Parasomnia is the monster in the closet you need to defeat

Most of us leave bed grudgingly every morning and get ready for work or school. As soon as the day is over and we are back home, we cannot wait to get back in bed and go back to dreamland. Not everyone is as lucky. Some of us can only hope to fall asleep and wake up feeling refreshed every morning. If that happens to your often, you might be a victim of parasomnia. Do not be alarmed. Close to 4% of the adults suffer from similar sleep disorders. It is very common in men over the age of 50 years. Close to 70% of American adults do not get enough restorative sleep at night. The percentage of children suffering from sleep disorders is also on the rise. That makes almost 70 million adults and 2 million children, who have experienced disorders of sleep and wakefulness. Among them, close to 60% suffer from chronic sleep disorders.

What are parasomnias?

Parasomnia is an umbrella term that encompasses all kinds of sleep disorder that involve abnormal movements, emotions, perceptions, behavior, and dreams during slumber. As a person falls asleep or remains asleep, he or she can experience states of partial arousals, distorted dream patterns, and enactment of dreams. These usually occur during transitional phases from wakefulness to NREM sleep or from wakefulness to REM sleep. Most parasomnias children experience result in verbal and physical behavior that can range from speaking gibberish in a half-sleep state to walking around without being completely awake. It is common for children to talk, and move in their sleep or to act out their dreams.

The primary challenge a parasomnia patient faces is the lack of enough rest. When your body is not resting like your brain, it results in additional exertion, unwanted arousals and incomplete rest. It can disrupt thinking, cognition, and problem-solving abilities. They can result in chronic fatigue syndrome, and patients can experience excessive daytime sleepiness (EDS) from the lack of restorative sleep.

What is the structure of sound sleep?

Sleep consists of five distinct stages – 1,2,3,4 and REM (rapid eye movement). A sleeper goes through these stages chronologically and then loops back to stage 1. One complete cycle of five stages usually takes between 90 minutes to 110 minutes for an adult. The duration of each stage can be between 5 and 15 minutes. The first REM stage is always the shortest of the night. As the sleeper progresses through the phases, the REM stage becomes progressively longer. Stage 1 and 2 of NREM sleep are lighter than the Stages 3 and 4. The latter stages are slow-wave sleep stages. Following stage 4 of deep slow wave sleep, our brains enter the REM stage, where all the vivid dreams reside. During the REM stage, the body should not move, but the brain emits waves similar to waking stages. A person should experience a total of 90 minutes to 120 minutes of REM during each night’s rest.

What are the different types of parasomnia?

When people suffer from parasomnia, they often fail to transit from wakefulness to NREM or REM to wakefulness. They have the tendencies to act out dreams during their REM stages. Most NREM or non-REM parasomnias are common in children. Adults usually “grow out” of these problems, but some continue to experience them. Factors like alcohol, emotional stress, physical stress, depression, a history of mental illness and fevered illness can trigger episodes of parasomnia in adults.

Non-REM parasomnia

Those, who experience sleep-related problems only during the NREM stages suffer from non-REM parasomnia. It is a highly heterogeneous affliction that can affect almost any individual above the age of 50. A wide range of symptoms can exemplify parasomnia. Here’s a brief account of the different disorders that fall under the category of NREM parasomnias –

1. Confusional arousals

Does it happen to you often? You wake up in bed, and you have no idea whether it is morning or evening? If it is real or if you are still in a dream state? It usually happens when a person experiences a “rude awakening” during their deep stage (non-REM 3&4) sleep. You wake up, sit up and try to look around. When it happens, you usually go back to sleep without getting off the bed or waking up fully.

In some instances, people can remain in the state of confusional arousal for a couple of minutes. However, they might stay unresponsive to external stimuli that include touch, voices, and commands. It is common in children, especially toddlers, who can go from moaning to thrashing around and crying during these stages. Only about 4% of the adults suffering from parasomnia experience confusional arousals. While it is not dangerous to the sleeper or co-sleeper, it can be the symptom of other parasomnias present.

