Parasomnias cover a range of sleep disorders. While there are medical treatments, alternative care may also benefit patients.
Types of Parasomnias
Sleep disorders involving unnatural behaviors, movements, perceptions, emotions, and dreams are called parasomnias. These problems happen during the entire sleep cycle: falling asleep, during sleep stages, and when waking. Parasomnias are typically “dissociative sleep states…partial arousals”. 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 (i.e., thrashing, crying, moaning) fall into this category. Sleep terrors are very disruptive and can lead to bodily and property damage. They can be caused by 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). In the category of REM (rapid eye movement) disorders, patients may act out their dreams. This can lead to injury to themselves or others. 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).1 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
Trying to wake someone suffering from a 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 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 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.4 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,8 massage, or chiropractic.