An Introduction To Parasomnias

A sleep disorder is a physical and psychological condition or disturbance of sleep and wakefulness caused by abnormalities that occur during sleep or by abnormalities of specific sleep mechanisms. Although the sleep disorder exists during sleep, recognizable symptoms manifest themselves during the day. Accurate diagnosis requires a polysomnogram, widely known as a "sleep test."

It is estimated that some 40 million Americans suffer from chronic, long-term sleep disorders. Another 20 to 30 million Americans suffer from some kind of sleep disorder on an irregular basis. The annual costs in productivity, health care, and safety have been estimated in the billions of dollars.

Parasomnia is a broad term used to describe various uncommon disruptive sleep-related disorders. They are intense, infrequent physical acts that occur during sleep. Some common parasomnias include sleepwalking, sleep talking, sleep terrors, nightmares, and teethgrinding.

Sleepwalking
Sleep Talking
Sleep Terrors
Nightmares
Teethgrinding (Bruxism)
Other Parasomnias

Sleepwalking

Sleepwalking, also called somnambulism, is when a person is able to perform complicated actions, including walking, while in deep sleep. Sleepwalking is an "arousal" disorder. These occur when a person is in a mixed state of awareness, i.e., both asleep and awake. Researchers believe sleepwalking stems from a temporary sleep mechanism malfunction that occurs during the deeper stages of sleep. Because sleepwalking does not occur during REM sleep, a sleepwalker is not acting out a dream.

Sleepwalking behavior can range from sitting upright in bed to driving a car a long distance. The sleepwalker is awake just enough to be active, but still asleep to be unaware of the activity. Sleepwalkers are usually unable to remember the activity. Most sleepwalkers appear awake, with their eyes wide open and dilated. He or she will not respond if spoken to. In some cases, sleepwalking is sometimes associated with incoherent sleep talking.

Injuries to the sleepwalker during such events are common, and simple precautions, like shutting doors and windows, can enhance safety. Sleepwalkers are not easily awakened. If awoken, the sleepwalker will be disoriented and agitated. The best advice is to direct the person back to bed or to a closer location to lie down. Do not inhibit the motion or movement of a sleepwalker, as they have been known to react violently to being detained.

Sleepwalking is a condition that is more prevalent in children. Boys are more likely to sleepwalk than girls. About 10 to 15% of children between the ages of 5 and 12 years old will have at least one episode of sleepwalking.

Researchers estimate about 18 percent of the population is prone to sleepwalking. It typically occurs around the onset of puberty and subsides a short time after. This parasomnia tends to run in families, and rarely indicates any serious underlying medical problem.

When Should I See a Doctor?

Since many young sleepwalkers discontinue their nighttime wanderings after puberty, there is usually no need for treatment. For younger children, a safe sleeping environment, free of harmful or sharp objects, is advised.

For children and adults, sleepwalking is usually a sign of a sleep deprivation, intense emotions, stress, or fever. As these circumstances resolve, sleepwalking incidences disappear.

Because most parasomnias are complex in nature, a sleep specialist should carry out diagnosis and treatment. Medical or psychological evaluation should be investigated if any of the following apply:

The sleepwalker has excessive daytime sleepiness.
The sleepwalker is violent.
The sleepwalker has injuries as a result of sleepwalking.
The sleepwalker disturbs others in the household.

For violent or troublesome sleepwalkers, medications in the benzodiazepine family have proven successful. This class of drugs is a depressant that slows the central nervous system. Forms of benzodiazepine are often prescribed for anxiety, muscle spasms, insomnia, and epilepsy. In sleepwalkers, it reduces motor activity during sleep. Hypnosis has also been found to be helpful for both children and adults.

Sleep Talking

Occasionally, a person may shout out a word or two of gibberish or even recite an entire speech during their sleep. Sleep talking that occurs during REM sleep is understandable, while talking in Stage 2 Sleep is usually garbled. Sleep talking, or somniloquy, is harmless and usually temporary. The sleeper usually has no memory of their action and it does not affect sleep.

Sleep Terrors

Sleep terrors, also called pavor nocturnus or night terrors, are the most extreme and dramatic of the parasomnias. This disorder is marked by a sudden arousal and a piercing scream or shouting.

The person who has a sleep terror will have signs of intense fear, such as wide eyes with dilated pupils, racing heart, sweating, and rapid breathing. It is not uncommon for a person experiencing a sleep terror to jump out of bed, run around agitated, or hurt themselves and/or others. Fighting is also common and may result in harm to the sleeper or bed partner.

Episodes usually occur during the first hour of falling asleep, the point at which deep sleep begins, and last about 15 minutes. After the episode, the person returns to sleep, unable to remember the incident in the morning because he or she was never fully awake. A sleep terror patient does not usually experience vivid dream images, but may recall fragments or images of a scene.

