Parasomnia is a term used to describe undesirable physical events that occur at sleep onset, during sleep or upon arousal from sleep. Those events reflect nervous system activity breaking through normal sleep.
Parasomnias are characterized by physical acts that occur during sleep. Common parasomnias include sleepwalking, sleep talking, sleep terrors, nightmares, and teethgrinding.
Sleepwalking occurs when one gets up from bed and walks around although one is still asleep. It may also be associated with other complex actions. In some instances, this is associated with confusion and fear. When confronted, hostile and violent behavior may occur.
Complex behavior including driving, eating, indecent exposure, and sexual behavior may occur in some instances. Sleepwalking most often occurs in the first third of the night's sleep out of slow wave sleep.
Sleepwalking may be a benign part of childhood and most children outgrow it. If, however, the sleep walking behavior poses any danger to the person or others, it needs to be evaluated and treated.
There is a strong familial component to sleep walking. Chances of having sleep walking can double if a parent had any sleepwalking either as a child or as an adult.
Sleep Terrors - Night Terrors
Typically, the patient sits up in bed with eyes wide open and screams a "blood-curdling" scream. The patient may kick and thrash and may say unintelligible things. At times, the patient may run around the house and, especially in adults, this may lead to violent actions.
During a sleep terror episode, individuals will not respond to voices and can be hard to wake up. Once they do wake up, they usually are agitated and very confused. Frequently, they will not have any memory of what took place.
Sleep terrors most often occur in the first third of the night out of the slow-wave stage of sleep. Serious and even deadly injury has been known to occur.
Sleep terrors may be normal in children and they may outgrow them. Normally, medical treatment is not needed unless it is very disruptful and causes injury.
An adult who continues or begins to have sleep terrors is at a greater risk of injury. In this case, it is important to get an evaluation and treatment.
REM Behavior Disorder (RBD)
RBD occurs when the muscle paralysis that is normally seen during Rapid Eye Movement (REM) sleep fails to occur. This causes the patients to act out their dreams. This is usually associated with complex physical activity, and may even be violent. RBD tends to get worse over time.
Although the symptoms may be somewhat similar, RBD should not be confused with sleepwalking. The confusion normally seen with sleep walking and night terrors is absent in RBD. It is normally easy to wake a person with RBD and, once awake, the patient is usually able to remember the details of the dream. The physical activity usually matches the actual dream activity.
RBD is a medical problem and is more common in men. It can appear at any age, but is more often seen at an older age. RBD is also more frequent in people with neurologic disorders. Parkinson's disease and RBD frequently coexist and patients with RBD may develop Parkinson's disease many years later.
People with RBD may have other coexistent sleep disorders such as Periodic Limb Movement Disorder and Narcolepsy. Some medications, such as some antidepressants, may cause RBD or make it worse.
Treatment of RBD usually involves the use of medication. Klonazepam is the most frequently used medication and usually produces good results.
Measures that ensure the safety of children and adults with parasomnias should be implemented to avoid injury to the patient or others. This includes alarms, special locks, and padding of sharp edges and corners. Understanding the disorder and its characteristic behavior helps avoid unnecessary agitation and injury.