Sleep Talking or Even Sleepwalking? You Might Have Parasomnia!

Unusual behaviors such as talking, walking, eating, or acting strangely while you sleep are collectively known as parasomnias, a type of sleep disorder.

These actions can happen during the transition into sleep, while asleep, or during arousal from sleep to wakefulness. A sleep partner may think you're awake during parasomnia episodes, but you're unconscious and unlikely to remember when you wake.

While parasomnias are common, particularly in children, they can be frightening and disrupt normal sleep patterns. They can also be dangerous as you're at risk of harming yourself or others. In some cases, they may also signal an underlying medical condition.

However, there are treatments available that can help people manage or even stop parasomnia episodes.

What is parasomnia?

Parasomnias are a group of sleep disorders that cause abnormal behavior during the transition between sleep and wakefulness or during arousals from sleep. They may include anything from talking or walking to more complex activities such as eating or driving.

Most people with parasomnias are unaware of their behaviors and don't remember them after waking up. In some cases, however, people may be aware of their actions but feel as though they're in a dream-like state and unable to control themselves.

Parasomnias most often occur in children, but they affect around 4% of adults.

Causes of parasomnia

There is no singular cause of parasomnia. Sometimes, it may be due to an underlying medical condition such as sleep apnea or chronic pain.

Other possible factors that may increase the risk of developing parasomnias include:

• Family history.
• Alcohol use disorder.
• Insomnia.
• Mental health issues.
• Restless legs syndrome (RLS).
• Sleep deprivation.
• Stress.
• Substance use or withdrawal.
• Taking medications, such as sedatives.

Types of parasomnias

Parasomnias may occur during any sleep stage and may involve various behaviors.

As you sleep, you cycle through NREM or non-rapid eye movement sleep and REM sleep or rapid eye movement sleep. NREM sleep is further divided into three stages: N1, N2, and N3. The cycles repeat around 4–6 times each night.

NREM sleep

NREM sleep, also called quiescent sleep, has three stages:

• N1: The lightest stage of sleep that occurs as you fall asleep. You may feel drowsy, and your muscles are relaxed. Brain activity slows, and you may experience hypnagogic hallucinations, which are visual or auditory sensations that seem real but are products of your imagination.
• N2: A period of light sleep when your eye movements stop, and brain activity slows.
• N3: Slow-wave sleep, that's the deepest stage of sleep. It’s when your breathing and heart rate are at their lowest. Slow-wave sleep is important for physical restoration and mental well-being.

NREM parasomnias

Here are some of the types of parasomnias that may occur during NREM sleep:

• Sleepwalking. Also known as somnambulism. This arousal disorder involves getting up and walking around while sleeping. You may also talk or perform typical daily activities like eating or watching TV. If you wake while sleepwalking, you may appear confused or disoriented.
• Sleep bruxism. This movement disorder affects around 13% of adults. It involves clenching or grinding the teeth during sleep and can lead to headaches, earaches, jaw pain, and abnormal tooth wear.
• Confusional arousal. This means waking up in a confused state and not knowing where you are or what you're doing. You may speak slowly, cry, or shout. The episodes may last anywhere from a few minutes to several hours. This parasomnia affects around 17% of children.
• Sleep terrors. Also called night terrors. They involve episodes of intense panic or fear during the first third of the night. You may scream and thrash around and have a rapid pulse and breathing rate. Sleep terrors are most common in children aged 3–7 years.

REM sleep

Rapid eye movement sleep is the final stage of the sleep cycle, beginning around 90 minutes after falling asleep.

During REM sleep, your eye movements are rapid, your breathing is shallow, and your heart rate and blood pressure increase. You may have dreams during REM sleep as your brain activity resembles a waking state.

REM parasomnias

These parasomnias may occur during REM sleep:

• REM sleep behavior disorder (RBD). This involves losing muscle paralysis during REM sleep, allowing you to act out your dreams physically. You may shout, kick, punch, talk, shout, or scream. Although RBD doesn't usually affect your sleep, it can lead to injuries. RBD is more common in males over 50. Doctors also associate them with neurodegenerative disorders, such as Parkinson's disease.
• Nightmares. These vivid and disturbing dreams can be terrifying and cause significant anxiety. If you experience them frequently, you may have a nightmare disorder.
• Sleep paralysis. Your muscles relax as you fall asleep. During REM sleep, the muscles relax completely in a state called atonia. If you're awake during atonia, the result is sleep paralysis. You may feel paralyzed and unable to move, speak, or breathe. A sense of fear or doom can accompany the paralysis. Episodes may last seconds or minutes and usually resolve spontaneously.

Diagnosis and treatment

Your primary care doctor can help rule out any underlying health conditions contributing to parasomnia.

They can also refer you to a sleep specialist who can diagnose your condition with an overnight stay in a sleep laboratory. This study, called a polysomnogram, records your brainwaves, breathing, and heart rate and allows a specialist to analyze your sleeping behavior.

The treatments for parasomnia may vary according to your symptom severity and age. However, your doctor may recommend medication if you have frequent or recurring parasomnia. These may include antidepressants, dopamine agonists, or benzodiazepines like clonazepam.

However, if medications cause your symptoms, your doctor may recommend alternatives or a different dose. You mustn't stop taking any regular medication without your doctor's approval.

Your doctor may also recommend cognitive behavioral therapy (CBT) to relieve any underlying mental health concerns like stress and anxiety. Other options include relaxation therapy, talk therapy, and hypnosis.

If you or your child's parasomnia follows a specific pattern, your doctor may suggest scheduled awakenings. This involves waking up around 15 to 30 minutes before the time when parasomnia behaviors usually occur. Doctors often use this technique for sleepwalking and night terrors.