Parasomnias

• Parasomnias are a class of sleep disorder where the sufferer experiences some sort of sleep arousal, usually between sleep stages 
• Sleep walking and night terrors are common parasomnias

Overview of Parasomnias

There are two types of parasomnias – those that occur as the body switches between different stages of sleep and those that involve abnormal REM sleep behavior. For the former, it is usually between stages 3 and 4 sleep that these parasomnias occur – stages which don't involve dreaming. The sufferer has some sort of arousal event as the body transitions between the stages. Many children experience parasomnias, and they are considered a normal, if undesirable, part of development.

Symptoms of Parasomnias

There are a number of common parasomnias:

Sleep Walking (somnambulism):

While not the most common, sleep walking is perhaps the most well-known sleep disorder. A sleep-walker may not be truly asleep, but they are at least in a state of consciousness where they have no recollection of the event. To an outside observer the person appears to be asleep (except for the fact they are wandering around). The sufferer may also engage in other activities once mobile – for example, eating.

The prevalence of sleep walking is 5-7% in children depending on the criteria used in the scientific studies. The rate in adults is approximately half that in children. Apart from any other activities that the sleep walker may engage in, just walking around in a state of limited consciousness will likely result in falls and injury. Contrary to popular opinion it is not dangerous to wake a sleep walker and is actually recommended in the interest of preventing injury.

Night Terrors:

Almost everyone will experience intense dreams and nightmares on occasion. These are a normal, albeit intense, part of REM sleep. Night terrors however are not just very bad nightmares – the sufferer experiences intense anxiety and often panic, is difficult to wake up, and can sometimes run around during an episode. Often the sufferer will not remember the night terror, but the chance of injury during the panic, and the sleep disruption to the patient and caregivers, means that night terrors are a concern.

Estimates of prevalence vary, but up to 5% of young children may experience night terrors, dropping to 1% in adults. Even though not classed as a parasomnia, frequent nightmares should also be addressed.

Confusion Arousal:

Again, this is more common in children than adults. Sufferers may toss and turn in bed, cry, and appear visibly upset. It is often hard to wake them up. It is unclear how many children suffer from confusion arousal, but it it rare over the age of five.

REM Sleep Disorder Behavior:

This parasomnia does not involve arousal from the deep 3 and 4 sleep stages, but rather occurs during REM sleep. Normally, to prevent the body acting out the dreams that we have, the brain effectively paralyzes most of the muscles in our body. This paralysis does not occur for people with REM sleep disorder behavior, and they find themselves acting out their dream. This can result in bodily injury to themselves and anyone that attempts to provide help. The vast majority of sufferers are male and tend to be older, but it has been seen across all ages in both genders.

Causes of Parasomnias

Parasomnias in children are an accepted part of the growing process but that does not mean that parents should not seek help for parasomnias in their children, especially when frequent or of a particularly intense nature. They are considered to just be part of the development of the brain. In adults the causes are unclear, but family history, stress, and drugs (especially some sleeping pills) are linked to parasomnias. For REM sleep disorder behavior, some neurological diseases are also known to be responsible – e.g. Parkinson's.

Treatment for Parasomnias

Treatment differs to some degree for each of the parasomnias – sleep walking for example is usually just managed by ensuring a safe as possible bedroom environment with few trip hazards, open stairwells, or easily opened windows. More problematic sleep walking may be treated with sedatives or antidepressants.

Treatment of night terrors focuses on removing stress, educating parents on how to best deal with them, and in severe cases, medication – again sedatives or antidepressants have been used with success.

For REM sleep disorder behavior, treatment again revolves around creating a safe bed environment, for both the sufferer and bed partner, and medications similar to the other parasomnias.

If you suspect you or your child has a problematic parasomnia, talk to your doctor or sleep specialist.