     2. Somnambulism

We usually know it by a more common name – sleepwalking. Thanks to Hollywood and popular literature, lots of people believe there are paranormal elements attached to sleepwalking. However, it is utterly explainable through neurology. Polysomnogram can help in the detection of similar parasomnias. About 4% of adults currently experience somnambulism and close to 17% children experience it during growing up.

The average sleep cycle involves five stages and varying qualities of sleep. Factors like anxiety, alcohol consumption, and drug abuse can lead to adults walking in their sleep. Scientists have uncovered several genetic factors that also influence the incidence of sleepwalking in people. The symptoms include people walking around during their bedtime, while looking awake, but being asleep. People usually do not respond to their names or other commands during this stage. Jostling them awake results in confusion.

     3. Night terrors

Children often scream in their sleep. Night terrors can be the reason most toddlers believe in the existence of monsters under their beds or their closets. They can experience terrifying nightmares, but they do not wake up when screaming for help or crying. It results in panic attacks and depletion of mental health in some children.

In certain extreme cases, scientists have noted physical harm. They might try to get out of bed, or they can thrash around. That can lead them to hurt themselves or the adults around them. Usually, trying to console them and putting them back to sleep at the moment, does not work. These attempts only extend the victims confused state.

About 3% of the adults can experience night terrors. Although, it is difficult to detect in adults since the sleeper has little to no recollection of the events. This type of parasomnia can become extremely violent in adults, and it can be dangerous for the co-sleeper as well. It is especially common in people with Post Traumatic Stress Disorder (PTSD). Sleep terrors are common during Stage 3 of Non-REM sleep.

     4. Sexsomnia

Sex is the sign of love between two healthy individuals, but it can become embarrassing for one of them if they enact sexual acts during sleep. It is a form of parasomnia that is usually present in an individual with a history of sleep-wake disorders. Just like sleepwalkers and sleep talkers, people suffering from sexsomnia have no recollection of the behavior they have exhibited at night in their sleep.

The symptoms of sleep sex can include fondling, intercourse, climaxing, and masturbation. Research shows that untreated sexsomnia in people with issues of sexual aggression can also result in sexual assault and rape. A person carrying out sexual acts in his or her sleep usually has his or her eyes wide open. They do not often respond to external stimuli. Several factors can exacerbate this condition including stress factors, sleep deprivation, alcohol, and drug abuse. Certain sedatives including zolpidem can increase the incidences of sexsomnia in people already suffering from one sleep-wake disorder.

     5. The nocturnal sleep-related eating sleeping disorder

Sleep eating is a variant of sleepwalking. It is a unique combination of parasomnia and eating disorders. Most experts consider somnambulistic eating as a variant of night eating syndrome (NES). However, people suffering from NES usually are in complete control of their consciousness. They are awake and aware of their surroundings.

Those suffering from NSRED can leave the bed, walk up to the refrigerator and binge on high-calorie food without waking up. They do not have the recollection of eating at night in the morning. Most people understand the presence of the condition from the empty wrappers, spoons, and forks on the sink, and leftover crumbs on their clothing.

Somnambulistic eaters experience the first bout of sleep binging within 2 to 3 hours of falling asleep. They binge on exclusively high fat and fried food, which they would consume in moderation during wakefulness. The danger of consuming inedible items including wood, glue, plastic and toxic materials makes NSED dangerous for everyone.

      6. Exploding head syndrome

It can occur to people of any age. It is a benign condition since it does not have any long-term repercussions in most. The sleeper “hears” loud explosion-like noises while falling asleep. The nature of the sound varies from explosions to utensils falling, doors closing loudly and gunshots.

The condition is harmless, but it can cause discomfort, inability, and fear during bedtime. About 10% of people report visual disturbances including lightning, flashes of light and visual static. It might be uncommon, but a few also describe strange feelings and tingling right before the auditory hallucinations. People can experience myoclonic jerks, rapid heartbeat, distress, and confusion. Profuse sweating and labored breathing is often a related effect.

REM parasomnias

The Random Eye Movement or REM stage of sleep is responsible for those incredible fairytale dreams. The more imaginative a person, the more bizarre are their dreams. However, the REM sleep is not devoid of its slew of disorders. Many people not only experience weird dreams, but they also try to enact them during rest.

