Sleep Disorders

What are sleep disorders?

Sleep disorders include a range of problems, from insomnia to narcolepsy, and affect millions of Americans.

Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Door alarms can help by awakening a person during an episode. Also, a person who suffers from parasomnias should not sleep on a top bunk, or next to a window. It is important to remove sharp objects from the bedside area and to be sure roommates and household members are aware of the problem and what to do about it.

How are sleep disorders diagnosed?

The term “parasomnia” refers to all the abnormal things that can happen to people while they sleep, apart from sleep apnea. Some examples are sleep-related eating disorder, sleepwalking, nightmares, sleep paralysis, REM sleep behavior disorder, and sleep aggression. Parasomnias can have negative effects on people during the daytime, including sleepiness.

When do parasomnias occur?

Parasomnias can occur as a person is falling asleep or at any point in the sleep cycle. If they occur while falling asleep, a person may experience disturbing hallucinations or sleep paralysis, which is when the body is unable to move for seconds or minutes. Sleep paralysis can be quite frightening, especially when it occurs with hallucinations.

Parasomnias that occur during sleep, such as REM sleep behavior disorder (RBD), often involve vigorous and harmful dream-enacting behaviors. RBD is a brain disorder that usually occurs in men over 50 years of age, but can affect people of any age who are taking certain medications, such as antidepressants, and people with neurologic disorders, such as Parkinson’s disease, narcolepsy or stroke. Other parasomnias that occur during sleep include nightmares and sleep-related groaning, which can be loud and prevent a person’s bed partner or roommate from sleeping.

In addition, there are parasomnias that occur when a person has abrupt, partial awakenings, such as confusional arousals, sleepwalking, sleep terrors, and sleep-related eating disorder.

Sleep-related hallucinations may also occur as a person is waking up.

How are sleep disorders treated?

Many people who suffer with parasomnias see an improvement in their symptoms simply by improving their sleep habits. Good sleep habits include keeping a regular sleep schedule, managing stress, having a relaxing bedtime routine, and getting enough sleep. There are also drug therapies that are used to control symptoms.

A person should seek treatment whenever there is risk for injury to oneself or another person from the parasomnia. It is also important to seek treatment if the parasomnia disrupts a person’s own sleep or the sleep of the bed partner or roommate, of if there is distress about the symptoms (e.g., nightmares), or if the frequency is quite high or escalating. An overnight sleep lab study may be needed.

It is important to keep in mind that no matter how weird, bizarre, or violent the behavior, a parasomnia is rarely linked with a psychiatric disorder. However, people who suffer from parasomnias may endure ridicule, confusion, and/or shame about their symptoms. In addition, bed partners, family members, and roommates may suffer sleep loss as a result of the parasomnia. In many cases, seeking help from a therapist or support group can help people with parasomnias and the people close to them cope with these issues.

When should I consider seeing a sleep specialist?

All patients with adult onset parasomnias (NREM and REM) need to see a sleep specialist for an evaluation. The evaluation should include a nocturnal polysomnographic study, and the sleep specialist will determine whether the patient needs an MRI of the brain or a neurologic work up. When parasomnias lead to injury or psychological distress to the patient or the bed partner, result in law breaking, impair functioning due to excessive daytime sleepiness, cause weight gain, or complicate the treatment of a primary Axis I disorder, a referral should be made to a sleep specialist for evaluation and treatment.