Parasomnias

Overview of Parasomnias

Parasomnias include movements or behaviors that may impair sleep continuance, associated with sleep, sleep stages, or partial arousals from sleep. Parasomnias can be divided into four groups of disorders: arousal disorders, sleep-wake transition disorders, REM sleep behavior disorders and nonspecific parasomnias.

Arousal Disorders

The arousal disorders usually occur in the first third of the night (when NREM is more common than REM).

• Sleepwalking or Somnambulism
• Night Terrors
• Confusional Arousals

Sleep-wake transition disorders

• Nocturnal Leg Cramps
• Somniloquy
• Rhythmic movement disorder
• Myoclonus

REM sleep behavior disorders

• Sleep paralysis
• REM sleep behavior disorder
• Hypnogogia
• Nocturnal Eating Syndrome

Nonspecific Parasomnias

• Bruxism
• Enuresis
• Snoring
• Sleep-onset Association Disorder
• REM sleep cardiac arrhythmias

Others

Catathrenia (groaning during sleep) is sometimes called a Parasomonia, although it could also be considered a feature of sleep-disordered breathing.

Trichotillomania – the impulse control disorder that causes people to pull their own hair out – has been proposed as a parasomnia – when the patient does it while asleep.

An article in the journal Sleep floated the idea that sleep-related scratching should be considered a parasomnia. Trichotillomania – the impulse control disorder that causes people to pull their own hair out – has been proposed as a parasomnia – when the patient does it while asleep.

Although these undesirable physical and behavioral incidents and actions during sleep can be worrying and occasionally hazardous to the sleeper, you should remember that frequent or particularly dramatic parasomnias are diagnosable and treatable in most cases. The effective therapy in most cases is medication with long- or medium-acting benzodiazepine, such as clonazepam, taken at night before sleep.

Hallucinations – Many people occasionally experience a hallucination in conjunction with sleep (39%), although for half of those people it happens less than once a month.  Hallucinations when falling asleep (hypnagogic hallucinations) are four times more common than when waking up (hypnopompic hallucinations).

Growing Pains? – An intriguing idea is that growing pains are a form of sleep disorder. Like parasomnias, they are relatively common in pre-school children and there appears to be a correlation with night terrors.

A Problemetic Mix of Waking and Sleep

A compelling model of brain functioning involves the flip-flop switch, a systems engineering model of neural network functioning. Whether or not this model is accurate enough, it is clear just from observing people in day-to-day life, that nature gave us a “sleep-wake switch”. A person is either awake or asleep, not both at the same time or mixed – or at least that’s the way we think it should be. Parasomnias, however, represent a pathology of this switch. The sleep and wake states are not stable and waking seeps into sleeping time while sleep occasionally seeps into waking.

Another way to classify parasomnias is between NREM and REM disorders, depending on what type of sleep they arise from. When people wake up from NREM disorders they are confused; people who wake from REM are alert and can often remember their dreams.

Epidemiology

Parasomnias occur more frequently in kids than in adults. Indeed, over 80% of preschool-age children experience parasomnia events. Some psychologists associate parasomonias in young (preschool) children with separation anxiety. There is a genetic predisposition for parasomnias, but specific genes and how they interact with the environment are not known.

The prevalence of parasomnias is estimated at 4% in the general adult population.

Treatment of Parasomonias

Treatments are behavioral and rarely pharmacological. Sometimes doctors feel no treatment is often preferable to available therapies because the symptoms are not severe, the disorders do not get worse or lead to other disorders, and the parasomnias that disappear over time are considered childhood issues because kids love them when they grow up. Further the science underlying the treatment of parasomnia is not as robust as some other medical treatments, perhaps because low incidences of the disorders means small sample sizes in trials and studies.

Experts generally warn against restraining sleepers in anticipation of confusional arousal, sleepwalking, or sleep terror. The bedroom should be made hazard-free to reduce risk of the person hurting anyone. Psychotherapy can often help reduce the incidence of these events, and sometimes patients are awoken right before their regular occurrence of parasomnia to prevent it.

Pharmacological treatment is more common for the rare but serious conditions of REM Behavior Disorder and nocturnal eating disorders.