      7. REM Sleep Behavior Disorder (RBD)

In the event of REM sleep behavior disorder, people do not experience muscle atonia during sleep. It is the condition during rest when the muscles of the body lose strength. It is an extremely relaxed state of skeletal muscles like in the event of REM sleep. Without the presence of atonia, people can move their hands and legs in their sleep. When people act out their dreams, they may risk falls, fractures, lacerations, bruises, and injuries to others as well.

Some patients take up the habit of creating pillow barricades around themselves to prevent hurting their co-sleepers or hitting the wall. Building an obstacle is a temporary solution, and it only works in familiar environments. Some people even go to the extent of tying themselves to the bedpost to prevent injury. Sleeping on a mattress without a platform or in an empty room obviously helps the case, but it is not possible in most regular households.

Men between the ages of 50 years and 65 years fall into the risk group of RBD. RBD can include vocalization, loud screaming, and swearing. It can also involve simple to complex motor activities. In some instances, it co-occurs with neurodegenerative diseases like Parkinson’s and Alzheimer’s. It can also be a side effect of anti-depressants, specific sedatives, and alcohol abuse. Chronic RBD is usually idiopathic.

       8. Sleep paralysis

Sleep paralysis is another sleep disorder that has incurred several paranormal connotations due to the uncanny nature of the events. Sleep paralysis can occur when a person is falling asleep. During these episodes, a person is unable to speak, move or wake up. One can experience auditory and visual hallucinations. The result is almost always fear.

People suffering from obstructive sleep apnea (OSA) and narcolepsy usually experience sleep paralysis frequently. There are no warnings for an episode, but stress, emotional trauma, and sleep deprivation can result in sleep paralysis. Incidences of alcohol abuse and drug abuse worsen the cases of sleep paralysis. About 80% of people have experienced sleep paralysis at least once. Only about 5% of them suffer from it regularly. As a result, there is a severe lack of concrete research on the matter.

      9. Catathrenia

It is a form of REM sleep disorder. The sleeper usually holds their breath and emanates loud groaning sounds. It is distinct for somniloquy and OSA. In the case of snoring, people produce sounds during inhalation. During Catathrenia, people usually make noises during exhalation.

Detecting Catathrenia is a little tricky since it sounds a lot like snoring to the untrained ears. Nonetheless, it can be equally or more disturbing than snoring to the sleeping partner. Most sufferers wake up to the sound they make. It disrupts proper rest, and it can lead to other health problems in the long run.

In short, parasomnia is an expansive field with extremely diverse symptoms. Sometimes, the signs and effects of one type have no semblance with another. Nonetheless, after decades of research, neuroscientists, sleep experts, neurologists, and psychiatrists have grouped these nine sleep and wake disorders as a parasomnia.

What causes parasomnia?

Although these are intriguing research topics, as of now, scientists have not been able to determine the specific causes of each. There are no triggers for each type of parasomnia, but certain factors increase the susceptibility of a person towards a set of parasomnias.

Here are a few factors that can increase your risks of suffering from parasomnias –

Nightmare disorder

• People who have personality disorders have higher chances of suffering from nightmare disorders.
• Medications like levodopa, lithium, thioridazine, perphenazine, fluphenazine, and beta-adrenergic drugs can also cause night terrors in adults.
• Feverish sleep, high fever, physical injury, and recent emotional trauma can cause it too.
• Obstructive sleep apnea is a potential cause for night terror disorders.

RBD

• RBD is complicated, and the presence of brain injury, history of brain trauma, surgery and tumors increase the chances of RBD.
• Neurodegenerative diseases like Parkinson’s and multiple system atrophy increase the chance of a person developing RBD.
• About 45% of the people suffering from RBD is either going through withdrawal from alcohol abuse or sedatives. Withdrawal from tricyclic antidepressants, and serotonin reuptake inhibitors can heighten the chances of a person suffering from RBD.

Sleepwalking

• Sleep deprivation, improper sleep hygiene, confusing sleep schedule and increasing levels of stress are triggers of sleepwalking.
• Sedative-hypnotic drugs, neuroleptics, and antihistamines can worsen sleepwalking.
• Nighttime seizures, heart problems, obstructive sleep apnea, and restless legs syndrome, are other distinct conditions that can lead to sleepwalking.
• PTSD, panic attacks and other dissociative disorders can cause it too.
• Scientists have discovered several genetic factors that can influence the symptoms of somnambulism.

