Parasomnias

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 Parasomnias are a group of sleep disorders that involve unwanted events or experiences that occur while you are falling asleep, sleeping or waking up. Parasomnias may include abnormal movements, behaviors, emotions, perceptions or dreams. Although the behaviors may be complex and appear purposeful to others, you remain asleep during the event and often have no memory that it occurred. If you have a parasomnia, you may find it hard to sleep through the night. 

Confusional arousals is a sleep disorder that causes you to act in a very strange and confused way as you wake up or just after waking. It may appear that you don’t know where you are or what you are doing. Your behavior may include the following:

• Slow speech
• Confused thinking
• Poor memory
• Blunt responses to questions or requests

When a confusional arousal occurs, you may seem to be awake even though you have a foggy state of mind. Episodes often start when someone else has to physically wake you up. Sleepwalking or shouting during an episode is common. Some people with confusional arousals also grind their teeth. These incidents may last a few minutes up to several hours. People with confusional arousals tend to have no memory of these episodes.

Confusional arousals are considered a parasomnia. This class of sleep disorder involves unwanted events or experiences that occur while you are falling asleep, sleeping or waking up.

Confusional arousals tend to occur as you wake from slow-wave sleep. This sleep stage is most common in the first third of the night. In some cases, these episodes may occur later in the night or during a daytime nap.

In some rare cases, adults may act very inappropriately or even hostile and aggressive. This behavior can put a huge strain on relationships. These extreme episodes are uncommon for most people who have confusional arousals.

One variation of confusional arousals is called severe morning sleep inertia. It can affect teens and adults. Sometimes it is called “sleep drunkenness.” The signs of it are the same as those of typical confusional arousals that occur early at night. The difference is that severe morning sleep inertia occurs in the morning when you are waking up.

Severe morning sleep inertia tends to happen every morning, and it can last for years. People with morning sleep inertia may miss time and perform poorly at school or at work. It also can be a source of conflict at home. In rare cases it can cause injuries and drowsy driving accidents.

Episodes of confusional arousals in children may seem bizarre and frightening to parents. The child can have a confused look on his or her face and “stare right through” you. Children may become more agitated when you try to comfort them. Most episodes last from five to fifteen minutes. But they may last as long as thirty to forty minutes in some youth.

Overall, confusional arousals are fairly harmless in children. Arousals are less common after the age of five years. Children who have confusional arousals often will sleepwalk when they are teens.

Confusional arousals are more likely if you have a relative with this sleep disorder. Other factors that can increase your risk for arousals include:

• Rotating shift work
• Night shift work
• Other sleep disorders (hypersomnia, insomnia, circadian rhythm sleep disorders)
• Not enough sleep
• Stress
• Worry
• Bipolar and depressive disorders

Potential causes for this disorder include the following:

• Recovery from sleep deprivation
• Alcohol consumption
• Obstructive sleep apnea (OSA)
• Periodic limb movement disorder (PLMD)
• Psychotropic medication use
• Drug abuse
• Being forced to wake up
• 
  

Confusional arousals occur at the same rate among both men and women. Rates are high among children and adults under the age of 35. It may occur in as many as 17 percent of children. About three to four percent of adults have confusional arousals.

Sleepwalking is also called “somnambulism.” It is a parasomnia. A parasomnia involves undesired events that come along with sleep.

Sleepwalking occurs when you get up from bed and walk around even though you are still asleep. It can also involve a series of other complex actions. Before walking, you might sit up in bed and look around in a confused manner. At other times, individuals may bolt from the bed and walk or run away. They may be frantic to escape from a threat that they dreamed or imagined.

You might talk or shout as you are walking. Your eyes are usually open and have a confused, “glassy” look to them. You might begin doing routine daily actions that are not normally done at night.

More often, it involves actions that are crude, strange, or in the wrong place. This might include urinating in a trash can, moving furniture around, or climbing out of a window. It can also result in hostile and violent behavior.

In rare cases, a patient will get in the car and drive away. He or she might even go for a very long distance. Indecent exposure and other sexual behaviors may also occur. Adults might dream or hallucinate while they sleepwalk. Some people will eat.

It can be very hard to wake a sleepwalker up. When you do wake up, you can be very confused. This is because you normally have no memory of the event. Adults sometimes recall bits and pieces of what took place. Less often, they will have a very clear memory of all that happened.

At times, you might even attack the person who wakes you. Men, especially, are often violent during these episodes. The walking can also suddenly end by itself. This might leave the individual in a very awkward place. At other times, the individual may return to bed while still asleep. He or she will have never awakened during the event.

