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Most of us hate leaving the bed in the morning. When the sun is still young, and the air is still cold, it is enough reason for us to sleep in for “just five more minutes.” For the many of us, sleeping is our favorite pastime, and we love to sneak in naps on lazy weekends. Sadly, that is the reality for only a handful of adults today. According to prominent research organizations and the American Sleep Association, about 70 million American adults suffer from some difficulty in falling asleep and staying asleep. Some of them dread the idea of going to bed at night due to the discomforts they face during sleep. These are also the people who push bedtime further back to the point they are ready to “drop dead” on their bed.
That brings many questions to our minds –
- What causes the distressing symptoms during sleep?
- Are most sleep disorders hereditary?
- Is it possible to treat and cure sleeping disorders?
- What kinds of discomfort qualify as sleeping disorders?
- What do medicine and sleep science call these disorders?
- What are the dangers of experiencing these?
- Who do sleep-related disorders affect?
What are the typical signs of parasomnia?
Sleeping disorders can be of various types. Almost all children experience nightmares from time to time. You may remember a couple of the unpleasant dreams you may have suffered as a child. Common recurring themes of nightmares among adults include public nudity, teeth falling out and running but not being able to move. According to sleep experts and psychologists, these nightmares are unpleasant but quite common. They do not qualify as sleep disorders unless they are causing you to wake up with physical discomfort in the middle of the night or keeping you awake for long hours. In most cases, we experience unusual dreams, but we remain asleep throughout the process. They do not cause us to frail about in our bed, strike out or to sit up and scream in a delirium. When these symptoms come in the picture, the case quickly escalates to sleeping disorders of the class parasomnia.
There are a few classic symptoms of parasomnia include the following –
- Abnormal movements
- Strange perceptions
- Overall unusual behavior
- Acting out dreams or nightmare while falling asleep or during sleep
Researchers define parasomnias as dissociated sleep states that lead to partial arousals. They associate these stages with transitions between REM or NREM sleep and wakefulness. Interestingly, sleep disorders do not always stem from nightmares or unpleasant dreams. Although a bizarre and scary dream may affect a person more, he or she is equally likely to act out the mundane dreams as well. It is common for children to do so, but when adults start enacting dreams of sexual nature in their sleep, it can be particularly embarrassing and scandalizing.
What are the two basic types of parasomnias?
Considering the fact that over 10% Americans currently suffer from one kind of parasomnia or another, there must be several studies that can shed some light on the cause, treatment and potential cure of the disorder. Before we go into that, we should try and understand the classification of these sleep disorders.
Non-rapid eye movement (NREM) parasomnias
The NREM parasomnias typically occur during slow-wave (stage 3 and 4 of NREM) sleep. That happens when the person is somewhere between complete sleep and wakefulness. There is physiological activation that causes the person to exit the full suspension of physiological movement, but he or she continues to sleep and dream. Research shows that these stages involve the activation of the cognitive process, the motor system and the autonomic nervous system (ANS).
Night terrors and confusional awakenings are more common during the childhood of a person than they are during adulthood. One expects these issues to go away as the child transitions into the teenage and eventually, adulthood. When the same incidents recur among adults, they likely suffer from parasomnia. Specific factors including sleep deprivation, depression, and medication for depression, physical stress and emotional stress can induce NREM parasomnias in adults.
During NREM parasomnia, a person can expect one or more of these symptoms –
- Night terrors
- Grinding of teeth
- Restless legs syndrome (RLS)
- Rhythmic movement disorder
- Somniloquy (sleep-talking)
Rapid Eye Movement (REM) parasomnias
Contrary to NREM parasomnias, these happen during the REM stage of sleep. The person loses atonia or muscle paralysis during this stage, which allows him or her to move about while dreaming. While REM is ubiquitous among adults, people rarely seek counsel or treatment. Patients experience a high risk of injuries resulting from the sudden movements, and they pose a threat to the co-sleeper as well. Patients do take precautionary measures that range from barricading themselves with pillows to sleeping on a low bed or mattress.
Research shows that the telltale signs of REM sleep disorders include the following –
- The sufferer is male (90% of RBD patients are male)
- The age of onset varies between 50 years and 65 years, but anyone between 20 years and 80 years can experience RBD on and off.
- Screaming, mumbling, swearing and other vocalizations may be present.
- Usually happens during the latter half of the (REM) sleep period.
- They might have other neurodegenerative diseases like Alzheimer’s, multiple system atrophy (MSA) and Parkinson’s.
- The person might be on anti-depressants and other psychoactive drugs.
- Over 45% of the times, the sufferers have a history of alcoholism and alcohol use.
Catathrenia is a form of REM sleep disorder during which a person is likely to hold his or her breath. It involves groaning during expiration. It does not have any known associations with obstructive sleep apnea and somniloquy. The person experiencing this sleep disorder is usually unaware of the noise, but the co-sleepers might find it disturbing. Interestingly, although the sufferer is unaware of the sound, they often find themselves awake in the middle of the night after constant groaning.
