Parasomnias are a group of sleep disorders. Patients sleepwalk, talk in their sleep, or experience shock. Children are more likely to be affected by parasomnias than adults.
What is parasomnia?
Literally translated, parasomnia means “occurring during sleep”. Similarly, doctors speak of parasomnia when a patient suffers from behavioral problems while sleeping. Accordingly, parasomnias are classified as sleep disorders. As a rule, the behavioral problems wake up the person concerned from their sleep. The patient can then no longer fall asleep or at least no longer perceives the sleep as restful. See ezhoushan for What does Hypertrophic Osteoarthropathy Stand for.
Parasomnias do not necessarily have to be related to waking up, but can also relate to a change in sleep stages. All parasomnias belong to the so-called dyssomnias. Medicine understands this to mean subjectively perceived and objectively observed anomalies in sleep. Children suffer from parasomnias more often than adults.
In addition to waking disorders such as pavor nocturnus, disorders of the sleep-wake transition such as myoclonus onset and REM sleep-associated disorders such as sleep paralysis are among the parasomnias. In addition, some erectile dysfunctions are known as parasomnias, such as abnormal dream behavior. Parasomnias are a relatively common phenomenon that is relatively harmless in most cases.
Research into the causes of parasomnias has not yet been completed, since sleep laboratories and the monitoring of sleep phases are a relatively young area of medicine. Since parasomnias tend to occur in childhood, medicine now assumes that the cause is a maturation disorder in the brain. Such a maturation disorder is usually temporary and harmless. Parasomnias in adulthood are much more complex and can be associated with abnormal behavior.
In such cases, a medical clarification of the sleep disorder is absolutely necessary. As soon as sleep disorders occur regularly in an adult, the patient’s health is at risk. Parasomnias are also stressful for the environment of those affected. Scientific studies now suggest that the activity of the postcentral gyrus is associated with parasomnias.
This area of the brain corresponds to a convolution on the parietal lobe in the cerebrum. The gyrus lies behind the central fissure and is home to the somatosensory cortex, where tactile perception is processed. Elevated activity in this brain region during deep sleep can apparently trigger parasomnias.
Symptoms, Ailments & Signs
The symptoms of parasomnia are extremely variable depending on the subgroup. In the waking disorder pavor nocturnus, patients cry out loud a few hours after falling asleep. They show physical excitement with tachycardia or cold sweats. The patients appear frightened and cannot be awakened or spoken to.
Disorders of the sleep-wake transition lead to disorders such as myoclonus onset. A sleep myoclonus refers to a sudden twitching and kicking of the legs, trembling or twitching of the extremities of those affected. Patients often throw up. Parasomnias associated with REM sleep include nightmares and sleep paralysis. This paralysis usually corresponds to a paralysis of the medial radialis, which is favored by sustained pressure during sleep.
Those affected can no longer move their arm with this phenomenon. Brief cardiac arrests can also occur during REM sleep, as in REM-associated asystole. In somniloquia, the patients speak in more or less differentiated monologues during their sleep. In contrast, patients with nocturnal jactatio capitis perform movement stereotypes during sleep. Somnambulism is one of the waking disorders and affects sleepwalking patients.
Those affected move out of bed without being awake and perform actions. With this type of parasomnia, there is incapacity to act in the event of a criminal act. A special form of somnambulism is sexomnia, in which the patient predominantly performs sexual acts.
Diagnosis & course of disease
The diagnosis and further classification of a parasomnia is based on various diagnostic classification criteria and coding systems. The relevant systems include, for example, the International Classification of Sleep Disorders published by the American Academy of Sleep Medicine.
The ICD-10 is also used for diagnostics. In many cases, a provocation of the sleep disorder in the sleep laboratory is an important diagnostic step. In most cases, patients with parasomnia have a favorable prognosis. In children in particular, sleep disorders resolve themselves in the course of brain development.
The parasomnia sufferers usually suffer from severe sleep disorders and sleep disorders. These complaints have a very negative effect on the patient’s quality of life and can reduce it extremely. Those affected are often irritable and appear stressed or slightly aggressive. Psychological limitations or depression can also occur due to the parasomnia and make everyday life of the person affected significantly more difficult.
Sleepwalking can also lead to accidents due to parasomnia. Those affected are often not rested and tired, although sleep cannot compensate for the tiredness. Paralysis can also occur during sleep and is perceived as very uncomfortable. In some cases, parasomnia can also lead to cardiac arrest.
Sleepwalking can also lead to criminal acts. The everyday life of those affected is significantly restricted by the parasomnia. Living with a partner can also lead to complications. This condition is usually treated with medication and relaxation exercises. Whether this will be successful cannot be universally predicted.
When should you go to the doctor?
If night terrors, sleepwalking, and other unusual symptoms recur, a doctor should be consulted. Parasomnias are expressed by various signs that must be clarified and treated. Otherwise, accidents and falls may occur during the uncontrolled actions. Therefore, the first signs of a parasomnia should be clarified and treated by a doctor. The doctor can determine the diagnosis based on anamnesis and a physical examination in the sleep laboratory and initiate further measures. If this is done early, serious complications can be avoided.