Sleepwalking most often occurs in the first third of a night’s sleep or during other long sleep periods. This is during the slow-wave cycle of sleep. Every now and then, it can occur during a daytime nap.

Episodes can occur rarely, or very often. They can even happen multiple times a night for a few nights in a row. The main risk is injury to self, the bed partner, or others in the same home. It can also disrupt the bed partner’s sleep.

Sleepwalking can usually be seen as a fairly normal part of a child’s early sleep patterns. The child with calm sleepwalking may quietly walk toward a light or to the parents’ bedroom.

At times, kids will walk to a window or door, or even go outside. This can put them at great risk. Older children may be more vocal and active as they sleepwalk. Children who sleepwalk will often talk in their sleep and have sleep terrors.

Sleepwalking is more common in children and affects both boys and girls. It can begin as soon as a child is able to walk. The rate of it in children is as high as 17 percent. It peaks by the time they are eight to 12 years old. Most children with it also had confusional arousals at a younger age.

Rarely, sleepwalking may begin at any time in the adult life, even when someone is in their seventies. Up to 4 percent of adults sleepwalk. In adults, men are more likely to display aggressive behavior when they sleepwalk.
There is a strong genetic and family link to having it. Your chance of having it can double or almost triple if one of both parents had sleepwalking episodes as a child or adult.

Episodes of sleepwalking and sleep terrors share many of the same causes. These include the following:

• Sleep deprivation
• Hyperthyroidism (overproduction of thyroid hormones)
• Migraine headaches
• Head injury
• Encephalitis (brain swelling)
• Stroke
• The premenstrual period
• Bloated stomach
• Physical or emotional stress
• Obstructive sleep apnea (OSA)
• Other sleep-related disorders or events
• Travel
• Sleeping in unfamiliar surroundings
• Some medications
• Alcohol use and abuse
• Noise or light
• Fevers in children

Sleep terrors is also called “night terrors.” It is a parasomnia. A parasomnia involves undesired events that come along with sleep.

In a typical episode, you will sit up in bed and pierce the night with a "blood-curdling" scream or shout. This scream can include kicking and thrashing. You may say or shout things that others are unable to understand. You will also have a look of intense fear with eyes wide open and heart racing. You may also sweat, breathe heavily and be very tense. At times, you may even bolt out of bed and run around the house. This response is more common in adults. It may also lead to violent actions.

Individuals having an episode of sleep terrors will not respond to voices and can be hard to wake up. Once they do wake up, they will be very confused. They may not know where they are or what is going on. Most often, they will not have any memory of what took place. At times, they may recall brief bits of a dream. This dream will likely involve great danger or fright. It can take a long time to comfort the patient once the episode is over.

It most often occurs in the first third of the time that you are asleep. This is during the slow-wave cycle of sleep. Episodes in adults can occur at any time in the sleep cycle. Adults are also more likely to recall a dream that was a part of the event.

Serious and even deadly injury can occur. Attempts to escape from bed or to fight can result in harm to the patient or others. Individuals may be embarrassed by the sleep terrors. This can greatly affect their relationships with others. 

 Sleep related eating disorder (SRED) is a parasomnia. A parasomnia involves undesired events that come along with sleep. SRED consists of repeated episodes of compulsive binge eating and drinking after waking up in the night. 

Episodes always occur in an “out of control” manner. They tend to occur when you are only partially awake. You may have only a partial memory or no memory of the event afterward. Other people are very alert as they eat. They recall much of the episode in the morning. It may be very hard to wake you up during an episode of eating. Trying to stop a person during an episode tends to provoke anger and resistance. 

A majority of people with SRED have an episode of eating nearly every night. Some eat more than once each night. These episodes tend to occur even though feelings of hunger and thirst are absent. The episodes can occur at any time in the night. 

Foods that are high in calories tend to be eaten the most. It is common to eat or drink thick and sugary foods such as peanut butter or syrup. The foods eaten during sleep are usually not preferred during the day.

The foods are consumed very rapidly. An entire episode may last for only ten minutes. This consists of the time it takes to get from bed to the kitchen and back to bed again. 

Injuries may occur during an episode. Sloppy food handling often occurs. You may or may not prepare hot or cold foods properly. This can cause cuts and burns. Fires can also occur from careless cooking. Alcoholic drinks are almost never consumed. You may find a very messy kitchen in the morning. This may cause you to remember the episode.

SRED may develop slowly over time. It may also begin quickly with nightly episodes of eating from the start. It is long lasting and does not seem to ease up over time. It may be a factor in causing depression. This can result from a sense of shame and failure to control the eating. Some people with SRED may avoid eating during the day. They may also get too much exercise in an attempt to prevent obesity.

