Parasomnias

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Things that go bump in the night are terrifying. Parasomnias are abnormal movements, emotions, behaviors, perceptions, and dreams that occur while falling asleep, sleeping, or awakening. Parasomnias can occur during arousals from rapid eye movement (REM) sleep or arousals from non-rapid eye movement (NREM) sleep.

What we offer at Sleep and Brain

Parasomnias can occur during arousals from rapid eye movement (REM) sleep and arousals from non-rapid eye movement (NREM) sleep. Our diagnostic process begins with a detailed clinical history to elucidate whether your parasomnia emanates from REM sleep versus NREM sleep as described below:

  • Non-REM Parasomnias

    • Night terrors

      • Do you abruptly arouse from sleep, crying and screaming, with your heart racing, breathing fast, and skin flushed? You may seem awake but are confused and can't coherently communicate. Someone trying to console you may agitate you further. Does this frenzied state last for minutes following by lying down and falling back to sleep? And when asked the following day, can you recall the episode? Whether a child or an adult, night terrors are a cry for help.

    • Sleepwalking

      • Do you ever walk or run with your eyes open but asleep? Have you bumped into things or fallen because you are not fully aware of your surroundings? And after walking, do you go back to sleep and awaken without recollection of having slept walked?

    • Confusional arousals

      • Have you awoken, sat up in bed, and looked around in a confused manner - reacting slowly to commands or trouble understanding questions posed to you in this confused state?

  • REM Parasomnias

    • Nightmares

      • Are your dreams vivid, instilling you with fear, terror, and anxiety? Do you dread recalling the harrowing details and returning to sleep, fearing to dream again?

    • Sleep paralysis

      • Have you been unable to move your limbs when falling asleep or waking up? Is the experience terrifying? And can sound or touch breaks the spell of sleep paralysis, allowing you to move freely again?

    • REM sleep behavior disorder

      • Do you act out your dreams? Are they violent? Rather than fighting an intruder, have you struck your bedmate? Rather than wrestling a rabid dog, have you fallen out of bed? Or more onerously, over time, have you noticed your movements are less fluid and your balance is lost?

Our careful clinical history coupled with a specialized physical examination elucidates the complex and multi-factorial causes of parasomnias as exampled below:

  • Brain Health Conditions

    • Anxiety in various forms (i.e., PTSD, OCD) can trigger confusional arousals, sleepwalking, and night terrors.

    • REM sleep behavior disorder is often an early sign of Parkinson's disease or other neurogenerative conditions.

  • Sleep Health Conditions

    • Sleep deprivation, irregular sleep-wake schedules, and narcolepsy can trigger sleep paralysis.

    • Sleep-disordered breathing can cause nightmares and night terrors.

  • Drugs

    • Psychotropic medications can elicit nightmares and REM sleep behavior disorder.

    • Alcohol can trigger sleepwalking.

  • Genetics

    • Sleepwalking can affect multiple family members.

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Parasomnias occur following an arousal from sleep. We may recommend sensitive home sleep testing with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.

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Laboratory sleep testing, performed in. your home, may be necessary to assess for causes of arousals from which parasomnias occur.

Given anxiety and other brain health conditions can trigger parasomnias, we offer sophisticated testing to elucidate areas of brain imbalance. A brain map can pinpoint which brain areas are hyperactive and hypoactive and assess which networks between brain areas are improperly functioning. Together, the data allows us to determine if a brain health condition is contributing to parasomnias.

Understanding the cause of your sleepiness is essential to customize a treatment regimen. Treating sleep problems may improve daytime alertness and vitality. We direct treatment toward the sleep disorder as exampled below:

    • Removing the tonsils, expanding the palate, and starting CPAP can help anxiety and disordered sleep symptoms.

    • Iron and dopamine deficiencies can cause RLS, PLMD, and, in part, ADHD. We treat RLS with iron supplements, medication, and non-medication therapies.

    • Identifying and eliminating the cause of awakenings from sleep

    • Utilizing light therapy to advance or delay your sleep cycle

In addition to treating an underlying sleep disorder, we institute robust behavioral interventions. Ensuring adequate sleep is vital as sleep deprivation can worsen parasomnias. Examples of non-medical forms of therapy that we may incorporate into your daily routine are as follow:

  • Ensuring your bedroom environment is conducive to sleep

  • Eliminating sources of sleep interruption like light and noise

  • Optimizing your diet as food can promote and hinder sleep

  • Assessing your nighttime habits and rituals

Although behavioral approaches are frequently helpful, some people with parasomnia, especially those with REM sleep behavior disorder, also receive treatment with medications. We use drugs judiciously as, at times, they can worsen parasomnias. Some of the medicines we prescribe for parasomnias include:

  • Melatonin

    • Melatonin is especially effective in REM sleep behavior disorder.

  • Clonazepam

    • Clonazepam is also effective in REM sleep behavior disorder, but we cautiously use it in the elderly due to the risk of falls and confusion.

 
 
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