People who already have Parkinson’s or who have another REM behavior disorder in addition to parasomnia are particularly at risk. People with mental health problems or neurological diseases are also among the risk groups and should consult a doctor if the symptoms mentioned occur repeatedly and do not go away on their own.
Behavioral problems during the day must also be clarified. If excessive daytime sleepiness or nocturnal awakenings occur more frequently, a visit to the sleep laboratory is recommended. Other serious complications must also be clarified if they occur frequently and severely limit well-being. In addition to the family doctor, the neurologist or an internist can be consulted.
Treatment & Therapy
Many sleep disorders do not require treatment. This applies, for example, to the onset myoclonus or the pavor nocturnus. In the case of children in particular, the parents of a parasomnic are made aware of the harmlessness of the disorder and encouraged to continue sending the child on school trips, for example despite the parasomnia. Those affected should not develop any avoidance strategies just because other people could experience the sleep disorder.
Cardiovascular arrest during sleep requires therapy, which is usually initially associated with a stay in a sleep laboratory. If arrest occurs, cardiopulmonary resuscitation is given. The primary causes must be clarified in more detail and, if necessary, eliminated by surgery or medication. Sleep talking may be treatable with clonazepam if the monologues are having a negative impact on roommates.
Relaxation exercises usually help against nocturnal jactatio capitis. If there is no improvement, medications such as antidepressants can help. Sleepwalkers with a tendency towards aggressive behavior are usually treated with sedative psychotropic drugs. Especially in adults, certain parasomnias can mark the beginning of a psychotic illness. In this case, psychotherapy is required.
Outlook & Forecast
The prognosis of parasomnias must be evaluated individually according to personal health conditions. In most cases, sleep disorders are temporary in children and adolescents. During the growth process, irregularities that are of a temporary nature often occur. Spontaneous healing is often documented. Short-term relapses are also possible in the course of life. If the disease progresses in this way, there is no reason for concern. They are considered harmless because they only appear for a short time.
The prognosis worsens if the sleep disturbances persist with a strong intensity. Consequential disorders and other diseases can occur in those affected. The interruptions and disturbances in sleep lead to severe impairments in coping with everyday life. Cardiovascular irregularities can occur. Signs of paralysis are also to be expected.
In severe cases, the affected person may die suddenly. If medical care is not sought, the prognosis is further worsened. In addition to the organic disorders, psychological stress conditions can occur, which lead to secondary diseases. Anxiety disorders, depression and other mental illnesses can develop and lead to a significant deterioration in health. The risk of accidents or drug abuse is also increased with a parasomnia. Those affected are often very desperate and need adequate medical care to improve the overall situation.
So far, parasomnias cannot be prevented because the causes have not been conclusively researched. As a general measure, relaxation exercises can be carried out for a relaxing sleep.
Since parasomnia is a collective term for a whole range of different sleep disorders, the type of follow-up care differs depending on the disorder. In some cases, no follow-up care is necessary. Night terrors (pavor nocturnus), the most harmless form, occur primarily in small children and disappear by themselves at the latest by puberty – usually earlier – without any consequences.
Some other sleep disorders such as nightmares, twitching while falling asleep or talking during sleep do not require treatment as long as they only occur temporarily and do not lead to a permanent burden on the person concerned. Sleep paralysis is also one of the symptoms that do not require treatment and are generally harmless and do not require aftercare.
If the patient suffers greatly from the experience, behavioral therapy may be useful to help manage the condition. In the case of sleepwalkers – if the cause cannot be remedied – it is necessary to secure the sleeping quarters in such a way that the risk of self-harm is minimized.
If the cause of the snoring problem cannot be eliminated (e.g. by surgically correcting the nasal septum or removing polyps), there are various methods of alleviating the symptoms. In severe cases associated with sleep apnea, it may be necessary to monitor sleep consistently. Measures such as weight reduction or abstinence from alcohol make sense.
You can do that yourself
Parasomnia sufferers should inform themselves comprehensively about the disease so that fears and insecurities can be reduced. At the same time, knowledge must be shared with relatives or people in your own household. Proper management of a sleepwalker is necessary to prevent an increase in symptoms.
Due to an emergency that can occur at any time, doors and emergency exits should never be completely locked. Despite sleepwalking, an escape route must always be freely accessible. On the other hand, measures that contribute to increased security are helpful. Alarm systems can be installed in the apartment, which signal to those around you that the person concerned wants to leave the front door while they are sleeping. Optimizing sleep hygiene can help to reduce sleep disorders. The bedding, the mattress and the environmental influences should be checked and, if there are any irregularities, adjusted to the needs of the person concerned. Background noise should be minimized and sufficient oxygen should be available. A regular sleep-wake cycle is also beneficial for improving the situation.
In addition to the external conditions, reducing internal stressors helps many patients. Emotional and mental problems of everyday life can lead to a worsening of the parasomnia. The use of relaxation techniques such as yoga or mediation as well as the offer of psychotherapeutic support is supportive.