Parasomnias May Be Common—But They're No Joke

We’ve all seen the cartoon and sitcom  characterizations of a sleepwalker: arms outstretched, eyes closed, mouth agape, feet shuffling clumsily. But even though parasomnias—a category of sleep disorders marked by abnormal behaviors, perceptions, and actions—may seem hilarious when Ed Norton is searching in his sleep for his long-lost puppy in The Honeymooners, the reality is no laughing matter. 

Parasomnias, says Bruno DiCosmo, MD, FCCP, who is board-certified in sleep medicine and directs WESTMED Medical Group’s Sleep Center, “are disorders of arousal—a state between asleep and awake.” The most common parasomnias include sleepwalking, sleep talking, nightmares, and sleep terrors. 

Says Praveen Rudraraju, MD, medical director of the Sleep Center at Northern Westchester Hospital, “Parasomnias can occur during NREM [Non-Rapid Eye Movement] sleep or during REM sleep.” The difference? “In NREM sleep, your mind is sleeping, but your body can move,” he says. “In REM, the mind is very active, but the body is paralyzed and there is no tone in the muscles.” This is why you rarely act out nightmares, which occur during REM sleep. 

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Night terrors, on the other hand, “occur in NREM, with sudden semi-arousals associated with intense fear and bolting out of bed, et cetera,” says Dr. DiCosmo.  As frightening as night terrors may be to the observer, Dr. DiCosmo says that “typically, there is no recollection” by those who experience them because the brain is asleep. Still, night terrors can sometimes signal other problems. Dr. Rudraraju says that “nocturnal seizures can mimic parasomnias, so a sleep study should be done to rule that out.”

During NREM, which includes three stages, from light and easily aroused (Stage 1) to deep (Stage 3), people can drive, cook, eat, smoke, or engage in sexual activity. Dr. Rudraraju has seen patients who have “cooked and eaten elaborate meals due to an NREM parasomnia called Nocturnal Eating Behavioral Disorder.” Patients with this disorder, he says, are often treated with medications such as Topamax.

In REM Behavior Disorder (RBD), the paralysis that usually accompanies REM sleep is not present, allowing the person to act out dreams, which are often very violent. “People can hit their spouses, fall out of bed, or worse,” says Dr. Rudraraju. RBD can sometimes be associated with Parkinson’s.    

Another frightening yet benign parasomnia is sleep paralysis, “in which the brain is awake but the muscles cannot function because they’re still in the REM stage,” says Dr. DiCosmo. Two of the most common parasomnias are sleep talking (which can range from jibberish to long narratives) and sleepwalking (which is often marked by a lumbering or unsteady gait). 

What about the old adage that it’s dangerous to wake a sleepwalker? It’s partially accurate, says Dr. Di Cosmo. “When a person is sleepwalking, their brain is still in NREM sleep but part of their nerve connections are awake, so they are able to walk, eat, et cetera. They can become agitated or violent if awakened. Usually, they will just go back to bed and fall fully asleep,” so simply guide the nocturnal wanderer back to bed without waking him.

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What to Do if You’re Experiencing Parasomnias

Doing or experiencing weird stuff in your sleep and don’t know how to stop it? First and foremost, visit your doctor and describe what’s been happening; medication and/or therapy may be in order. Also, maintain good sleep habits. “Avoid sleep deprivation and alcohol, maintain consistent sleep-wake cycles, and treat underlying sleep disorders, such as sleep apnea or restless limbs,” advises Dr. DiCosmo. If safety is an issue, keep the mattress on the floor, use gates and alarms, and remove sharp and dangerous objects.  Finally, talk to your doctor about a sleep study, which will monitor brain waves, breathing, heart rate and rhythm, muscle movements, and eye movements, to help pinpoint the problem.

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