking disorder as the person starts banging his head forcefully on the pillow while lying flat and lifting the upper body along with the movement of hands and knees.

The episode of change lasts a few minutes and might prolong for 30 minutes. 

Types Of REM (Dreaming) Parasomnias

Nightmares 

Nightmares are considered to be bad dreams with explicit and unsettling content that cause fear, terror, or anxiety feelings the person.

The person tends to wake from sleep in a state of terror abruptly and tends to see disturbing themes like images of ghosts, monsters, animals, or wrong people in nightmares. 

Causes of dreams include factors such as past traumas, some alarming events of the day, loss of loved one’s anxiety or illness, etc. frequent nightmares result in disturbed sleep schedules and lead to poor mental health and lethargic conditions.

Sleep Paralysis

In sleep paralysis, the individual becomes unable to move the body parts like limbs. It occurs while falling asleep or waking up.

Normally brain functions to relax the muscle and still the body to fall asleep; this is called atonia.

When atonia occurs when the person is awake, it is sleep paralysis.

During sleep paralysis, eye movement and breathing remain intact; however, movement of the body isn’t possible.

This episode continues for a few seconds or minutes but tends to settle fear in the person. 

REM Sleep Behaviour Disorder (RBD)

In this condition, the individual tends to move limbs and body parts while dreaming in an attempt to act out violent or traumatic dreams.

It might be a side effect of certain medications like antidepressants.

If RBD is not controlled at an early stage, then it can become dangerous and lead to fatal injuries to that individual or their bed partner.

RBD can be confused with sleepwalking or sleep terrors; however, in contrast to them, the RBD person can be woken up quickly during the episode, and they are also able to recall their actions and that vivid dream.

The activities associated with RBD include kicking, jumping, grabbing, shouting, swearing, etc. 

Other Parasomnias

These following do not fall under NERM OR REM-related parasomnia, however, are distinctly reported

Bedwetting or Sleep Enuresis:

Sleep enuresis is a condition in which an individual is unable to control urination while being asleep.

It can be primary or secondary. If the individual is unable to control it from infancy onwards, then it is considered to the primary.

When the relapse occurs after gaining control of the condition, then it is said to secondary bedwetting. Primary bedwetting might be genetical i.e.; it runs in the family.

Overall, enuresis can be a symptom of certain medical conditions like diabetes or urinary tract infections.

Exploding Head Syndrome (EHS):

The exploding head syndrome is hearing sudden loud noise or flash of light in the head just before falling asleep or when one wakes up suddenly in the night.

Experiencing EHS can settle fear or feeling of distress in the individual, or he thinks that he is suffering from a stroke.

The occurrence of EHS episodes varies i.e.; it may rarely attack or many times in one night.

This event usually is harmless, but a muscle twitch or sudden jerk might result in pain.

Sleep Talking:

Sleep talking is the condition in which someone starts talking during sleep.

The listeners might not be able to understand what they say as the words seem to jumble under the influence of this condition. 

The individual might be imitating his dream and can become loud due to violent thoughts.

It is widespread in any stage of age and appears to occur at the same rate among men or women. It is a part of NERM OR REM.

Sleep-Related Eating Disorder (SRED):

It is the type of parasomnia which consists of repeated episodes of compulsive binge eating drinking after awakening from sleep.

The patient can eat uncooked food.

The patient can have no or partial memory of the event, and it is often difficult to wake them during the episode that results in provoking anger or agitation inpatient.

The patient can report unexplained weight gain or morning anorexia. 

Catathrenia (sleep-related groaning): 

Catathrenia is a rare form of parasomnia, which includes prolonging groan, and is accompanied by an oronasal flow.

These episodes predominantly occur during REM but some cases occur in NREM sleep.

Sleep Hallucinations:

These are the parasomnias, which include the undesired experience of imagined events that seem very real.

These involve sensations of sound, touch, taste, smell, or motion but are mainly visual. The person might not be sure if they are awake or asleep.

These occur when someone is about to fall asleep (hypnagogic) or is just waking up (hypnopompic).

The sleep paralysis and hallucinations may occur at the same time but on different nights.

Sleep Bruxism:

Sleep Bruxism is associated with teeth grinding that includes involuntary, excessive, or unconscious grinding and clenching of teeth.

Sleep Bruxism can lead to problems like the discomfort of jaw muscles and abnormal wear of teeth.

A mouthguard can be used in some cases to prevent grinding that can keep from causing severe dental surgery.

Sexomnia:

Unusual sexual behaviour during sleep characterizes sleep disorder.

They occur during stage three of NREM and may range from sexual vocalization, intercourse, assault, masturbation, or fondling with a bed partner.

