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Parasomnias

What are parasomnias?

Parasomnias are disruptive physical events or experiences that occur within sleep or during sleep state transitions (i.e.. while trying to fall asleep or awakening from sleep). These include disorders such as: sleep walking, sleep talking, sleep eating, nightmare disorder, and night terrors.

What causes parasomnia?

The precise cause of parasomnias remains unclear. During sleep, the central nervous system is relatively ‘quiet’; and transmission to muscles is suppressed. This is a protective mechanism, so we don’t ‘act out our dreams’. With parasomnia, there is central nervous system activation during sleep with transmission to skeletal muscles, the autonomic nervous system, or higher cognitive centers. In some cases, this results in the individual ‘acting out their dreams’. At other times, the mind attempts to make sense of the increased physical activity, and therefore creates experiences surrounding the physical activity. Put another way, the individual is ‘dreaming out their acts’.

Parasomnias occur most frequently during sleep wake transition, and may in fact be triggered by sudden awakening from deep sleep. Suffice it to say, the boundaries between sleep and wakefulness are blurred, and parasomnias inhabit this ‘grey zone’. In the case of sleep walking, an individual will suddenly wake up from slow wave sleep. They may perform complicated tasks (and in fact their EEG indicates that they are awake), but they believe they are asleep. The opposite occurs with autonomic behaviors. As an example, an individual might drive somewhere but not remember exactly doing so for a few seconds or minutes. In this case, their EEG would indicate they were sleeping, yet they were performing a complicated task.

Do I have a parasomnia?

The diagnosis of parasomnia is based on history. Each parasomnia has specific features that can be identified by a trained physician. Sleep studies can be helpful in ruling out disorders which mimic parasomnia such as seizures, but they are not necessary to make a definitive diagnosis. Having said that, some sleep disorders such as obstructive sleep apnea may worsen parasomnia. If suspected, a polysomnogram (sleep study) can be useful in terms of ruling other sleep disorders.

Do I need treatment?

In general, treatment is not required unless the behaviour results in injury to either the individual or their bed partner. However, in some cases, the behaviour or experiences are sufficiently distressing that treatment is required.

Treatment varies depending on the type of parasomnia. First and foremost, addressing sleep quality is paramount. Sleep deprivation may increase parasomnia frequency and sometimes increasing total sleep time or treating insomnia is sufficient. Psychological stressors may also aggravate parasomnia, and some people respond to lifestyle changes or cognitive behavioural therapy. Finally, drugs such as clonazepam, tricyclic antidepressants, or seizure medications have been employed.

Examples of parasomnias:

Nightmare disorder: The individual will experience frightening dreams that are associated with elevated heart rate and breathing, sweating, and arousal. Complete alertness and subsequent recollection of the dreams differentiates nightmares from sleep terrors.

Sleep terror disorder: Sleep terrors typically result in extreme panic, a loud scream during sleep, followed by activities such as hitting objects or moving in and out of the bedroom. Unlike with nightmares, there is rarely any associated dream content. This is a disorder of arousal that primarily occurs during stages 3 and 4 of non-REM sleep.

Sleepwalking disorder: Again, this disorder arises during slow wave (stage 3 and 4) sleep. Unlike with sleep terrors, the exhibited behaviour is complex. The subject performs complex automatic behaviors, such as wandering aimlessly, carrying objects, going outdoors, and performing other activities of varying complexity and duration. There is rarely any memory or dream content associated with the activity.

REM sleep behavior disorder: The patient will typically out their dreams, typically in a violent (or physical) fashion. As an example, the patient may dream of attacking ninjas, which then results in them attacking their bed partner. REM behaviour disorder arises from REM sleep and is felt to be related to a lack of suppression of muscle activity during sleep.




