What is parasomnia?
Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, during sleep, between sleep stages, or during arousal from sleep. There are many different types of parasomnias that can affect people of all ages, but they tend to be more common in children and decline with age. Some of the most common parasomnias include sleepwalking, sleep terrors, REM sleep behavior disorder, nightmares, sleep paralysis, sleep talking, teeth grinding, and bedwetting. Parasomnias can range from benign to potentially dangerous or disruptive depending on the specific disorder. Understanding the types of parasomnias and who is most likely to suffer from them is important for managing these sleep disturbances.
Common parasomnias
Here are some of the most prevalent parasomnias:
Sleepwalking – Also known as somnambulism, sleepwalking involves getting out of bed and walking around while still partially asleep. It typically occurs during deep NREM sleep. Sleepwalking is more common in children but can occur in adults too.
Sleep terrors – Sleep terrors are characterized by abrupt awakening from sleep in a terrified state. They most often occur in children during deep NREM sleep. Episodes usually last 1-10 minutes and the person has no memory of the event the next day.
REM sleep behavior disorder – This involves acting out vivid and intense dreams by moving, shouting, hitting, jumping out of bed, etc. It occurs during REM sleep due to a lack of normal muscle paralysis. It is more common in older adults.
Nightmares – Frightening dreams that result in awakenings from REM sleep. More common in children but can occur at any age.
Sleep paralysis – Brief inability to move or speak when waking up or falling asleep. It is caused by REM sleep muscle paralysis lingering into wakefulness.
Sleep talking – Uttering words or sounds when asleep. It can occur during any sleep stage. More common in children but some adults sleep talk too.
Teeth grinding – Also called bruxism, this involves clenching or grinding of the teeth during sleep. It often happens during arousals from NREM sleep.
Bedwetting – Involuntary urination during sleep, also called sleep enuresis. It is more common in younger children but some adults also struggle with bedwetting.
Who is affected by parasomnias?
While parasomnias can occur in adults, certain disorders are much more prevalent among children and tend to decrease with age. Parasomnias also sometimes run in families, suggesting a genetic tendency. Let’s look at who is more likely to experience different parasomnia disorders:
Children
Children are more prone to parasomnias like:
– Sleepwalking – Occurs in 15-40% of children, peaks around ages 8-12 years old
– Sleep terrors – Affects up to 6.5% of children, peaks between ages 4-12 years
– Bedwetting – Affects 5-10% of 6-year-olds, 10-15% of 5-year-olds
– Sleep talking – Very common, affects over 50% of young children
– Nightmares – Affects 10-50% of 3-6 year olds
The immaturity of children’s nervous systems is thought to contribute to these parasomnias being more common in childhood. They tend to decrease with age as the nervous system matures.
Adults
Parasomnias that are more prevalent in adults include:
– REM sleep behavior disorder – Affects 0.5% of general population, higher rate in older men
– Sleep paralysis – Occurs in about 8% of the general population
– Sleep talking – Declines through adolescence but still occurs in some adults
– Teeth grinding – Affects 8-10% of the general adult population
For adults, parasomnias may be caused by psychological factors like stress and anxiety or other sleep disorders like sleep apnea. Certain medications, substances, and medical conditions can also trigger adult parasomnias.
Elderly
Older adults are more prone to:
– REM sleep behavior disorder – Prevalence increases to 1-2% in people over 60
– Sleepwalking – Uncommon in seniors but incidence rises in dementia
– Teeth grinding – May affect 14-20% of elderly
The increased rates of parasomnias in the elderly may be related to changes in sleep patterns and brain activity, neurodegenerative diseases, and side effects of medications.
Risk Factors
In addition to age, there are various risk factors that make a person more likely to experience parasomnias:
Genetics
Many parasomnias have a genetic component and tend to run in families. If a parent or sibling has a parasomnia, a person is at increased risk.
Mental health disorders
Anxiety, depression, bipolar disorder, PTSD, and schizophrenia are linked to higher rates of certain parasomnias. This includes nightmares, sleep talking, teeth grinding, and REM sleep behavior disorder.
Neurological disorders
Dementia, Parkinson’s disease, Tourette syndrome, and ADHD are associated with increased parasomnia rates. Parasomnias may be early markers of neurodegenerative diseases.
Sleep disorders
Sleep apnea, restless legs syndrome, narcolepsy, and circadian rhythm disorders can trigger parasomnias as the normal sleep cycle gets disrupted. Treating these can often resolve parasomnias.
Medications
Certain prescription drugs, over-the-counter medications, and recreational substances are linked to parasomnias as side effects. These include antidepressants, stimulants, beta blockers, alcohol, and illicit drugs.
Sleep deprivation
Not getting enough sleep consistently can make people more vulnerable to parasomnias. Fatigue lowers the arousal threshold from sleep.
Stress
High stress levels tend to increase the frequency or severity of several parasomnias including sleepwalking, nightmares, and bruxism. Stress impacts sleep quality.
Diagnosis
Diagnosing parasomnias usually involves:
– Medical history – Looking for potential risk factors and family history
– Sleep study – Polysomnography or at-home sleep apnea testing to identify other sleep disorders
– Sleep diaries – Logging sleep patterns, symptoms, and episodes
– Activity monitoring – Wrist actigraphy to record movements overnight
– Video recording – Capturing episodes via home video monitoring
Based on the findings, doctors can determine the type of parasomnia and recommend appropriate treatment approaches.
Treatments
Treatments for parasomnias aim to prevent episodes and avoid injury or disruption. Options include:
Improving sleep hygiene
Getting sufficient sleep, maintaining a consistent schedule, winding down before bed, limiting naps, and having a comfortable sleep environment helps manage many parasomnias.
Avoiding triggers
Reducing stress, adjusting medications if needed, and treating underlying conditions like sleep apnea, anxiety, and ADHD can prevent parasomnia triggers.
Safety measures
For disorders like sleepwalking, safety precautions include padding furniture, locking doors/windows, floor-level beds, alarm systems, etc.
Medications
Sedatives, antidepressants, and hypnotic agents may be used short-term in some cases to prevent or minimize parasomnia episodes.
Psychotherapy
For disorders like nightmares or sleep terrors, therapies like imagery rehearsal therapy and cognitive-behavioral therapy can help lessen symptoms.
Self-hypnosis
Learning self-hypnosis relaxation techniques may help reduce bruxism and some other parasomnias for some patients.
Conclusion
While parasomnias can affect people across all age groups, certain disorders are more prevalent in populations like children, adults, and the elderly. Risk factors include genetics, neurological and mental health conditions, sleep disorders, medications, stress, and sleep deprivation. Diagnosing parasomnias involves sleep studies, symptom tracking, and ruling out other causes. Treatments focus on safety, managing triggers, and using medications or therapy sparingly for severe cases. Parasomnia disorders often resolve or improve with age, but temporary management is important to prevent sleep disruption and potential injury.