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Parasomnia Disorder – What It Is and How to Get Better Sleep

parasomnia disorder

You lie down to sleep, and you expect—in fact, you need—a restful experience. Just as you drift off to sleep, though, you wake up in terror or confusion. Or maybe as you fall asleep or wake up, you experience terrifying periods of paralysis. If you experience these or other sleep disorders, you might be suffering from parasomnia disorder.

So what is parasomnia disorder?  How is it treated?  Most importantly, how can you get better sleep? Find answers to these questions and more in this guide.

What Is Parasomnia Disorder?

The term parasomnia is actually an umbrella term for several sleep disorders. Each is characterized by abnormal behaviors or experiences that are associated with sleep. These experiences and behaviors can appear at any point in the sleep-wake cycle. In each case, parasomnias disrupt sleep or cause poor quality sleep.

Parasomnias are most common during childhood. However, approximately 4% of American adults suffer from parasomnias.

What Causes Parasomnia Disorder?

Various factors may increase a person’s risk of experiencing parasomnia disorder.  These include:

  • A family history of parasomnia, especially among first-degree relatives
  • Restless legs syndrome (RLS)
  • Insomnia
  • Sleep apnea
  • Sleep deprivation
  • Chronic pain
  • Mental health conditions
  • Substances abuse, addiction, or withdrawal
  • Certain medications, including sedatives

Is Parasomnia a Mental Illness?

Parasomnia disorder is listed in the DSM-5, the manual for diagnosing and treating mental disorders. Parasomnias are also more common among individuals with psychiatric conditions. Historically, therefore, parasomnia was assumed to be a sign of mental illness. 

However, more current research suggests that the unusual experiences and behaviors of parasomnia may be associated with the brain’s efforts to transition from wakefulness to sleep and from one sleep stage to another. Furthermore, parasomnia has a variety of causes. 

What Are the Symptoms of Parasomnia?

The symptoms of parasomnia depend on the specific type of parasomnia afflicting a person. In general, signs of parasomnia include:

  • Unusual and undesirable behaviors during sleep, including speaking, walking, moving
  • Confusion upon waking
  • Paralysis upon waking or when falling asleep
  • Unexplained cuts or bruises
  • Fatigue during the day

What Are the Different Types of Parasomnias?

Different types of parasomnias are classified by the phases of sleep they affect. People experience two main phases of sleep: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Parasomnias can occur during each of these stages. The third type of parasomnia is classified as “other” because these disturbances are not specific to NREM or REM sleep.

NREM Parasomnias

NREM parasomnias occur during the first phase of sleep. The NREM sleep phase actually includes four stages. The first stage of NREM sleep is considered “shallow” sleep. In the remaining three stages, sleep progressively deepens. In total, NREM sleep lasts approximately 90 minutes.

Parasomnias that affect NREM sleep are considered disorders of arousal. They can involve frequent but incomplete periods of wakefulness. During these periods, a person’s thinking abilities and the ability to respond to others are limited. Usually, upon waking, the sleeper has no memory of the sleep disturbance.

Common NREM parasomnias include confusion, arousal, sleepwalking, and night terrors.

Confusion Arousal

A person who wakes up in a state of confusion may be suffering from confusion arousal. 

During an episode, a person may not know what they’re doing or where they are. Responding with fear or anger to this confusion, the person may cry or shout. They may also have difficulty responding to others who attempt to intervene. Reaction time and speech are both slowed during confusion arousal. Confusion arousal can also affect coordination and memory.

Episodes of confusion arousal can last minutes or hours.


Young sleepwalking woman

Young sleepy woman suffering from somnambulism at home

Sleepwalking is also called somnambulism. In addition to walking, periods of somnambulism can involve other behaviors. These include talking and engaging in daily activities, like cleaning or driving.

Another category of NREM parasomnia is a sleep-related eating disorder. Individuals with a sleep-related eating disorder may eat excessively or ingest harmful substances during sleep.

Both sleepwalking and sleep-related eating disorders can be dangerous.

During a period of somnambulism, a person has limited responsiveness and awareness. If a person awakes while sleepwalking, he or she may be confused. The person also may not recall engaging in activities during sleep.

Night or Sleep Terrors

Night terrors involve intense fear or panic during the first phase of sleep. Night terrors, or sleep terrors, are most common among young children. However, night terrors in adults remain a genuine—and disturbing—phenomenon. 

Night terrors usually last between 30 seconds and a few minutes. During this time, a person may show signs of panic, including screaming and thrashing. They may also exhibit rapid breathing and heart rate, sweating, and dilated pupils.

A person experiencing a night terror usually cannot respond to outside stimuli, like a partner’s attempt to wake them. After the episode, the person often falls back to sleep. He or she may not remember the terror the next day.

REM Parasomnias

REM sleep follows the four stages of NREM sleep. In fact, throughout the night, the body cycles between NREM and REM sleep approximately every 90 minutes. 

