Parasomnias (sleep problems)

Parasomnias are a group of sleep problems that are described as odd behaviours or experiences in your sleep. They happen while you're sleeping or going between different stages of sleep, as you fall asleep or as you wake up. Examples of parasomnias include:

• Sleep talking: When you say words, phrases, or even conversations during sleep. While it can wake or confuse people you sleep next to, it is usually harmless and not remembered by the person talking in their sleep.
• Teeth grinding: Most people don’t know if they grind their teeth when they sleep. They may be told by people they sleep next to who hear the grinding at night. Other symptoms include aching teeth just after waking up or headache, jaw joint and/or ear pain. 
• Sleepwalking: This is when you get out of bed and walk around while still asleep. Sleepwalkers may engage in a range of activities at night from simple movements to complex tasks, all without knowing or remembering these things.
• Night terrors (sleep terrors): These are intense episodes of fear and panic during sleep. They often involve screaming, rapid heart rate, and sometimes movements. People having night terrors are usually difficult to wake and can’t always remember what happened afterwards.
• Sleep eating: This is when you eat while you’re asleep and don’t remember doing it when you wake up. You may eat very quickly or eat odd combinations of food, foods you don’t normally eat or are allergic to, or eat things that aren’t food. 
• Confusional arousals: This is when the person appears to be confused or acts in a strange or unusual way. With confusional arousal, you’re actually asleep even though others think you’re awake.
• REM sleep behaviour disorder: With REM (raped eye movement) sleep behaviour disorder, you may get violent or act out in a physical way during REM sleep. For example, you may dream about attacking a monster then attack your partner.

You may or may not remember your parasomnia. Parasomnias can disrupt sleep patterns and, for some people, are safety risks.

Most people experience a parasomnia during their lifetime. They can occur at any age but are most common in children, with a lower incidence after age 25 years of age. Almost all adults who experience parasomnias would have had them during childhood.

It's not fully understood why some people are more likely to have parasomnias. It's thought that for some people they occur because their brain does not prevent them from acting out their dreams. It may be due to a blurring of the sleep-wake cycle.

With others, parasomnias have been linked to mental health conditions (eg, depression, anxiety, and PTSD). Neurological disorders such as Parkinson’s disease can also increase your risk for parasomnias.

Parasomnias are often triggered when a person is slightly awakened during the transition between different stages of sleep. This could happen from noise, temperature changes, sleep apnoea (when breathing momentarily pauses during sleep), or restless legs.

Things that make parasomnias worse

Parasomnias are more likely to be worse if you:

• don’t get enough sleep
• have trouble sleeping (called insomnia)
• have a sleep problem, like sleep apnea
• are stressed.

A parasomnia is diagnosed based on your symptoms and history.

• You'll need to see your healthcare provider and talk about your sleep and what’s happening while you sleep.
• They will ask what the parasomnias are like, how often they occur, when they occur, and the type of behaviour that occurs. 
• If you have someone who has seen your symptoms while you were asleep, it may be helpful if they come with you to your appointment.
• Your healthcare provider will also ask you about your medical conditions, medicines, stress levels and alcohol and caffeine consumption.
• You may be referred to a sleep specialist. A sleep specialist will talk to you about your symptoms and let you know if a type of sleep test is right for you. You may have a test that gathers information about your sleep during each stage of sleep. 

Parasomnias are common and generally get better over time. There are a few things you can do to manage them.

• Lifestyle changes: Parasomnias may be reduced by lifestyle changes to improve your sleep quality. For example, it's important not to drink a lot of alcohol or caffeine, and to keep a regular sleeping pattern. Read more about tips to help you sleep. 
• Your sleep environment: If the parasomnia involves leaving the bed, it's important to make your environment safe. For example, place locks on second story windows, remove furniture, mats and electrical cords (that you may bump into or trip on) from around your bed. Keep dangerous items such as knives or matches locked or hidden away, and lock doors so you don’t wander off.
• Cognitive behaviour therapy (CBT): Your healthcare provider may suggest CBT if your parasomnia is linked to anxiety or insomnia. 

Guidance for household members

During parasomnia, the person should not be woken, this may increase disturbance or cause violent behaviour. If they have left their bed, the person should be gently helped back to bed without waking them up. If there's a history of violence, keep an eye on them but leave them alone.

Medicines

Medicines are only used in rare cases and only after all other treatments have been tried. You may need medicines if you’re at risk of harming yourself or your partner, or if parasomnia episodes are becoming more frequent and poor sleep is disrupting your life. If you are prescribed medicines, take them as directed by your doctor. These medicines may affect your ability to drive safely and it's best not to take them with alcohol.