PARASOMNIAS

PARASOMNIAS

Parasomnias are undesired behaviors which occur during sleep. There are two main classifications of parasomnias; REM parasomnias and NREM parasomnias.

NREM Parasomnias

Sleepwalking (Somnambulism) is one of the most common parasomnias. People with this condition get up out of bed and walk around but they are still asleep. The person’s eyes remain open but they often have a glassy stare. When sleepwalking a person might do activities that they would normally do during the day but more often they involve actions that are crude. For instance, a person sleepwalking may urinate in a trash can or climb out a window. People can be violent when sleepwalking and can injure themselves or others. It is very difficult to awaken as a sleepwalker. Certain medical conditions, such as obstructive sleep apnea, increased the frequency of sleepwalking.

Sleepwalking is more prevalent during the first decade of life and affects up to 10% of children but often gradually diminishes until adulthood. Having a first-degree relative who sleepwalks increases one’s risk of developing this behavior. Untreated OSA can also increase the frequency of sleepwalking. Certain sleeping pills can cause sleepwalking. Sleep deprivation, stress, alcohol consumption, and sleeping in an unfamiliar environment can also exacerbate sleepwalking. Frontal lobe seizures can sometimes be confused with sleepwalking.

Treatment of sleepwalking involves evaluating underlying or contributing causes to the condition, such as OSA. Avoidance of both alcohol and sleep deprivation is also recommended.

Behavioral strategies to reduce sleepwalking include placing the mattress on the floor and sleeping in a sleeping bag. This makes it more difficult to leave the bed.

Home safety is very important if one sleepwalks. Ideally, the bedroom should be on the first floor to minimize injury if one climbs out the window. Weapons and car keys should be locked away at night. An alarm or bell should be placed on the bedroom door to alert other family members about a potential sleepwalking event. If one finds a room-mate who is sleepwalking it is best to gently lead them back to their bedroom to avoid injury.

If sleepwalking persists there are prescription medications which can reduce or eliminate these events.

​​​​​​​REM Behavior Disorder

REM Behavior Disorder (RBD) is one of the most common parasomnias which occurs during REM (dream) sleep. It occurs more frequently in men over the age of 50. People with RBD act out their dreams and often yell when asleep which can result in injury to oneself or their bed partner. People who have this condition often describe their dreams having persecutory themes which are violent and intense.

Normally during REM sleep, the only muscles which move are the eyes, tongue, and diaphragm (for breathing). BRD occurs because the brain’s control center which normally paralyzes the body during REM sleep does not work correctly. This condition is seen more frequently in people with Parkinson’s disease and certain types of dementia. People with untreated obstructive sleep apnea can have symptoms which mimic REM behavior disorder.

There are several medications that effectively treat RBD and prevent these behaviors from occurring. The most effective is Clonazepam which is a prescription medication taken before bedtime.