Ryan Hays, M.D. Answers Questions On: Parasomnias

Parasomnias comprise a variety of abnormal, complex behaviors that happen during sleep – from simply sitting up in bed to sleepwalking to shouting, punching, kicking, or otherwise acting out dreams. These conditions are often poorly described, unrecognized, and misdiagnosed.

Because epileptic seizures that arise from sleep also involve uncontrollable behaviors during impaired consciousness, they can be difficult to distinguish from parasomnias – even for physicians.

The treatments for parasomnias and epilepsy differ significantly, so it’s important for patients who experience worrisome sleep behaviors to see a sleep medicine specialist.

By performing thorough, very specialized evaluations and using state-of-the-art testing, we can make the correct diagnoses and provide the most appropriate evidence-based therapies.

People who experience parasomnias can be at risk for a number of things – from fairly harmless to quite severe.

Sleepwalkers, for example, can easily injure themselves. In rare cases, parasomnias can cause behaviors such as jumping out of windows or ingesting harmful substances – all while people are asleep.

Certain parasomnias also can be the first manifestations of other neurological conditions, such as Parkinson’s disease.

In these cases, parasomnias may occur years prior to the onset of more well-known Parkinson’s symptoms such as tremors and trouble walking. Early identification of these parasomnias may one day allow us to start disease-modifying therapies sooner than we’re currently able to do.

No, we see these disorders across the age spectrum.

For example, many children sleepwalk, with the prevalence typically peaking around ages 6 and 7 and the condition resolving between ages 10 to 12. Because sleepwalking is often harmless in children, treatment frequently isn’t necessary. We tend to be more concerned about patients who don’t outgrow it.

Sleepwalking that persists or develops in adulthood typically warrants an evaluation to determine whether other conditions could be disrupting normal sleep physiology. If we can identify and treat those sleep disruptors, the parasomnia may improve, as well.

Young adults may suffer from an REM or non-REM parasomnia and/or sleep-related epileptic seizures. Because the conditions cause similar body movements, making a correct diagnosis requires us to test for all possible conditions.

Older adults tend to present with a parasomnia termed REM behavior disorder (RBD), during which they may experience vivid, violent dreams and actually act out their dream content with yelling, punching, kicking, and lunging.