Parasomnias: Types, Causes, and Symptoms

What is a parasomnia?

Parasomnias are types of sleep disorders that involve unusual and unwanted behavior while you’re sleeping. They include well-known conditions, such as sleep talking and sleepwalking, as well as lesser-known issues like sleep paralysis. While parasomnias are more common in children than adults, they can occur at any age.

When you’re sleeping, your brain cycles through several stages of sleep, ranging from wakefulness and light sleep to deep sleep and dreaming sleep. Your brain needs time to transition from one of those stages to the next, and a parasomnia may occur when something disrupts that transition.

Depending on when exactly the disruption takes place, you may or may not remember the experience. However, it can still be distressing for you as well as anyone you share a bed with. You might wake up in a different room, confused as to how you got there, or yell incoherently in your sleep, leaving your bed partner shocked and concerned.

Parasomnias can also impact your sleep quality. You may experience daytime fatigue because of frequent sleep disruptions. Or repeatedly having vivid nightmares can make you feel too anxious to sleep. Because sleep quality impacts mental and physical health, these disorders can have a ripple effect on your overall well-being.

Whether you or a loved one is affected by these disruptive disorders, know that most parasomnias can be treated with lifestyle changes, professional treatment, or a combination of both.

Types of parasomnia

Parasomnias are categorized by which stage of sleep they take place in—either nonrapid eye movement (NREM) sleep or rapid eye movement (REM) sleep.

Non-REM parasomnias

These occur when you’re in the first three stages of sleep (or non-REM sleep). They are sometimes referred to as arousal disorders, as your brain is partially aroused by some condition or environmental factor, leading you to act out or talk in unusual ways.

You might not remember these events the next day but will likely learn about them from others, such as a partner, roommate, or family member. During non-REM parasomnia, your eyes might be open, which can be especially confusing for those around you.

Confusional arousal

During confusional arousal, you appear awake but also disoriented and confused. For example, you look around the room with a dazed look in your eyes, reach for things that aren’t there, or slowly mumble nonsensical things to those around you. These episodes typically only last a few minutes, but, in rare cases, can last up to an hour.

Two subtypes of confused arousal include sleep drunkenness, which involves being disoriented when waking up, and sexsomnia, which involves sexual acts, such as masturbation.

Sleepwalking

During sleepwalking episodes, you get out of bed and walk around, often acting out behaviors that you’d engage in if you were fully awake. For example, you might try to rearrange your closet or go to the kitchen and take cookware out of the cabinets. In some cases, you might wander from your home or even try to run away from an imagined threat, like a monster chasing you in your dream.

Sleep terrors

This type of parasomnia comes with intense fear, sometimes causing you to cry out, thrash, or even jump out of bed. You’ll likely exhibit other symptoms of terror, like increased heart rate and sweating; however, none of this is caused by a bad dream, as is the case with nightmares. A sleep terror episode can last from several seconds to several minutes. There appears to be a connection between sleep terrors and psychiatric disorders since it’s more common in people who experience phobias, severe depression, or high anxiety.

Sleep-related eating disorder

Sometimes considered a subtype of sleepwalking, this disorder involves eating or drinking while partially conscious or completely unconscious. You might consume lots of food, leading to unintentional weight gain, or even consume things that will later make you sick, such as uncooked meat.

REM-related parasomnias

The following parasomnias take place during REM sleep, the stage of sleep associated with dreaming. Because of this, you’ll typically recall the content of your dreams when you wake up.

REM sleep behavior disorder

Typically, when you’re in REM sleep, your body is naturally paralyzed, which prevents you from acting out your vivid dreams. This is called muscle atonia. However, if you have REM sleep behavior disorder, muscle atonia is disrupted. The symptoms can range from vocalizations, such talking or laughing in your sleep, to physical actions, such as flailing. This disorder is commonly associated with some underlying neurological issue.

Sleep paralysis

During sleep paralysis, muscle atonia sticks around longer than it should, keeping you paralyzed even as you move from REM sleep to wakefulness. The experience is temporary, lasting seconds to minutes, but is often terrifying. It’s sometimes accompanied by frightening hallucinations, such as shadowy creatures holding you down or cryptic voices in your bedroom.

Nightmare disorder

Almost everyone experiences the occasional nightmare. However, nightmare disorder involves a pattern of vivid, unpleasant dreams. Unlike sleep terrors, you’ll often awake with a memory of the distressing nightmare. Nightmare disorder is often more common in people with psychiatric conditions like schizophrenia, PSTD, and borderline personality disorder.