Why is insomnia not a type of parasomnia?
That finally brings us to insomnia. Apart from pop songs and Hollywood, social media has made ‘insomnia’ a trend. When a person suffers from the lack of sleep for two nights in a row, the person claims himself or herself as an insomniac. What we need to understand is that it is a disease that renders a person unable to fall asleep at desired or socially acceptable bedtime. As a result, the person finds himself or herself awake till 3 am or 4 am in the morning, for multiple nights in a row. When a person suffers from the lack of sleep for over two months, then the doctors and sleep experts pronounce it as a case of insomnia.
It can be recurrent and intermittent, or it can be chronic. In cases of chronic insomnia, a person is unable to fall asleep in spite of staying awake for over 24 hours at a stretch or suffering from sleep deprivation for a couple of days. It is indeed a sleep disorder, but it is not a form of parasomnia. While parasomnia involves abnormal movements and the inability of a person to remain asleep, insomnia consists of the ability of a person to fall asleep. The leading causes of it include increasing consumption of caffeine, alcohol or wakefulness stimulating drugs. It can also be a result of depression, chronic pain, psychological stress, physical injuries, restless legs, menopause, premenstrual stress syndrome, and hyperthyroidism.
Usually, cognitive therapy, sleep therapy and sleep medication help with the treatment of insomnia. Since the person has no problem staying asleep and with the quality of rest, there is no question of rectifying behavior during sleep.
What are the different types of primary parasomnia?
We should get about 8 hours of sleep each night. Experiencing parasomnia can keep you from getting the rest you require. Here are the six most common types of parasomnia that can keep you up at night and doze during the daytime –
- REM sleep behavior disorder (RBD) – During RBD, the sleeper’s brain is in a highly active state. The EEG shows the activities to be similar to that of the waking stages. Dream-enacting is the typical sign of RBD that can affect men more frequently than women. Although the exact causes remain unknown, this recurs with neurodegenerative conditions. It can eat away 20% to 25% of the sleep period. Just like most REM sleep disorders, it is common among the elderly and middle-aged men. There are pieces of evidence to suggest that RBD may be hereditary and genetics may have a significant role to play in it.
- Sleepwalking – Sleepwalking or somnambulism is more common among children than it is among adults. When children do not outgrow the habit of walking in their sleep even during their tween and teen years, it is worrisome. Adults exhibiting sleepwalking tendencies often wander onto the streets from their home while they are sleeping. There are records of people unlocking their doors, starting their cars and driving while sleeping as well. It is very dangerous for the people and the ones involved in these incidents. However, trying to jostle someone awake is not a good idea during one of their episodes. It is better to guide them back to bed gently and to stay with them until they are back to regular sleep. Certain medications show promise in the treatment of sleepwalking. Benzodiazepines, anticholinergics, antipsychotics, and selective serotonin reuptake inhibitors are potential treatments of the condition, although there is no cure. The sufferer should avoid high beds, bunk beds and bedrooms with French windows for safety reasons. Prolonged sleep deprivation, caffeine, and alcohol worsen the disorder.
- Night terrors – Night terrors are very different from nightmares. They are common during NREM sleep, while nightmares occur during the regular dreaming (REM) phase. When a person experiences night terror, he or she is likely to struggle, sit up, scream and make gestures. It can be frightening for the co-sleeper. The person experiencing the sleep terror might even have his or her eyes open. However, they are not likely to have any memory of the incident the next morning. The person is usually in a delusional state and is not fully awake. Therefore, trying to reason with the person or coaxing him or her back to sleep does not work. It affects only about 3% of the adult population. Two episodes may have days or weeks between them. They are usually unpredictable. They may even occur multiple times during the night. Research shows a genetic dependence and autosomal mode of inheritance of the disease. There are not a lot of treatment options, but psychotherapy, counseling, benzodiazepines and tricyclic antidepressants can help in the treatment of night terrors among adults. Behavioral therapy usually works effectively for children and young adults.
- Nocturnal sleep-related eating disorder (NSRED) – NSRED is a modified form of somnambulism or sleepwalking. Those sleepwalkers, who regularly walk to the fridge or kitchen and eat while they are at it, suffer from this bizarre yet severe form of sleep disorder. It is an NREM sleep disorder just like somnambulism. It is especially dangerous when the sleepwalker indulges in food items they are allergic to. People who have diabetes, Celiac disease, and cholesterol related problems are always are a higher risk of damaging their health if they suffer from NSRED. The danger catapults when the person tries to use sharp tools in his or her sleep or tries to use the stove and microwave for cooking, while asleep. The treatments are prolonged and involve extensive counseling, like sleepwalking. There is no long-term cure, and without proper therapy, the problem can recur within a couple of days, weeks or months. There is no particular trigger, although discomfort during sleep, sleep deprivation, increased stress and alcohol consumption increase the chances of its recurrence.
