Parasomnias – Symptoms
Many parasomnias have relatively mild or harmless symptoms. In some cases a parasomnia can be bothersome enough to require medical attention. A few parasomnias, most notably REM sleep behavior disorder, often require medical attention.
Non-REM (NREM) Sleep Parasomnias
Sleepwalking involves getting up from bed and walking around when you are still asleep. You may wake up in another room or outside your home and not remember how you got there. Sleepwalking sometimes involves a series of other complex actions that are often crude, strange or in the wrong place. This can include things like moving furniture around, urinating or even running. Your eyes are usually open and have a confused glassy look to them during a sleepwalking episode. Being woken up will not harm a sleepwalker, though they may be confused or angry. Trying to restrain a sleepwalker may result in aggressive behavior such as kicking or biting.
A confusional arousal is when you act in a way that is strange and confused as you wake up or just after waking. You may seem to be awake even though your state of mind is still foggy. You may speak slowly, have confused thinking, poor memory or respond to questions and requests bluntly and nonsensically. Confusional arousals often begin when a noise or someone else wakes you up and can last from a few minutes to a few hours. You tend to have no memory of these episodes.
You sit up in your bed and pierce the night with a blood-curling scream. With the look of intense fear with year eyes wide open and heart racing, you may even kick, thrash and shout things that other people cannot understand. This is a typical night terror (or sleep terror) episode. Most often, you will not have any memory of what happened. At times, you may recall brief segments of a terrifying dream. Night terrors usually happen in the first half of the night. Night terrors are often alarming to bed partners or parents.
REM Sleep Parasomnias
REM Sleep Behavior Disorder
This potentially dangerous sleep disorder causes you to act out vivid dreams as you sleep. The dreams are filled with action and may even be violent. REM sleep behavior disorder differs from sleepwalking in that you rarely walk, open your eyes or leave the room. Instead you may kick, punch or flail in response to your dream. Episodes get worse over time and may result in an injury to yourself or to your partner. If you think you might have REM sleep behavior disorder, you will need to see a sleep medicine physician.
Nightmares are disturbing dreams that occur in your sleep and wake you up. Everyone has these now and then. Nightmare disorder is when you have frequent nightmares that disturb your sleep. You may wake frequently from nightmares or have anxiety that makes it difficult to fall asleep or get back to sleep.
Sleep paralysis causes you to be unable to move your body when you are falling asleep or when you are waking up. You are fully aware and unable to speak or move your arms, legs or head. These episodes typically last for seconds or minutes. Sleep paralysis typically ends on its own, but may also stop when someone touches you or speaks to you. Sometimes you may hallucinate during these episodes.
You may talk out loud during sleep. The subject matter is often loud and fairly nonsensical. By itself, sleep talking is very common and tends to be harmless. It may also be a feature of another sleep disorder such as REM sleep behavior disorder, sleepwalking, night terrors or sleep related eating disorder.
Adults or children may accidentally urinate during sleep. Primary bedwetting results from a failure to wake up when the bladder is full, or a failure to prevent a bladder contraction. This is common in children, as bladder control and waking before wetting the bed are skills that you acquire as you grow and develop. Secondary bedwetting occurs often in children who have recently faced strong social or mental stress. In adults, secondary bedwetting may be a sign of another medical problem such as diabetes or a urinary tract infection.
Sleep Related Groaning
Also called catathrenia, sleep related groaning causes you to make loud, vocal groaning noises as you sleep. Your breathing may become unusually slow while you groan. You may take a slow deep breath in, followed by a long moaning exhale, ending with a sigh or a grunt. The sound can last up to 40 seconds and often repeats in clusters for two minutes to one hour.
Exploding Head Syndrome
This parasomnia causes you to hear a loud imaginary noise just before you fall asleep or awaken. It can sound like a bomb exploding, cymbals crashing or a painless loud bang. Episodes can be distressing and people often mistakenly think they are having a stroke or brain problem. Try to get more sleep each night to alleviate the symptoms.
Sleep Related Eating Disorder
This parasomnia is defined by repeated episodes where you rapidly binge eat and drink after you wake up in the night. These episodes are out of control and tend to occur when you are only partially awake. You may only have a slight memory or no memory of the binge. This may occur nightly. The food is often highly caloric and consumed in strange combinations. People with sleep related eating disorder might accidentally injure themselves by eating toxic substances, burning themselves or causing fires.It is important to seek medical treatment if your behaviors are dangerous to yourself or others.
REM sleep behavior disorder and sleep related eating disorder may require immediate medical attention due to risk of injury. See a board certified sleep medicine physician as soon as possible if you think you have either of these disorders.
A sleep specialist will often ask you to complete a sleep diary for two weeks. This will give the doctor clues as to what might be causing your problems. You can also rate your sleep with the Epworth Sleepiness Scale. This will help show how your sleep is affecting your daily life. The doctor will need to know your complete medical history. Make sure to tell the doctor of any past or present medications and if you have ever had any other sleep disorder.
A sleep medicine physician will try to determine if there is something else that is causing your parasomnia or making the symptoms worse, such as:
Another sleep disorder
A medical condition
A mental health disorder
The sleep medicine physician may want to examine your sleep using an in-lab sleep study. Also known as a polysomnogram, a sleep study charts your brain waves, heart beat and breathing as you sleep. It also looks at how your arms and legs move and records your behavior during sleep on video. This will help show if you get out of bed and do anything unusual during your sleep study.
The sleep medicine physician will recommend a treatment based on the parasomnia diagnosis. Members of the sleep team can help you manage your parasomnia using medication, behavioral therapy or lifestyle change.
If you sleepwalk or have a parasomnia that causes you to get out of bed, there are steps you can take to make your home safer:
Add locks or alarms on your windows and doors
Sleep on the ground floor
Clear your bedroom of things that might cause you to trip or fall
If you are diagnosed with obstructive sleep apnea, treatment using CPAP or an alternative treatment may improve the symptoms of related parasomnias.
You may also be instructed to follow these tips to minimize your symptoms:
Get a full night of sleep every night
Keep a regular sleep-wake schedule
If you use sleeping pills, use the medication as directed
Make adjustments to your work schedule if you are a shift worker
Avoid alcohol and drug use