Parasomnias - Causes, Types and Treatment Options

Types of Parasomnias

Parasomnias cover a range of sleep disorders. While there are medical treatment options available, the methods which are employed in alternative care may also benefit patients through more natural means. Sleep disorders involving unnatural behaviors, movements, perceptions, emotions, and dreams are called parasomnias. These problems happen during the entire sleep cycle: starting with falling asleep, continuing during each of the sleep stages, and, finally, when waking.

NREM

Parasomnias are typically based on dissociative states of sleep the occurrence of partial arousals throughout the night. NREM, or non-rapid eye movement, parasomnias happen in SWS (slow wave sleep). The autonomic nervous system, cognitive, and motor processes are activated in these parasomnias. Night terrors, sleepwalking (somnambulism), sleep talking, and confusional arousal, which includes such symptoms as thrashing, crying, and moaning, fall into this category. Sleep terrors are very disruptive and can lead to both bodily and property damage. They can be caused by complications in childhood development, sleep deprivation, alcohol, stress, depression, or illness. Other disorders in the NREM category of parasomnias include sleep eating and sex, teeth grinding (bruxism), bedwetting (enuresis), and restless legs syndrome. Bruxism can fracture the teeth can cause temporomandibular joint disorder (TMJD).

REM

In the category of REM (rapid eye movement) disorders, patients may start to physically act out their dreams. This can lead to injury to themselves or others. Normally, the body naturally becomes inactive during sleep, preventing such issues from occurring. The sleep disorders affect the body to the point where they do not go through all of the proper functions, thus allowing the brain to send signals to the muscles which then act out the movements. 90% of those with REM sleep behavior disorder (RBD) are men, typically over age 50.

Acute RBD is a side effect of medication (i.e., antidepressants). Chronic RBD may be associated with neurodegenerative disorders (i.e., Parkinson’s disease, dementia). Narcolepsy is a risk factor for RBD as well. Other REM disorders include sleep paralysis and catathrenia (breath holding and groaning). In sleep paralysis, the patient suddenly wakes up while their body is still in an inactive state. This paralysis is meant to keep the patient from acting out their dreams, but it could also be very distressing for patients when they wake up but are unable to move their muscles for a short period of time.¹

Causes of Sleep Disorders

As previously mentioned, patients might make lifestyle choices which could contribute to the onset of parasomnias. For example, a patient might drink alcohol to assist in falling asleep. Contrary to popular belief, this is not a good idea because alcohol is a stimulant which, when it is metabolized, will wake the patient up and make it difficult to fall back asleep later in the night. Those who do not practice good sleep hygiene are also more likely to suffer from difficulties with sleeping. Unfortunately, those who have to work unusual hours for their jobs will also have trouble with their quality of sleep. Parasomnias tend to run in families, and brain disorders may cause some of them as well. Medications and other sleep disorders, such as obstructive sleep apnea, can trigger parasomnias.²

Some sleeping pills, used to treat insomnia, can have side effects that lead to parasomnias and addiction. It is dangerous to use sleeping pills with alcohol. Ambien, for example, may be linked to rare cases of parasomnias such as sleep eating, sleep sex, sleep driving, and sleepwalking. These situations may be due to zolpidem toxicity. Because the patient is still asleep even when doing these waking activities, they involuntarily left in potentially dangerous situations, especially when leaving the house.⁴

Treatment Options

Trying to wake someone who is actively suffering from an episode of parasomnia by yelling or shaking can lead to a violent response. Sharp objects should be kept out of reach, and door alarms may be helpful, depending on the symptoms of the particular condition. Good sleep hygiene, such as stress reduction, bedtime routines and schedules, and even drug therapies may be used to treat those with parasomnias. Treatments and sleep studies become more critical when there is risk of injury to the patient or others.³

General medications prescribed to treat parasomnias include benzodiazepines, anticonvulsants, antiparkinsonian medications, dopamine agonists, and opioid analgesics.⁵ Dealing with any underlying stress or mental illness can also benefit those suffering from parasomnias. Some may find relief with anti-depressants. Hypnotherapy and relaxation techniques can be beneficial. Smoking and caffeine should be avoided. Scary movies can cause nightmares. Heavy drapes and room alarms can be useful for those who sleepwalk. A bedtime routine with herbal tea and warm milk can help with night terrors.⁶ Scheduled waking may also be useful in some patients.⁷ There are many other options for relaxation and sleeping, including melatonin, lavender, St. John’s Wort, and chamomile. Some patients may respond to meditation, yoga, acupuncture, aromatherapy, acupressure, massage, or chiropractic.⁸