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Sleep Centre Home OSA Diagnostic Tests OSA Treatments Online Sleep Class Suggestions for Better Sleep SnoreSat Instructional Video New Telehealth Insomnia Management Program Referral Process Referral Form Download Form Physician Training Respirology Residents Rotation Sleep Fellowship CPAP Providers Research Projects Links Contact Us	Sleep Centre Foothills Medical Centre Online Sleep Class Page 12 of 16 Parasomnias What are parasomnias? Parasomnias are disruptive physical events or experiences that occur within sleep or during sleep state transitions (i.e.. while trying to fall asleep or awakening from sleep). These include disorders such as: sleep walking, sleep talking, sleep eating, nightmare disorder, and night terrors. What causes parasomnia? The precise cause of parasomnias remains unclear. During sleep, the central nervous system is relatively ‘quiet’; and transmission to muscles is suppressed. This is a protective mechanism, so we don’t ‘act out our dreams’. With parasomnia, there is central nervous system activation during sleep with transmission to skeletal muscles, the autonomic nervous system, or higher cognitive centers. In some cases, this results in the individual ‘acting out their dreams’. At other times, the mind attempts to make sense of the increased physical activity, and therefore creates experiences surrounding the physical activity. Put another way, the individual is ‘dreaming out their acts’. Parasomnias occur most frequently during sleep wake transition, and may in fact be triggered by sudden awakening from deep sleep. Suffice it to say, the boundaries between sleep and wakefulness are blurred, and parasomnias inhabit this ‘grey zone’. In the case of sleep walking, an individual will suddenly wake up from slow wave sleep. They may perform complicated tasks (and in fact their EEG indicates that they are awake), but they believe they are asleep. The opposite occurs with autonomic behaviors. As an example, an individual might drive somewhere but not remember exactly doing so for a few seconds or minutes. In this case, their EEG would indicate they were sleeping, yet they were performing a complicated task. Do I have a parasomnia? The diagnosis of parasomnia is based on history. Each parasomnia has specific features that can be identified by a trained physician. Sleep studies can be helpful in ruling out disorders which mimic parasomnia such as seizures, but they are not necessary to make a definitive diagnosis. Having said that, some sleep disorders such as obstructive sleep apnea may worsen parasomnia. If suspected, a polysomnogram (sleep study) can be useful in terms of ruling other sleep disorders. Do I need treatment? In general, treatment is not required unless the behaviour results in injury to either the individual or their bed partner. However, in some cases, the behaviour or experiences are sufficiently distressing that treatment is required. Treatment varies depending on the type of parasomnia. First and foremost, addressing sleep quality is paramount. Sleep deprivation may increase parasomnia frequency and sometimes increasing total sleep time or treating insomnia is sufficient. Psychological stressors may also aggravate parasomnia, and some people respond to lifestyle changes or cognitive behavioural therapy. Finally, drugs such as clonazepam, tricyclic antidepressants, or seizure medications have been employed. Examples of parasomnias: Nightmare disorder: The individual will experience frightening dreams that are associated with elevated heart rate and breathing, sweating, and arousal. Complete alertness and subsequent recollection of the dreams differentiates nightmares from sleep terrors. Sleep terror disorder: Sleep terrors typically result in extreme panic, a loud scream during sleep, followed by activities such as hitting objects or moving in and out of the bedroom. Unlike with nightmares, there is rarely any associated dream content. This is a disorder of arousal that primarily occurs during stages 3 and 4 of non-REM sleep. Sleepwalking disorder: Again, this disorder arises during slow wave (stage 3 and 4) sleep. Unlike with sleep terrors, the exhibited behaviour is complex. The subject performs complex automatic behaviors, such as wandering aimlessly, carrying objects, going outdoors, and performing other activities of varying complexity and duration. There is rarely any memory or dream content associated with the activity. REM sleep behavior disorder: The patient will typically out their dreams, typically in a violent (or physical) fashion. As an example, the patient may dream of attacking ninjas, which then results in them attacking their bed partner. REM behaviour disorder arises from REM sleep and is felt to be related to a lack of suppression of muscle activity during sleep.
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