Parasomnia – To Sleep or Not to Sleep

What is Parasomnia?

People usually associate sleeping with a kind of peace. We close our eyes, drift off, and allow the subconscious mind to surface. We go to sleep and wake up refreshed and energized for a new day. But not all of those are that lucky. Many people suffer from different kinds of sleep disorders. Parasomnia is the term used to describe a group of these disorders, characterized by activities like moving, talking, or flashes during sleep.

Those suffering from these disorders may seem conscious, but they are usually unaware of and don’t remember their actions.  Parasomnia can be of many types. The most common are the following: Sleepwalking Sleepwalking, or as it is technically called Somnambulism, is a common parasomnia. It is classified as a behavioral disorder.

Sleepwalking does not exclusively refer to walking in sleep, it can also involve talking and complex behaviors while still asleep. Complex behaviors include running, getting dressed, moving furniture, or even sexual behavior. Sleepwalking episodes can last anywhere between a few minutes or even up to half an hour. The person automatically returns to bed or may wake up feeling confused. Sleepwalking affects more children than adults.

 One study showed that about 30% of children between the ages of two and 13 experience sleepwalking. In adults, the prevalence is around 4%.

Generally, the consequences of sleepwalking are mild insomnia symptoms and feeling excessively tired during the day. But in some cases, there can be health consequences like accidental injuries, mishandling sharp objects, or even violent behavior in the unconscious state. These actions may also be embarrassing, like sexual behavior, emotional outbursts, and urinary incontinence.  Sleep talking Somniloquy or sleep-talking is another widely known type of parasomnia. As the name suggests, it refers to talking in one’s sleep.

Talking can be full conversations, mumbling, or merely groaning. In the lighter stages of sleep, sleep-talking is usually congruent and understandable. Somniloquy is generally harmless. Sleep deprivation and sleep apnea are linked to chronic sleep talking and can cause some worry.   Sleep-related groaning, though similar, gets a name of its own – Catathrenia. Unlike snoring, this is not a respiratory disorder. Humming, exhaling slowly and deeply, and cracking sounds are the typical variants. Like sleep talking, it poses only a mild danger in the form of fatigue.  Night terrors

Night terrors are different from nightmares.

Nightmares refer to troubling, often fear, or anxiety-inducing dreams. Both adults and children tend to remember parts or the entire episode. On the other hand, night terrors are a parasomnia that the experiencer is not consciously aware of. Another difference is that Nightmares occur during REM sleep while Night terrors are typical in non-REM sleep. Night terrors are not dreams, but that’s a sudden fear reaction.

A night terror can last up to five minutes and is associated with symptoms like crying, sweating, fast heart rate, kick, hit or thrash, being hard to awaken, and scared and confused when conscious. Like other parasomnias, daytime sleepiness and disturbed sleep are common complications. With night terrors, injury to self or someone nearby is also possible.

There are some other less significant types like: Nocturnal eating disorder – it generally occurs in addition to sleepwalking. Eating or drinking during non-REM sleep, typically when semi-conscious, is the main symptom in this subclass of parasomnia. When the food is consumed too fast or in dangerous combinations, sleep-related eating can pose certain dangers.  Sexsomnia – this is a sleep disorder characterized by exhibiting sexual behavior while asleep.

Sleep texting, sleep-related scratching, sleep-related hallucinations and bedwetting are precisely what the name suggests. Classification Depending on the frequency, parasomnia is classified into:

1. Mild: incidents occurring few times a month
2. Moderate: once or twice a week
3. Severe: episodes occur every night

And depending on the duration over which symptoms exist

1. Acute: Symptoms and episodes last around a month
2. Subacute: between a month and a year
3. Chronic: Episodes continue over a year.

Causes of Parasomnia

Parasomnia is caused and triggered by a variety of factors.

1. Genetics – Family history seems to play a role in predisposing people to parasomnias. Around 50% of children, who sleep walk, have a parent with a history of it. When both parents have a history of non-REM parasomnias, about 60% of children also experience it.
2. Medications – Many medications have been known to aggravate or even trigger sleep disorders.
3. Tricyclic antidepressants and MAO inhibitors are linked to REM-disturbed sleep disorders.
4. Zolpidem is associated with Sleep-related binging disorders, and Beta-adrenergic blocking agents seem to trigger sleep-related hallucinations.
5. Sleep deprivation – While parasomnias can present with symptoms of insomnia, the converse is also possible. Many studies show that there’s a relationship between lack of sleep and sleepwalking. Certain insomnia medications also increase the chances of parasomnia.
6. Brain injuries – Brain trauma caused by accidents or conditions like encephalitis can also trigger parasomnias.
7. Fever – in children, a strong relationship between fever and sleepwalking or talking has been observed.
8. Other sleep disorders – Obstructive sleep apnea, that is, when breathing is affected during sleep and restless leg syndrome, urges to move the limbs while lying down, are both linked to increased risk of parasomnia.
9. Stress – Whether one suffers from acute stress or a more extended version of anxiety and stress disorders like PTSD, sleep is usually affected by stress. Fragmented sleep and mental disturbances both seem to increase the susceptibility of parasomnias.

Diagnosis and Treatment:

Parasomnia is diagnosed with the help of medical tests, family histories, and tests in a sleep lab. Once confirmed, like most other psychological disorders, parasomnia can be treated and managed by combining medication, therapy, and lifestyle changes.

The combination is determined by the intensity of the symptoms and the frequency of episodes.  Medication  Drugs are usually prescribed when parasomnia is recurrent and frequent. Some examples include melatonin, dopamine agonists, and levodopa.

When the symptoms are being caused by medication, the doctor might change the dosage or the medicine itself. Remember to always consult your doctor before changing or stopping your medicines.

Cognitive behavioural therapy Parasomnia is related to other mental health disorders, like depression, anxiety, and stress. Thus, it makes sense to undergo CBT for parasomnia, and it’s underlying cause simultaneously.

Lifestyle changes Scheduled awakening can help minimize behaviors that follow a pattern. Parents or family members commonly use it to assist children or adults who sleepwalk or have night terrors. Keeping the room devoid of sharp objects and even locking the doors and windows also help reduce the chances of accidents.

Parasomnia is a curable sleep disorder.

In conclusion, parasomnia is a sleep disorder involving many unconscious activities like walking, sleeping, moaning, and night terrors and hallucinations in the sleep. It can cause disruptive sleep and accidental injuries. But it is treatable through medication and behavioural therapy.