[Read: Childhood Insomnia and Sleep Problems]

Causes of parasomnia

Parasomnias seem to be caused, at least in part, by genetics. For example, if one of your parents has a history of sleepwalking, you’re more likely to as well.

Certain circumstances can also trigger or increase the risk of a parasomnia. Environmental disruptions, such as light, noise, the movements of a partner, or even your own movements, can result in a parasomnia episode.

Factors that increase your risk also include:

Sleep deprivation and unusual sleep schedules. For instance, shift work or jet lag could disrupt your normal sleep patterns.

Stress. When you’re under heavy stress, you might notice that sleepwalking episodes increase in severity of frequency. In addition, recurring nightmares and REM sleep behavior disorder are often associated with post-traumatic stress disorder (PTSD).

Medication. Certain types of medication, including antidepressants or mood stabilizers, can affect your sleep cycles, increasing the risk of parasomnias.

Illness and fever. You might notice an uptick in episodes of parasomnia when your body is battling some form of sickness.

Pregnancy. A 2023 survey of 325 women found that parasomnias, such as night terrors, sleepwalking, and nightmares, increased during pregnancy.

Drugs or alcohol use or withdrawal. Drugs and alcohol can interfere with normal sleep and increase the risk of parasomnias. One systematic review found that alcohol abuse was linked to NREM parasomnias, while alcohol withdrawal and cocaine abuse were associated with REM sleep behavior disorder.

Neurological disorders. In some cases, neurological issues can be the underlying cause of parasomnias. REM sleep behavior disorder can be linked to neurodegenerative conditions, such as narcolepsy, Parkinson’s disease, and Lewy body dementia.

Parasomnia symptoms

Symptoms of parasomnias can vary greatly depending on the specific condition. While sleep paralysis, for example, can be easy to self-diagnose, its symptoms can look very different to sleep-related eating disorder. However, there are some common warning signs to look for, such as:

Waking up feeling disoriented. You might either wake up in the middle of the night or in the morning feeling confused or in a daze.

Daytime fatigue. If you experience a parasomnia, you may feel groggy and tired, as if you didn’t get good sleep throughout the night.

Vocalizing or moving in your sleep. A sleep partner or someone you share your home with might alert you to these symptoms the following morning.

Mysterious bruises and scratches. You might notice injuries that are the result of your overnight flailing or sleepwalking.

Moved items. You might notice items that you’ve moved around in your bedroom or things that have been knocked over. In the case of sleep related eating disorder, you might notice missing food left out when you wake up in the morning.

Tips for coping with parasomnias

Although they can be frightening and disorienting to both you and those you live with, it’s possible to reduce parasomnia episodes.

Treating your condition will require you to learn as much as you can about your condition and take preventative measures to reduce the risk of injury. Then, you can begin to incorporate some lifestyle changes to improve sleep and manage the symptoms.

If the disorder is the result of an underlying condition, you’ll also need to address the root cause.

Tip 1: Collect information on your parasomnia

Start by learning the basics of sleep architecture—the various stages of sleep your body moves through and what happens in each stage. Once you understand how sleep works, you’ll be better prepared to manage parasomnia symptoms. In addition, learning more about each condition can reduce your fear of strange but ultimately unharmful experiences, such as sleep paralysis.

When it comes to sleep disorders, not everyone has the same experiences. So, aside from building general knowledge, you should gain a deeper understanding of your own relationship to sleep and parasomnias. A sleep diary can be a useful tool here.

Keeping a sleep diary

By tracking your habits and symptoms, you’ll have an easier time determining if lifestyle choices are related to your parasomnias. For example, you might find that you regularly experience confusional arousal after drinking alcohol.

Some things to include in your diary:

• Your recent bedtime and waketime
• Total time spent asleep
• How you felt at bedtime (stressed, relaxed, etc.)
• How you felt in the morning
• Food and drink consumption throughout the day (especially several hours before bedtime)
• Medication and recreational drug use throughout the day
• Activities you engaged in before bed
• Noticeable parasomnia symptoms (such as sleep paralysis or moved items)

Download or print HelpGuide’s sleep diary (PDF)

A fitness tracker can help supply some of this information, including total hours of sleep. Other factors, such as whether you talk or move in your sleep, can be impossible to track on your own. You might need to ask someone else in your household to monitor your or set up a recording device.

Tip 2: Create a safe environment

Certain types of parasomnia come with the risk of self-injury or injury to others. For example, during a lengthy sleepwalking episode, you might leave your bedroom and tumble down the stairs. Or perhaps you knock over a lamp while acting out a dream due to REM sleep behavior disorder.