Problems resulting from SRED include the following:

• Eating strange forms or combinations of food, such as raw bacon, buttered cigarettes or coffee grounds
• Eating or drinking toxic substances, such as cleaning solutions
• Eating foods to which you are allergic
• Suffering from insomnia due to sleep disruption
• Sleep-related injury
• Loss of appetite in the morning
• Stomach pain
• High cholesterol
• Excessive weight gain and obesity

 Sleep eating disorder  is defined by repeated episodes where you rapidly binge eat and drink after you wake up in the night. These episodes are out of control and tend to occur when you are only partially awake. You may only have a slight memory or no memory of the binge. This may occur nightly. The food is often highly caloric and consumed in strange combinations. People with sleep related eating disorder might accidentally injure themselves by eating toxic substances, burning themselves or causing fires.

People with sleep eating disorder often:

• Have repeated episodes of “out-of-control” eating and drinking during the time when they sleep
• Eat strange forms or combinations of food
• Eat or drink inedible or toxic substances
• Have eating episodes that disturb their sleep, causing insomnia. As a result, their sleep is not refreshing or you are very tired during the day
• Injure themselves
• Do something dangerous while getting or cooking food
• Have a loss of appetite in the morning
• Have their health decline from eating foods that are high in calories

It is also important to know if there is something else that is causing your problem. It may be a result of one of the following:

• Another sleep disorder
• A medical condition
• Medication use
• A mental health disorder
• Substance abuse

 It is not known how many people have SRED. Like other eating disorders, it is much more common in women than in men. Females represent about 65% to 80% of SRED patients. The average age when it first occurs is 22 to 29 years. It tends to be an ongoing and long-lasting problem. 

Recurrent isolated sleep paralysis is a parasomnia. A parasomnia involves undesired events that come along with sleep. Sleep paralysis causes you to be unable to move your body at either of the two following times:

• When falling asleep (hypnagogic or predormital form)
• When waking up from sleep (hypnopompic or postdormital form)

 Normally your brain causes your muscles to relax and be still as you sleep. This is called “atonia.” Sleep paralysis seems to be when this atonia occurs while you are awake. Sleep paralysis is “isolated” when it appears without any other signs of narcolepsy. 

An episode of paralysis may cause you to be unable to speak. It can also make you unable to move your arms and legs, body, and head. You are still able to breathe normally. You are also fully aware of what is happening. An episode can last for seconds or minutes. The episode usually ends on its own. It may also end when someone touches you or speaks to you. Making an intense effort to move can also end an episode. Sleep paralysis may occur only once in your life. It may also happen many times in a year.

It can be very scary when you are unable to move. You may feel anxious and afraid. Some people also hallucinate during an episode. They may see, hear or feel things that are not there. They may even think that another person is in the room with them. These hallucinations may also appear without the sleep paralysis.

Sleep paralysis tends to first appear in the teen years. It then occurs most often when you are in your 20s and 30s. It may continue into your later years. It is not a serious medical risk.

Sleep paralysis can be one sign of narcolepsy. Other signs include disturbed sleep at night and falling asleep suddenly during the day. Recurrent isolated sleep paralysis does not disturb your sleep. 

Nightmares that occur frequently and keep you from getting restful sleep are considered a sleep disorder. Nightmare disorder is a parasomnia, a category of sleep disorders that involves unwanted events or experiences that occur while you are falling asleep, sleeping or waking up.

If you have nightmare disorder, you may fear going to sleep or worry that each night you will have another nightmare. You may also feel anxious and scared when you wake up from a nightmare and be unable to fall back to sleep. Sleep loss can cause you to have even more intense nightmares. As a result, you may experience daytime sleepiness.

Nightmares are usually coherent visual dreams that seem real and get more disturbing as they unfold and cause you to wake up. These most often happen towards the end of your sleep period. These dreams most often involve imminent physical danger. Nightmares may also focus on other distressing themes and provoke negative emotions such as:

• Anxiety
• Fear
• Terror
• Anger
• Rage
• Embarrassment
• Disgust
• Other negative feelings

In most instances after you wake up, you will be able to clearly remember the details of your nightmare. A disturbing dream that does not wake you up is not considered a nightmare. Instead it is simply a bad dream. It is possible to have more than one nightmare, often with similar themes, during a night of sleep.

Nightmares tend to happen during REM sleep, the last stage in the sleep cycle. About 20-25 percent of your total sleep time is in REM sleep. The REM stage gets longer during each sleep cycle and your final period in REM may last up to an hour. Because of this, nightmares are most likely to occur in the final third of the night. Nightmares that arise from trauma, such as in people with PTSD, may also occur in earlier sleep stages.

