Parasomnias are a group of sleep disorders that can occur in different forms while the patient isn’t aware of the event. Therefore, it is crucial that patients with parasomnias are well-educated about these disorders since they can result in some serious physical damage.

These events can occur while the person is falling asleep, sleeping, or waking up, and result in abnormal movements, emotions, behavior, and dreams. In the long-run, this can lead to disrupted sleep, poor general health, physical injuries, and psychological issues.

The first type is NREM (non-rapid eye movement) parasomnias which feature confusional arousals, eating disorders related to sleep, sleep terrors, and sleepwalking. Second, REM (rapid eye movement) parasomnias are characterized by REM sleep behavior disorder, nightmares, and repeated isolated sleep paralysis. Other parasomnias include exploding head syndrome, sleep enuresis (bedwetting), and hallucinations.

How do Parasomnias Differ from Common Arousal?

If a person experiences confusional arousals it means that he/she wakes up briefly, behaves strangely, and then has no recollection of them waking up in the night.

And, when speaking of parasomnias, we must note two concepts. First, sleep and wake aren’t mutually exclusive. Second, an overlap between wake and REM and wake and NREM is very common.

Sleep Stages Overlapping

When we sleep, we transition from one to another stage or state like REM, NREM, and wake. But, these stages aren’t always well divided and the borders become fuzzy and overlap which is usually closely linked to parasomnias.

NREM parasomnias – wake and NREM overlap

Patients may experience: confusional awakenings, enuresis, eating disorder, somnambulism (sleepwalking), sleep terrors, and sexsomnia.

REM parasomnias – wake and REM overlap

Patients may experience: sleep paralysis, nightmare disorder, cataplexy, RBD (REM behavior disorder), and hallucinations (hypnagogic or hypnopompic).

REM and NREM Overlap

Patients may experience: since they are asleep, there’s not much consequence.

Status Dissociates – Wake, REM, and NREM overlap

Patients may experience: quick repetitive variations of all three states.

RBD – REM Sleep Behavior Disorder

A sleep disorder characterized by unpleasant, vivid dreams accompanied by vocalization and rapid movements during REM sleep is called RBD (REM sleep behavior disorder). It may begin with mild events but then progress gradually and worsen. Plus, RBD is also closely linked with multiple system atrophy, Lewy body dementia, Parkinson’s disease, which are all serious neurological conditions.

If the following apply to you, you may be at greater risk of suffering from RBD:

• Male at the age of 50 or more
• Suffer from a neurodegenerative disorder
• Take antidepressants
• Have narcolepsy

How is REM Parasomnia Treated?

Even though strict medical treatment options haven’t been established yet, several options have been proven to be effective in combating REM parasomnia:

• Enhancement of sleep hygiene
• Meditation/ relaxation before bedtime
• Cognitive-behavioral therapy
• Melatonin and clonazepam
• Antidepressants
• Understanding all the sleep stages
• Image rehearsal therapy

NREM Parasomnias

NREM (non-rapid eye movement) parasomnias typically happen in the first half of the night since they occur during SWS (slow-wave sleep). In these events, the brain hasn’t completely transitioned into non-REM sleep, thus it can conduct activities without being aware of them.

How is NREM Parasomnia Treated?

Similar to REM parasomnia treatment, several options may help treat NREM parasomnia, but there isn’t a consensus on how to treat these conditions. So, here’s a list of the treatment options based on the severity of NREM parasomnia:

Mild NREM Parasomnia

• Knowledge and understanding of sleep stages
• Improvement of sleep hygiene
• Avoid drinking hours before going to bed
• Make the environment safe for such events
• Take naps during the day

Moderate NREM Parasomnia

• Cognitive-behavioral therapy
• Hypnosis
• Psychotherapy

Severe NREM Parasomnia

• All of the above-mentioned plus medications