Sleep-related eating disorder

• The exact causes of it are still unknown, but the presence of obstructive sleep apnea, narcolepsy, and restless legs can induce sleep eating disorders.
• Hypnotic medications like zolpidem and antipsychotics can cause sleep-related eating.
• People going through anorexia and bulimia can also experience this non-REM sleep disorder.

As you can see, a few of the triggers and possible causes of some of the parasomnias are now clear to the specialists. However, the extent of the effect of each of these factors varies between two people significantly.

Why is the diagnosis of parasomnia necessary?

Diagnosis of non-REM and REM sleep disorders is challenging. In the case of adults, the lack of an observer can defeat the objective of a diagnosis. Even when you have a co-sleeper or a roommate, the observations might not be accurate or scientific. In most cases, people need diagnosis and treatment for parasomnias due to high risk of injury.

When you see a sleep specialist, he or she will ask you to maintain a sleep diary. You should do it for two to three weeks. Try to write down your experiences as carefully as possible. Ask for input from your roommate and co-sleeper. They will always provide value-adding data since they can hear you or watch you when you act out in your sleep. Apart from that, you need to give the sleep specialist with information regarding any other medical condition you might have, history of substance abuse, mental health problems, and medication history.

That might be enough for the doctor to understand if you have a sleep-wake disorder. However, they will need to conduct more in-depth studies to check the kind of sleep disorder you might have. They can ask you to come in for an in-lab sleep study. Or, they can set up a temporary observation system in your bedroom. It is uncommon, but possible in some instances. Today, sleep experts usually rely on polysomnogram to find out all they need to know about your brain activities, limb movements, and sleep disorders. fMRIs are generally not necessary, and doctors recommend that in certain unique cases.

Treatment

Improving sleep habits can reduce episodes of parasomnia. Sticking to a proper schedule, staying away from blue light emitting devices after the evening and eating the last meal at least two hours before bedtime helps in the control of parasomnia symptoms. Getting a light workout in the mornings and evenings can stimulate the proper melatonin metabolism in the body. Melatonin is the neuro-hormone that governs the onset and quality of sleep in human beings. Regularizing your nighttime routine can help your body maintain the proper melatonin balance.

Your sleep medicine specialist can help you with the treatment of sleep disorders based on your parasomnia symptoms and diagnosis. Apart from minute changes in lifestyle and diet, you might need medication to manage your sleep. People with RBD benefit from regular therapy and administration of clonazepam. It is one of the most popular drugs for the treatment of sleep disorders, although it can cause dependence upon long-term use. It is imperative that you use the medication as your physician has directed. Do not increase or decrease the dose without consulting your doctor.

Since the types are diverse, the treatment methods can vary significantly between two experts. Some believe in managing sleep behavior disorders through medication, while others believe in cognitive behavioral therapy for managing episodes of sleepwalking, bruxism, sleep sex and sleep-related eating disorder.

Parasomnia is not a dangerous condition, as long as the person does not pose a threat to himself or his family. Sleepwalkers with access to knives, guns and car keys can be extremely dangerous for him and those around him. If you live alone, and you have the habit of walking in your sleep, you need to lock away the sharp objects and ammunition, keep your car keys in a safe place, and secure the locks on your doors and windows. If your neighbors are friendly, do mention your predicament to them. That will come to aid in the event of a sleepwalking-related emergency.

Insomnia vs. Parasomnia

People with insomnia find it difficult to fall asleep and staying asleep during any time of the day. It sounds a lot like delayed sleep onset disorder, but those with delayed onset of sleep can experience complete restorative sleep if they can sleep in. Their condition prevents them from falling asleep at a socially acceptable bedtime. On the other hand, those with insomnia cannot fall asleep at any time at all. Whether they want to catch a quick afternoon nap or they want to fall asleep at 4 am after an unusually late movie night, they are unable to do so.