Sleep terrors usually occur during stage 3 or stage 4 sleep, the deepest stages of sleep, and children have more deep sleep than adults. Therefore, like sleepwalking, sleep terrors are more common in children. They are also more prevalent in boys. Only 1 to 6% of children between the ages of 4 and 12 experience sleep terrors. Sleep terrors typically do not continue into adulthood (less than 1% of the adult population).

Children experiencing a sleep terror may have a strange expression on their face. They are typically unresponsive to their environment; this also includes any comfort that may be offered. In fact, attempting to reassure or calm the child down often results in increased agitation.

For children and adults, sleep terrors can be the result of stress, psychological disturbance or sleep deprivation. Sleeping in a different bed may also trigger episodes of sleep terrors.

When Should I See a Doctor?

For children under six years of age, occasional sleep terrors usually do not require treatment. Often, sleep terrors in children older than six may be suggestive of an emotional disturbance or a lack of sleep. It is important that a parent be aware of situations in the child's life that may be the trigger of sleep terrors, such as a new school, divorce, or a death in the family.

For children, medical treatment is not necessary unless the child's disturbed sleep causes violent behavior or excessive daytime sleepiness. Bringing up episodes of sleep terrors by parents or siblings only makes the child feel odd or silly. Family members should avoid teasing the child, as it may contribute to the stress or anxiety the child has already. Treatment includes adequate sleep, frequent exercise, and sometimes medication for occasional circumstances, such as sleepovers or summer camp.

In contrast, sleep terrors in adults are serious and abnormal. It is usually indicative of excessive agitation or sleep deprivation, depression, or anxiety. Sleep terrors have also been associated with post-traumatic stress disorder. It is highly recommended that an adult who has sleep terrors see a sleep specialist. In some cases, sleep terrors may be the result of certain medications or withdrawal from a medication. If this is the case, discussing sleep terrors as a side effect with a physician is advocated.

Nightmares

Sleep specialists term a "bad dream" a nightmare if the sleeper is aroused from REM sleep and can recall the dream, often in great detail. A nightmare is composed of a very vivid and frightening dream. Common themes include another person assaulting, attacking, or chasing the person having the dream.

Nightmares are not associated with bodily reactions such as increased heart rate, faster breathing, or sweating. They occur mainly in REM sleep and consequently, late during the sleep cycle in the last third of the night.

Nightmares are normal in children and adults. They are indicative of an unresolved issue or a psychological problem that still troubles the individual, such as what to do if attacked. When the problem is solved, the nightmare disappears.

For young children, having a parent reassure and comfort him or her after a nightmare is helpful in establishing the dream as "not real." Some children will want to discuss the dream, while others maybe fearful at bedtime because of a prior nightmare.

When Should I See a Doctor?

Treatment for nightmares is rarely needed. Only in cases of severe or frequent nightmares are hypnosis or medication required.

Teethgrinding

Grinding of teeth, or bruxism, is a common nighttime occurrence. In fact, 80 to 90% of children and adults grind or clench their teeth during sleep. It is more common in children. Chronic teethgrinding, however, occurs in less than 5% of adults.

Most teethgrinders are unaware of their parasomnia. A bed partner who is awakened to the noise, or a dentist who finds teeth with excessive wear more often reports it. Patients may complain of a sore jaw, headaches, or frequent awakenings. Chronic teethgrinding can lead to dental damage or injury.

There is little evidence to suggest that bruxism is associated with any medical or psychological problems. It may be related to stress and uneven alignment of the teeth and jaw.

When Should I See a Doctor?

A chronic teethgrinder should consult with a physician if he or she suffers from excessive daytime sleepiness, frequent nighttime awakenings, or disturbs others in the household. In most cases, the physician will be able to refer the individual to a dental specialist or orthodontist.

There are a number of methods to minimize teethgrinding. If a patient has dental reasons for teethgrinding, the problem can be corrected orthodontically. Rubber mouth guards or dental splints are devices designed by dentists to prevent grinding. Relaxation techniques have also proved helpful.

Other Parasomnias

Sleep-eating: a rare variation of sleepwalking. This disorder is characterized by recurrent episodes of eating during sleep, without conscious awareness. It is most common in young women.
Hypnagogic hallucinations: episodes of dreaming while awake. Common in narcoleptics, but also seen in sleep-deprived individuals.
Nocturnal seizures: seizures during sleep that cause the victim to cry, scream, or walk; usually treated with medication.
REM behavior disorder: the paralysis that normally occurs during rapid eye movement sleep is incomplete or absent, allowing the sleeper to "act out" dreams.
Rhythmic-movement disorder: most frequently seen in young children, it results in recurrent head banging and body rocking. Behavioral treatments may be effective in severe cases.