Medications like SSRI’s might be trigger sexsomnia, or the event can exacerbate with Parkinson’s disorder with impulse control disease

Causes of Parasomnia:

Some of the underlying conditions might be the cause of parasomnia:

  • Using medicines with CNS-related side effects like sedatives, hypnotics, SSRIs, beta-blockers or tricyclic antidepressants,
  • Usage of non-pharmacological products like caffeine, alcohol or nicotine, etc. 
  • Undergoing stress or anxiety
  • Depression or other mental illness
  • Confusion or dementia
  • Other sleep disorders like narcolepsy, restless leg syndrome or sleep apnoea

Diagnostic Aspects of Parasomnia

The beginning of evaluation is a careful interview of the patient along with with with family any family members.

The specialist will recommend completing a sleep diary for two weeks, which will give a clue about the cause of the problem. 

They might ask for any other sleep disorder, medical condition.

Any current medication, and mental stress or disease, etc. the physician can use an in-lab sleep study to examine the sleep known as a polysomnogram, which will help to show if the patient does something unusual during sleep. 

Treatment of NREM Parasomnia

Treatment will be recommended based on the diagnosis of parasomnia. Ways of overcoming parasomnia include lifestyle changes, behavioural therapy, and the use of medication.

Precautions for sleepwalking include adding locks or alarms on windows and doors, sleeping on the ground, clearing out bedroom off things that may cause a person to trip or fall while sleepwalking.

Some of the tips to minimize the symptoms include:

  • Getting full night sleep
  • Schedule the sleep and wake timings 
  • Medications like sleeping pills should be used as directed
  • Making adjustments to everyday working schedules to get proper sleep
  • Alcohol and drug use or abuse must be avoided.

Medicinal Treatments for Parasomnia:

The use of benzodiazepines helps to suppress REM sleep and limit disorder.

Drugs that can be used to treat parasomnia include valium, which is useful in children, especially with night terrors, alprazolam (Xanax), which is the second choice of drug in parasomnias and clonazepam (Klonopin) that can be used as an alternative for diazepam.

Anticonvulsants like carbamazepine, valproate, and gabapentin can be used to inhibit arousal from sleep.

Some Helpful Resources

  1. Hypnosis in the Management of Sleep Disorders
  2. Sleep Disorders For Dummies
  3. Stahl’s Illustrated Sleep and Wake Disorders
  4. The Nocturnal Brain: Nightmares, Neuroscience, and The Secret World of Sleep
  5. The Book of Sleep: 75 Strategies to Relieve Insomnia

Conclusion:

 Parasomnias can be described as disruptive sleep-related disorders characterized by undesirable or unreasonable physical or verbal behaviours and experiences.

These occur during various stages of sleep or are or REM associated disorders like sleepwalking, sleep terrors, nightmares, etc.

The best approach to overcome parasomnias is the lifestyle changes or proper managing of sleep schedule.

Other precautions include safety measures like sleeping on the floor, adding locks to the door.

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Certain medications can also help treat parasomnias. 

Frequently Asked Questions

Q1. Is parasomnia a mental illness?

There is still no evidence available that parasomnia is a mental disorder, but it is closely related to a psychiatric disorder, i.e. depression. 

Q2. How do you know if you have parasomnia?

The most severe symptom of having parasomnia is excessive sleeping, and this indicates that the individual is suffering from parasomnia.

Q3. Can you sleep without knowing it?

The experience of sleeping without knowing it is not uncommon; it is a symptom of parasomnia.

The individuals can sleep anywhere, anytime without warning.

Q4. What does it mean to be under sleep paralysis?

Sleep paralysing refers to the sensation of being in a conscious state of mind but not being able to move.

It happens when an individual goes through the stages of sleep and wakefulness and while transitioning from these stages, they are not able to speak or move about for a couple of seconds or minutes.

Sometimes, people experiencing sleep paralysis report feeling great pressure on their chest or a choking sensation. 

Q5. What are the symptoms of parasomnia?

There are various symptoms of Parasomnia, some of which include sleepwalking, sleep eating disorders, confusional arousals, sleep paralysis or sleep terrors. 

Q6. What is “parasomnia disorder”?

Parasomnia is a class of sleep disorders that are related to undesirable experiences or events that may happen while you are about to fall asleep or about to wake-up (this may also happen while sleeping).

The disorders in this group may include various emotions, behaviours, abnormal movements, disturbing dreams or perceptual disturbances. 

References:

  1. What is parasomnia disorder?
  2. Is parasomnia a mental illness?
  3. What are the symptoms of parasomnia?
  4. What is arousal parasomnia?
  5. What are spontaneous arousals during sleep?
  6. What is a confusional arousal?

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