Insomniacs often report not being able to remain asleep for long periods. Most people who have insomnia usually show a plethora of symptoms including fatigue, lack of focus, impaired cognition, low energy levels, and mood instabilities. Decreasing levels of productivity and performance during the daytime are also ubiquitous effects of insomnia.

These effects and symptoms overlap significantly with parasomnia. Many adults erroneously believe that parasomnia and insomnia are synonymous. However, parasomnia can only occur when a person is asleep. Chronic parasomnia can last for years. People suffer from poor quality of rest night after night. However, they usually do not face any problems falling asleep unless they have other existing conditions like delayed sleep onset.

Parasomnia and melatonin

RBD involves enactment of dreams. It can involve dangerous and violent behavior. It is dangerous for the sleeper and those around him or her. One of the primary treatments for RBD has been clonazepam and doctors have been recommending it to adults for decades now. However, research shows that clonazepam can be habit forming and those trying to stop experience unpleasant withdrawal symptoms. Clonazepam and similar drugs promote dependence on sedatives. Most of them can cause next-day hangovers, in case the person fails to get enough sleep.

Research suggests that people are now going for melatonin therapy. Doctors all over the world are recommending the natural neuro-hormone for treating tendencies of parasomnia in teens and adults. Since it is a naturally occurring substance in the body, the tolerance for it is quite impressive. The side effects are minimal. Most importantly, it is not addictive like most sedatives and hypnotics. It has a better tolerance profile than clonazepam in all ages. Moreover, it does not interact with most other drugs people might take for related or unrelated conditions.

In the US, melatonin is available as an over the counter (OTC) supplements. Many companies now sell it in the form of easy to swallow gummies. Some lifestyle companies include melatonin in their nighttime calming tea in combination with lavender essence and frankincense. Since it does not pose a high risk, many psychiatrists and sleep doctors are now prescribing it for children, who have frequent episodes of night terrors, sleepwalking and confusional arousals.

Naturally, the concentration of it should peak at around 2 or 3 am and then decline steadily till morning. Melatonin supplements before bedtime can improve the quality of nighttime rest. It can set the circadian rhythm in place. Those with circadian rhythm disorders and myriads of other sleep-wake disorders, benefit from regular consumption of the neuro-hormone supplement.

What can you do to keep parasomnia at bay?

Since the causes of parasomnia are not as clear as any other disease or disorder, steering clear of it can be challenging. A growing number of adults are falling prey to sleep disorders due to the surging stress in their work life, lack of a work-home balance and shortage of physical exercise. Too many late nights, addiction to caffeine, nicotine, and alcohol abuse are other reasons people are experiencing poor quality of rest at night.

However, there are a few natural ways you can get better sleep than you do right now.

1. Restrict your mobile, computer and laptop use till the evening. Keep a gap of at least two hours between watching TV and going to bed.
2. Keep your TV, computer, and laptop out of your bedroom.

• Banish blue-lights from your bedroom. Go with warm-tone or daylight LEDs. Install dimmers to all lights.

1. Keep your bedroom cool, dark and quiet. If possible, install noise dampeners on the windows. Advanced curtains with noise dampening designs are now available as well.
2. Install thick carpets or rugs to absorb sound if you have particularly noisy neighbors.
3. Get hold of a reliable white noise machine. White noise can be of various types, and they always help you sleep better.

• If white noise does not work, try pink noise. You don’t have to get a machine. Load pink noise MP3 files in your flash drive and play it through your sound system.
• Keep your pets out of your bedroom. They are the primary source of dust, pollen and dust mites. You might be getting allergies and breathing trouble from too much pet dander on your bed.

1. Vacuum at least once a week. Change the sheets and wash them in warm water to remove unpleasant odors.
2. Sometimes, old and lumpy mattresses keep people from getting proper rest. If you are waking up each morning with inexplicable back pains, it might be time to give mattress shopping a thought.
3. Spritz lavender and orange essential oil around the room before heading to bed. These are relaxing and refreshing scents that should promote good quality rest.

These are a few home remedies that should work for those experiencing isolated and infrequent episodes of parasomnia. However, for those with chronic parasomnia, these will only be mildly comforting. Sleep disorders are real problems, and they deserve the attention of specialized medical professionals.