Nightmares can happen to anyone, but nightmare disorder is relatively rare. The key difference for nightmare disorder is the inability to get sufficient sleep because of disturbing dreams. An estimated 2-8 percent of people have nightmares that cause sleep problems.

Nightmares are especially typical in children aged 3-6 years. Up to 50 percent of young children have severe nightmares that cause them to wake up their parents. Nightmares in children tend to peak by ten years of age. After that time, nightmares usually decrease. Some children continue to have nightmares as teens and adults. This may be a lifelong problem for these individuals.

An estimated 50-85 percent of adults report having the occasional nightmare. Nightmares tend to become less frequent and intense as you age. Women tend to report nightmares more often than men, but are also more open to discussing their dreams.

Other sleep disorders also classified as parasomnias are sometimes mistaken for nightmares:

Night terrors – These episodes cause you to wake up disoriented from slow-wave sleep in intense fear with your heart racing. Night terrors may cause you to scream, kick, thrash or bolt out of bed. It’s usually difficult to remember what happened, though you may be able to recall brief segments of a terrifying dream. Night terrors tend to occur in the first third of the night.

REM sleep behavior disorder - A potentially dangerous sleep disorder that causes you to act out vivid dreams as you sleep. The dreams are usually filled with action and may even be violent. Because these actions may result in injury to yourself or your partner, REM sleep behavior disorder is considered a dangerous condition that requires medical attention. This disorder is most common in middle-aged men.

 Bedwetting is also called sleep enuresis. It is a parasomnia. A parasomnia involves undesired events that come along with sleep. Bedwetting occurs when a person urinates by accident in his or her sleep. 

It results from a failure to wake up from sleep when the bladder is full. It may also result from a failure to prevent a bladder contraction. These are skills that you acquire as you grow and develop. 
There is a wide range in the age at which these skills are gained. Urinating is a reflex for infants when they are asleep and awake. This occurs up to about 18 months of age. 
From 18 months to about three years of age, a child begins learning to delay urination when the bladder is full. First the child learns to do this while awake. 
At a later age, he learns to do this while asleep. The developmental maturity of the child will help determine the age at which this skill is gained. 

Most children should be able to control their bladders during sleep by the time they are about five years of age. Thus, bedwetting is not considered a sleep disorder unless it occurs at least twice a week in a person at least five years of age.

Bedwetting can be primary or secondary. A child with primary bedwetting has never regularly stayed dry during sleep for six straight months. 

A child or adult with secondary bedwetting had earlier stayed dry for at least six straight months. Then he or she began bedwetting at least twice a week for a period of at least three months.

The amount of vasopressin in your body normally increases during sleep. This is a hormone that is produced by the pituitary gland. It reduces the amount of urine that is produced by the kidneys. 
The increase in vasopressin keeps you from having to go the bathroom so often at night. A small number of children with primary bedwetting lack this normal increase of vasopressin during sleep. As a result, they have more urine than their bladders can hold. If they do not wake up, then they will wet their beds.

A child’s self-esteem can be hurt when he or she wets the bed. This is the main risk involved with primary bedwetting. How well the child’s family deals with the symptom is very important. Their reaction will determine to a great extent how severe the problem becomes. 

If your child is older than five years of age and has primary bedwetting they may:

• Urinate by accident during sleep at least twice a week
• Regularly stay dry during sleep for a period of at least six months in the past

If you or your child is older than five years of age and have secondary bedwetting they may:

• Urinate by accident during sleep at least twice a week
• Regularly stay dry during sleep for a period of at least six straight months in the past

 Primary bedwetting is present at the following rates in children and teens:

• 10% of six-year-olds
• 7% of seven-year-olds
• 5% of 10-year-olds
• 3% of 12-year-olds
• 1% to 2% of 18-year-olds

Primary bedwetting is more common in boys than in girls. The rate of children with primary bedwetting who get better on their own is about 15% each year. 

There appears to be a genetic link to primary bedwetting. Children are more likely to have it if their parents and/or siblings had it as children. Bedwetting is reported by 2.1% of older adults in assisted-living homes. It is more common among women than men.

Some people may also urinate by accident when they are awake. This tends to be related to a physical problem. Social or mental stress is rarely the cause of primary bedwetting. But it does occur more often in the following children:

• Children with attention-deficit/hyperactivity disorder
• Children living in disorganized families

Secondary bedwetting occurs more often in children who have recently faced a strong social or mental stress. This includes the following:

• Parental divorce
• Physical or sexual abuse
• Neglect
• 
  

Children with secondary bedwetting are also more likely to have constipation and to soil their pants. 