During REM sleep, the eyes move rapidly beneath their lids. A person also breathes more rapidly, and the heartbeat and blood pressure increase. At the same time, the body becomes extremely relaxed, entering a temporary state of paralysis.

Common REM parasomnias include REM sleep behavior disorder (RSBD), sleep paralysis, and nightmare disorder.

REM Sleep Behavior Disorder (RSBD)

RSBD occurs when the body fails to enter the normal, temporary state of paralysis during REM sleep. A person suffering from RSBD becomes physically and verbally active during REM sleep. They may talk or scream. They may also punch, kick, or thrash around. Experts believe this activity is a response to dreams. 

Most dreams occur during REM sleep. While these dreams can be intense, the body, under normal circumstances, is paralyzed. Under normal circumstances, the dreamer cannot physically respond or become “involved” in the dream. A person with RSBD experiences dysfunction in the muscles that should be paralyzed. Thus, they may appear to act out their dreams.

A person with RSBD can experience episodes nightly or periodically. Especially vivid or frightening dreams are common triggers for individuals with RSBD. Upon waking, a person may clearly remember the dream that triggered the episode.

RSBD is more common among older individuals. Some neurological disorders, including Parkinson’s and certain forms of dementia, are also associated with RSBD. Finally, some anti-depressants have been linked to RSBD.

RSBD does not usually hinder sleep. However, it can be dangerous. The violent movements associated with RSBD put the sleeper at risk for serious injury.

Sleep Paralysis

Temporary paralysis is a normal part of the REM sleep phase. However, people with sleep paralysis experience paralysis periods—usually lasting a few minutes—at the wrong times. They may experience paralysis while falling asleep or upon waking.

This terrifying experience can produce anxiety associated with sleep.

Nightmare Disorder

Everyone experiences nightmares. However, individuals with nightmare disorders are plagued by frequent and vivid nightmares. In these nightmares, a person’s safety or survival is threatened. 

Frequent nightmares contribute to a host of daytime problems, including:

  • Fatigue
  • Anxiety
  • Impaired cognition

People who have post-traumatic stress disorder (PTSD) usually suffer from nightmare disorder as well.

Other Parasomnias

Parasomnias that fall into the category of “other” tend to occur during the transition from sleep to wakefulness or vice versa. They may also afflict an individual during NREM or REM sleep.

Exploding Head Syndrome

A person with exploding head syndrome, or sensory sleep starts, will imagine a loud noise just as they are falling asleep. They may also see a flash or even feel an exploding sensation.

Although generally painless, these sensory experiences can produce anxiety associated with sleep.

Sleep-related Hallucinations

Hallucinations, which may involve sight, sound, and touch, can occur as they fall asleep or wake up. Severe hallucinations can even involve movement as a person tries to escape the experience. Unfortunately, hallucinations can even persist after a person wakes up.


Bedwetting, or sleep enuresis, involves involuntary urination during sleep. While bedwetting is common in young children, frequent and persistent bedwetting after the age of 5 is considered parasomnia.

Can Parasomnia Be Cured?

Fortunately, parasomnia can be treated. If you’re struggling with severe symptoms like those described above, it’s important to see your doctor. He or she can identify or rule out any underlying health conditions. 

Your doctor can also refer you to counseling or prescribe medication, if necessary.

Night terror treatment, for example, often involves talk therapy. In fact, cognitive-behavioral therapy and hypnosis are common treatments for various parasomnias. Among medications, benzodiazepines and other tranquilizers may help those who sleepwalk or suffer from RSBD.

While seeing your doctor is important, there are also steps you can take at home to increase the quality of your sleep.

How to Get Better Sleep

Getting better sleep with parasomnia can be challenging. However, paying attention to your daytime and bedtime routines can help.

First, maintain a good sleep routine. Go to bed and wake up at about the same time, even on weekends or other days off.

Second, get plenty of physical activity during the day. At the same time, avoid intense physical activity too close to bedtime. 

Also, avoid late-day exposure to other factors that hinder sleep. These include caffeine, large meals, alcohol, and screen time.

Finally, pay attention to your bedroom environment. The ideal bedroom environment is cool, dark, and quiet. It also includes a comfortable mattress. Experts recommend replacing your mattress every five to eight years. Studies consistently show that attending to this schedule produces significant improvements in sleep quality.

Getting the Sleep of Your Dreams with Parasomnia: Your Mattress Matters

Sleep disorders, like parasomnia disorder, affect more than sleep. They cause fatigue and anxiety even during the day. What’s more, certain parasomnias, like sleepwalking and RSBD, can even lead to serious injuries.

Treating these conditions is, therefore, essential to your overall health. Many parasomnia sufferers require talk or prescription therapies. However, at-home measures, like purchasing a new mattress, complement medical treatments.

As you look for the best mattress for you, count on Beloit Mattress. Get started with our Mattress Matcher today.

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