In general, the time you spend sleeping is when your body rests and regenerates. For people with parasomnias, sleep is not as restorative.
A person with parasomnias may seem alert, walk, talk, eat, or do other activities, but be unaware because the brain is only partially awake. A person with another type of parasomnia may also experience sleep terrors or paralysis. These disorders are also due to the fact that the brain is slightly more aware than usual during sleep.
Parasomnias are not worrisome in themselves; the main danger lies in the fact that an affected person injures himself or others without knowing it.
What are the different categories of parasomnias?
It’s normal to go through five stages of sleep (stages 1-4 and REM sleep) each night, with stages 1-4 reflecting progressively deeper states of sleep. But the fifth stage, REM sleep, is the only stage during which the brain processes information from the day. It is also the time when we most often have dreams.
There are two types of parasomnias: parasomnias related to REM sleep and parasomnias not related to REM sleep. The difference between the two is that REM (REM) sleep parasomnias involve abnormal behaviors or emotions that occur during REM sleep, such as exaggerated dreams, night terrors, and sleepwalking. Non-REM sleep parasomnias occur during the non-REM stages of sleep and can include sleepwalking, nightmares, teeth grinding, and strange body movements. Both types of parasomnia can have underlying physical or psychological causes. It is therefore important to consult a professional if you experience symptoms.
What are the causes of parasomnias?
A sleeping person is unaware of transitioning through the five stages of sleep, but it is during these transitions that parasomnias are likely to occur. They are often triggered when a person is slightly aroused during the transition, for example by a noise, a change in temperature, sleep apnea (when breathing stops momentarily during sleep) or restless legs.
Although it’s unclear exactly why some people are more likely to suffer from parasomnias, some have been linked to psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder.
Parasomnias unrelated to REM sleep usually occur in people between the ages of 5 and 25 with a family history of similar parasomnias. Parasomnias related to REM sleep can affect people of all ages.
What treatments are considered for the two types of parasomnia?
Treatments for REM sleep parasomnia and non-REM parasomnia can vary depending on the type of disorder and its severity. Treatment options may include:
Lifestyle modifications may include establishing regular bedtimes, avoiding stimulating activities before bedtime, engaging in peaceful activities to relax before bedtime, such as reading or bathing, avoiding eating large meals near bedtime, exercising regularly but not near bedtime, and reducing stress.
Medications used to treat REM and non-REM sleep parasomnias may include:
- Tricyclic antidepressants (TCAs): are sedative drugs that block the uptake of neurotransmitters such as norepinephrine and serotonin.
- Selective serotonin reuptake inhibitors (SSRIs): are antidepressant drugs that affect serotonin levels in the brain.
- Benzodiazepines: reduce anxiety by increasing the activity of GABA receptors.
- Melatonin agonists: (like ramelteon) mimic the action of melatonin in the body, which helps regulate sleep and wake cycles.
- Modafinil: works by increasing the release of norepinephrine and blocking the reuptake of dopamine
- Carbamazepine and other anticonvulsants: used to decrease abnormal electrical discharges in the brain that can lead to seizures or neurological symptoms such as spasms or tics associated with certain parasomnias.
Finally, you can also use psychotherapy, which consists of talking about your thoughts or feelings with a qualified therapist in order to identify the triggers for episodes or to understand how to manage your behavior when they occur. Cognitive-behavioral therapy is a type of psychotherapy that aims to help patients become aware of their thought patterns so they can change them if necessary.