A disorder such as confusional arousals (waking during a very deep stage of sleep) may involve a child urinating in a strange place during sleep. Otherwise, this child tends to keep a dry bed at night.

Secondary bedwetting can occur at any age. It can be related to or caused by any of the following:

• An inability to concentrate urine, as in sickle cell disease or some forms of diabetes
• An increase in urine production caused by the use of caffeine, diuretics, or other substances
• A urinary tract problem, such as urinary tract infections or an irritable bladder
• Chronic constipation and involuntary soiling of the pants
• A neurologic problem, such as seizures and epilepsy
• Obstructive sleep apnea (OSA)
• Social or psychological stress
• Among older adults, it may be related to symptoms of the following:
• Congestive heart failure
• Obstructive sleep apnea (OSA)
• Depression
• Dementia

Sleep related hallucinations are a parasomnia. A parasomnia involves undesired events that come along with sleep. Sleep related hallucinations are imagined events that seem very real. They are mainly visual. They may also involve your senses of sound, touch, taste and smell. They may even involve a sense of motion.

It is easy to confuse them with a state of dreaming. You may not be sure if you are awake or asleep. They may be similar to nightmares. But when you wake up from a nightmare, you are aware that it occurred while you were asleep. It is clearly recognized as a dream. It is not thought to be real.

They generally occur at one of the two following times:

• As you are about to fall asleep (hypnagogic)
• As you are just waking up (hypnopompic)
• 
  

If they occur during the day, then they may be sign of narcolepsy. People with narcolepsy may have daytime episodes of the following:

• Sleep attacks
• Sleep paralysis
• Hypnagogic hallucinations
• 
  

The hallucination and the sleep paralysis may occur at the same time but on different nights. You may also have separate episodes of sleep talking or sleepwalking.

You may also have complex visual hallucinations in the form of stationary images of people or animals. These tend to occur just after you are suddenly awakened. You do not recall being in the middle of a dream when you wake up. You clearly know that you are awake. At first you are often afraid and think that the images are real. You may jump out of the bed in terror. This can cause you to injure yourself.

These images may be distorted in shape or size. They may remain present for many minutes. They tend to go away if a light is turned on. These episodes are much rarer. At times they may be caused by a migraine headache. In this case the head pain quickly follows the visual images. 

Exploding head syndrome is a parasomnia. A parasomnia involves undesired events that come along with sleep. Exploding head consists of a loud noise that you suddenly imagine just before you fall asleep. It can seem like a violent explosion has gone off in your head. It can also occur as you wake up in the night.

It has also been described in the following ways:

• A painless loud bang
• A clash of cymbals
• A bomb exploding
• 
  

At times it may seem like a less alarming sound. Episodes can cause a high level of distress and fear. Many people think that they are having a stroke. The number of attacks varies. They can happen very rarely. They can also occur many times in one night. Having many episodes can greatly disturb your sleep. Some people report having a cluster of attacks over several nights. Then a few weeks or months will pass before it occurs again. 

A flash of light may come along with the sound. A muscle twitch or jerk may also occur. The event is normally painless. A sudden stab of pain in the head has at times been reported.

The cause of exploding head is not known. It may occur more often when you are very tired or under stress. In many people the episodes occur less often over a period of years.

Exploding head syndrome can be confused with other headache syndromes. But exploding head is normally painless. Headache syndromes can cause great pain. 

You may have Exploding Head Syndrome if you:

• Imagine a sudden loud noise or explosion in your head just before falling asleep or just after waking up in the night
• If these sounds are normally free of any sense of pain
• If these events wake you suddenly with a sense of fright
• 
  

It is also important to know if there is something else that is causing the imagined sound. Instead of being exploding head syndrome, it may be a result of one of the following:

• Another sleep disorder
• A medical condition
• Medication use
• A mental health disorder
• Substance abuse

 The medical term for this activity is "somniloquy." It occurs when you talk out-loud during sleep. A listener may or may not be able to understand what you are saying.

The subject matter being talked about tends to be harmless. It may also make no sense at all. At other times, the content may be vulgar or offensive to a listener. The talking can occur many times and might be quite loud. This can disrupt the sleep of a bed partner or roommate.

Sleep talking may occur in any stage of NREM sleep or REM sleep. It is still unknown if the talking is closely linked to dreaming.

Sleep talking is very common. It is reported in 50% of young children. About 5% of adults are reported to talk in their sleep. It occurs at the same rate in both men and women. It also appears to run in families. 

If you feel you or your family member has any of the above concerns please call us today to consult with Dr. Mathur.