Some ideas to ensure physical safety:

• Place your mattress as low as possible to the floor to prevent falls.
• Remove any fragile items from your nightstand.
• Set up your bedroom on the first floor of your home if possible.
• Remove any weapons or potentially dangerous objects from your bedroom.
• Pad sharp edges, like the corners of wooden furniture.
• Lock your bedroom door and windows if you sleepwalk.
• Consider installing an alarm that will wake you up if you try to open doors.
• Declutter your floor to minimize tripping hazards, such as rugs or cords.
• Avoid sleeping in a common space or sharing a bedroom if you’re worried your actions might affect others.

The measures you take should be specific to your symptoms and their severity. Use the information in your sleep diary to help steer you toward the best solutions.

Tip 3: Improve sleep hygiene

Good sleep hygiene involves following a set of practices that can improve your basic sleep quality and help you avoid sleep deprivation. The following sleep habits may be useful in reducing REM and NREM parasomnias.

Darken your room. Even small sources of light can disrupt your sleep. If your work schedule requires that you sleep during the day, consider using an eye mask to block out sunlight.

Keep it quiet. Ensure your television and other sources of sound are silenced before bed. If you can’t control noise sources, such as the sound of traffic outside, use ear plugs or a sound machine.

Experiment with room temperature. For many people, the best temperature range for sleeping is 60 to 68 degrees Fahrenheit. This can vary though, with some studies showing that older adults sleep best in 68 to 77 degrees.

Reduce your use of caffeine, alcohol, drugs, and other substances that disrupt sleep. Stimulants like nicotine can make it difficult to get to sleep on time. Meanwhile, alcohol and sedatives can be disruptive to transitions between sleep stages.

Be careful with food and drink choices. Eating a big meal before bed might result in indigestion, which makes it difficult to fall asleep or stay asleep. Drinking too much liquid can come with a similar consequence, as you’ll need to use the bathroom in the middle of the night.

Tip 4: Be consistent with bedtime

A major part of sleep hygiene involves going to bed and waking up at roughly the same time each time. Doing so allows your brain to settle into a familiar pattern, which can improve overall sleep quality. An erratic sleep schedule, on the other hand, may increase your risk of experiencing parasomnias and negatively affect your mood and cardiovascular health.

Decide on a regular bedtime and time to wake. Most adults need between seven to nine hours of rest each night. Younger people tend to need more. For example, a teenager might need eight to 10 hours.

Build a pre-bed routine that helps you to wind down each night. Perhaps, an hour before bedtime, you could routinely meditate or enjoy a warm bath to promote relaxation.

Maintain consistency on weekends. Even though it can be tempting to stay up late and sleep in on weekends or holidays, doing so can disrupt your sleep-wake rhythm. Do your best to stick to your routine.

Use naps wisely. Long naps or naps close to your actual bedtime can make it harder for you to sleep the next night. However, when carefully timed, naps can be a useful way to boost your alertness and overcome daytime fatigue. To avoid grogginess after the nap, aim for a nap that is either about 20 minutes or 90 minutes long.

[Read: How to Sleep Better]

Tip 5: Manage stress and anxiety

Because high stress during the day can trigger parasomnia episodes at night, it’s important to find ways to manage your stress levels. For example, you can aim to reduce environmental stressors, such as limiting “doom-scrolling” on news or social media sites. Or you can practice setting healthier boundaries with coworkers, friends, and family members who stress you out.

Next, try incorporating some of the following relaxation techniques into your daily routine:

Practice mindfulness. Mindfulness involves centering your full attention on the present and approaching your experiences with a nonjudgmental mindset. One way to do this is to focus on current sensations, like the feeling of a breeze, the taste of a juicy apple, or the sound of birds chirping. With regular practice, you’ll find this may lower your stress and even help you fall asleep faster. Try out HelpGuide’s body scan meditation as an introduction to mindfulness meditation.

Adjust your breathing. When you’re experiencing high stress, your breathing quickens along with your heart rate. These are signs that your stress response (or fight-or-flight response) is active. However, if you aim to control your breathing, you’ll likely notice your stress recede as well. That’s because deep, slow breathing helps activate your body’s parasympathetic nervous system—also known as the rest-and-digest response.

Journal. Journaling can involve writing about stressful events, how they made you feel, and reflecting on your emotional reaction. This helps you get things off your chest and organize your thoughts, relieving stress in the process. Journaling doesn’t need to be a complicated exercise. For example, try spending five minutes writing a to-do list for the next day. This might help you offload some stress before bed.

