“Parasomnias” is a term that covers a range of sleep disorders and disorders, from common events like sleepwalking to the really bizarre ones like “Exploding Head Syndrome”. If you have any of these parasomnias here is what you can do. (If these symptoms persist, talk to your doctor about a sleep study.)
1. Sleepwalking (somnambulism)
If you’ve ever woken up and found yourself outside of bed without knowing how you got there, you may have experienced somnambulism, better known as sleepwalking. You might even wake up to look at a half-drunk box of orange juice, text your mom, or even go outside in complete darkness. That’s why sleepwalking isn’t just scary for onlookers; it can actually be dangerous!
In fact, more than half of adult sleepwalkers have shown violent sleepwalking behavior. Seventeen percent have sustained enough injuries to require medical attention, like a patient jumping out of a third-floor window in their sleep. The puzzling part is that most sleepwalkers do not experience pain while sleepwalking, even if they are already in danger.
What to do about it: When you see someone sleepwalk, gently guide them back to bed. If you sleepwalk frequently, speak to your doctor about a medication review or possibly a sleep study. In the meantime, lock the front door, hide your keys, and put away anything else that could pose a threat to you and those around you.
Surprisingly, sleepwalking can be triggered by strong positive emotions. This doesn’t mean you should avoid doing things that give you pleasure, but do consider meditation or a period of relaxation before bed to help you achieve a state of emotional equilibrium before heading off to dreamland.
2. Sleep-related eating disorder
Closely related to sleepwalking is sleep eating, in which someone involuntarily ingests food while sleepwalking.
Sleep eaters also often experience insomnia and drowsiness during the day. But it is possible that some of them are more conscious than normal sleepwalkers during sleep-eating episodes. This can lead to significant weight gain because people with sleep-related eating disorder cannot control their food intake during the night.
What to do about it: Avoiding alcohol and drugs, limiting stress, and maintaining a regular sleep-wake cycle can help.
3. REM behavioral sleep disorder (RBD)
Here is a disorder often disguised as sleepwalking: REM behavioral sleep disorder.
One difference between RBD and sleepwalking is that RBD involves living out dreams. This happens during REM sleep in the second half of the night, while sleepwalking usually takes place during the deep sleep you get in the first half of the night.
Sleepwalkers tend to have calm and neutral behavior. But during an RBD episode, the sleeper dreams and performs whatever happens in their dream – usually an action like fighting or running, although sometimes it can also be an elaborate behavior like playing the piano.
Normally, your brain “turns off” your muscles (called “REM atony”) to prevent you from living out your dreams. With RBD this safety mechanism fails and the dream spills over into the body and plays it like a puppet.
What to do about it: Of course, safety is the number one concern at RBD. Many patients do not know that they will achieve their dreams until their bed partner bruises or they annoy the cat. A sleep neurologist can help manage your symptoms.
4. Sleep terrors (also known as night terrors) and nightmares
Fear of sleep seems, well, terrifying. You might burst out of bed screaming and heartbroken for a few seconds or even minutes.
It is important to note that “sleep horrors” and “nightmares” are very different. Nightmares are disturbing dreams that are sometimes scary enough to panic us and can even affect our mood the next day. These typically occur in the second half of the night as dreaming occurs primarily during REM sleep.
Sleep scares, on the other hand, occur during deep sleep in the first half of the night, and there are no dreams. Someone in the middle of a sleep terror episode isn’t really awake – they’re disoriented, scared, and unable to coherently talk about what’s happening. The next morning, they may not even remember what happened. If someone woke you up during a sleep scared, you don’t know why you are feeling so scared.
What to do about it: Sleeping horrors, while common in young children, are not harmful, and they are often more frightening to parents than to the children themselves, who don’t even remember their nightly horrors the next day.
Parents should not try to wake the child during a sleep scare, but rather watch out for their safety during the event and behave normally during the day. If the sleep fright is more likely to occur at the same time during the night, you can gently wake your child half an hour before the usual horror time to possibly prevent the sleep fright.
5. Sleep paralysis and hypnagogic / hypnopompic hallucinations
If you’ve ever woken up completely immobilized and perhaps felt a heaviness on your chest and a sense of fear or doom, you have experienced sleep paralysis.
Along with paralysis, people sometimes see, hear or feel things that are not there. These are known as “hypnagogic” or “hypnopompic hallucinations”. Usually people describe seeing shadowy figures in the room or standing over their bed or spiders crawling on their walls or in their bed. Sleep paralysis and associated hallucinations have even spawned alien abduction theories.
What to do about it: As with most other parasomnias, getting enough sleep consistently, following a set sleep schedule, and avoiding substances can help.
6. Head exploding syndrome
Now for the really bizarre. Exploding head syndrome is when a person hears or feels a very loud noise in their head, usually during that blurry time just before they fall asleep or just after they wake up. The loud noises can feel like an explosion in your head, although there is usually no pain. Or they can also sound like loud hammering or cracking, clinking pots, thunder or electric crackling.
What to do about it: Sleep scientists don’t yet know exactly why this rare syndrome occurs, but it seems that stress and emotional tension make it more likely. Usually it is enough just to give it a name and learn that it doesn’t indicate a serious medical problem.
Parasomnia Tips Summary
- Ensure security. Lock doors and put away car keys, keep sharp objects out of reach and, if necessary, sleep in a separate room from your partner.
- Stabilize your sleep schedule. By keeping a steady biological clock, you can help your brain switch between sleep and wakefulness normally.
- Get enough sleep. Sleep deprivation is a common trigger for parasomnias such as sleep paralysis.
- Minimize alcohol and drugs. Substances that affect your brain function can also affect your sleep and dreams.
- Ask your doctor about your medication. Sometimes drugs prescribed for insomnia, depression, or other mental disorders can cause parasomnias as a side effect.
- Ask your doctor about a sleep study. Sometimes symptoms such as sleep-related hallucinations and sleep paralysis can indicate narcolepsy. Living out dreams and frequent nightmares can indicate a neurological or psychiatric condition that also requires special care. A full exam with a sleep specialist can either help calm you down or alert you to the right treatment.
Medical disclaimer: All content here is for informational purposes only. This content is not intended to replace the professional judgment of your own mental health provider. Please contact a licensed psychiatrist for all individual questions and problems.
A version of this post also appears under Quick and Dirty Tips.
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