Learn to rescript your nightmares

Another exercise, called imagery rehearsal, may be effective specifically for managing nightmare disorder.

Write down the non-distressing events and themes of your recurring nightmare, but in detail, come up with a more positive, pleasant ending. Imagine the new storyline throughout the day and as you fall asleep. Some research shows that this practice can reduce nightmare frequency. For example, a recurring nightmare involving a car crash can be turned into a dream in which the car takes flight, safely drifting above the clouds.

Experiment with self-hypnosis

Hypnosis or hypnotherapy isn’t about getting into a state of sleep, but rather into an extremely relaxed but focused state in which you’re more suggestible. It seems to aid with various conditions, like sleepwalking, sleep terrors, and nightmares, if their root cause is stress or trauma.

For self-hypnosis, start with a relaxation exercise like imagery meditation, progressive body relaxation, or deep breathing. Once you feel calm and relaxed, you can introduce post-hypnotic suggestions. You might simply repeat them in your head as a mantra.

• If sleepwalking is an issue, you might tell yourself, “When my feet touch the floor, I will feel safe, secure, and return to bed.”
• For sleep paralysis, you might tell yourself, “I’m not afraid. I can let the experience pass and fall back to sleep.”

When to seek professional treatment

If your parasomnia episodes worsen, increase in frequency, or don’t respond to self-help measures, it may be time to seek professional treatment.

Before making a diagnosis, a medical professional will examine your sleep history and assess your physical or mental health. If you’re taking medication, they’ll likely review those and determine if any of those drugs are contributing to your parasomnias.

You might be asked to keep a sleep diary if you aren’t already doing so. If you share a bed with someone, any information they can contribute will likely be helpful, since they may have witnessed your sleep disturbances.

Polysomnography, which involves a diagnostic tool that can record your brain waves, heart rate, breathing, and other measurements as you sleep, may be used.

Meditation and other treatment options

Your doctor may prescribe benzodiazepines or antidepressants, the most commonly used drugs to treat parasomnias. However, other drugs may be useful, depending on the type and severity of your disorder. For example, melatonin, an over-the-counter sleep supplement, might also be recommended.

Common treatment options aside from medication include psychotherapy and clinical hypnosis. Scheduled awakenings may also be a useful strategy. This involves using an alarm or another person waking you up 15 to 30 minutes before you typically experience an episode. Again, the exact treatment may vary based on the type of parasomnia.

[Read: Sleep Therapy]

A professional can also help identify and manage any underlying condition that may be causing your parasomnia, such as a form of dementia. PTSD, substance-use disorder, or narcolepsy.

How to help someone with a parasomnia

If you share a bed with someone who has parasomnia, you likely feel concerned for their health. You might be worried they’ll sleepwalk themselves into a dangerous situation or that their nightmares are taking a psychological toll. You might also feel frustrated about how their actions affect your rest or disrupt other members of your household.

Show empathy. Don’t shame them for their sleep issues. They have no control over their behavior when they’re asleep and likely feel bad for disrupting your rest. Instead, be empathic and offer your support.

Help them track their symptoms, including frequency and severity. It’s possible they have no recollection of issues like sleepwalking and sleep talking. So, your reports can be crucial for determining which steps will reduce parasomnias. If the other person wants to seek a formal diagnosis, your input can be helpful during that process as well.

Offer reassurance and positivity before bed. Remind them that they are safe and secure and the issue can be managed. This is especially important if your child has a parasomnia.

Assist with scheduled awakenings. Scheduled awakenings may be used to treat regularly occurring NREM issues like sleep terrors and sleepwalking. It’s best done with input from a sleep expert and may take several weeks before improvement is seen.

Should you wake up someone who’s currently experiencing parasomnia?

When it comes to NREM parasomnias, such as night terrors or sleepwalking, even if the person appears to be in distress, they likely won’t even remember the incident the next morning. However, forcibly waking them up can leave them bewildered and agitated.

Instead, you should handle them gently and ensure they don’t hurt themselves. For example, you might guide a sleepwalker back to bed if they try to leave the room.

If a person is experiencing discomfort during REM, such as a nightmare or sleep paralysis, you’ll likely have a hard time noticing in the moment. The signs can be subtle, such as quickened breathing, but largely indistinguishable from normal dreaming. In these cases, the most important thing to do is simply offer the person comfort once they awaken.

Despite how frightening and disruptive parasomnias can be, they can be managed. You might need to experiment with different self-help strategies and professional treatments, but it is possible for you or your loved one to enjoy restful nights of sleep again.

Last updated or reviewed on August 8, 2024