- Teeth grinding – Bruxism or teeth grinding is a distinct form of parasomnia. Children often grind their teeth during sleep and parents attribute that to bad dental hygiene, caries, and even worms. Once they enter their early teenage years, the problem should go away on its own. However, there are instances when young adults and adults have preserved this habit. Apart from causing fatigue of the facial muscles, long-term bruxism can lead to attrition. Repetitive grinding of teeth can cause teeth to wear, crack and chip. Dentists commonly refer to it as a parafunctional activity. It currently affects between 8% and 31% of the population. Sleep bruxism affects the males and females in a population equally. Psychological and physiological stress equally affects the incidences of sleep bruxism among both the sexes. Further evidence from studies of affected individuals shows that a majority of the sufferers have had at least one family member, who showed signs of teeth grinding. Another research into the genetics of bruxism showed that people with teeth grinding are more likely to pass it onto their children.
- Unspecified parasomnia – When a person exhibits more than one classic symptom of different types of parasomnias, sleep experts, psychiatrists and doctors usually state that he or she has unspecified parasomnia. There are instances when an adult shows symptoms of RBD, somnambulism, somniloquy, and NSRED at the same time. That is where things become complicated. It is any way challenging to diagnose and treat any form of parasomnia, but when the disorder comes in several forms, the potential treatment becomes almost impossible. Multiple factors contribute to the sleep disorder and as a result, addressing just one issue will not help the patient. The causes vary significantly between people, but in the majority of the cases, they revolve around physiological problems. There might be problems with the area of the brain that minds the wakefulness and sleep states. He or she might suffer from hormonal imbalances.
What causes parasomnia episodes?
We have gone through the six most prominent types of parasomnias among people. These sleep disorders interfere with sleep quality and lead people to feel sleep deprived. It is only fair that the sufferers get to know what causes their fatigued sleep and sleep disturbances. However, even with the advent of medical technology, the understanding of these disorders is limited. Medical professionals, psychologists, and sleep experts are still trying to figure out the exact causes of these disorders and the triggers for individual episodes.
There have been certain theorizations and facts that point towards possible causes. Here’s a list of factors that might be keeping you from getting proper rest –
- REM and NREM disorders might have their roots in degenerative neuronal diseases. Parkinson’s, Huntington’s, Alzheimer’s, and Multiple System Atrophy (MSA) or Shy Drager syndrome can lead to parasomnia.
- Several types of parasomnia have their roots in human genetics. Bruxism, sleepwalking, sleep-talking, and RBD may have autosomal inheritance patterns. Children with any form of sleep disorders are likely to have at least one parent, who suffers from the same.
- Middle-aged and senior men are more likely to suffer from parasomnia episodes regularly.
- Preceding days of the lack of enough rest can lead to parasomnia (REM) sleep disorder episodes.
- There is significant dependence on the incidence of sleep disorders and addiction. Addiction to prescription medication, hallucinogenic drugs, alcohol, and nicotine worsen the cases of parasomnia.
- Improper sleep hygiene, uncomfortable humidity and temperature settings, allergy attacks during sleep and insufficient (mattress) support can start an episode of insomnia.
- Studies show that people, who indulge in coffee and caffeinated drinks right before bedtime have higher chances of suffering from sleep disorders.
- Eating fatty and fried food can trigger acid reflux and heartburn that can lead to cases of parasomnia among the predisposed population.
- Physical stress including discomfort due to digestive challenges, injuries, and chronic pain can trigger episodes of REM or NREM disorders.
- Previous cases of brain injury, brain tumors, tumors of the brainstem and craniotomies always increase the chances of the patient developing parasomnias in the future.
Parasomnia is a heterogeneous disease. There are several categories and subcategories. Therefore, it is only fair that there are multiple potential causes of the same, instead of just one.
What are the other causes of parasomnias?
Sometimes, the inability to get enough rest per night does not stem from heredity or physiological stress. Sometimes, disorders of other organ systems lead to disturbances in sleep quality and duration. Typically, arrhythmias, dyskinesias, convulsions, and regurgitation can lead to disturbances during sleep. Sleep apnea, allergic reactions, and breathing difficulties often keep people in a delusional stage when they are trying to fall asleep. Evidence suggests that high fevers from diseases like malaria and dengue usually keep people in such semi-awakened states. These stages of semi-wakefulness also qualify as parasomnias, but unlike RBD and sleepwalking, the causes are not in the brain.
When separate organ systems (either one or multiple) contribute to such confused states of sleep and wakefulness, researchers and doctors prefer to call it secondary parasomnia. Idiopathic or primary parasomnias are prevalent among male patients, but secondary forms of the disorder depend on the incidence of the disease that causes the disturbances of sleep. For the treatment of secondary parasomnias, cognitive behavior therapy, modulation of sleep hygiene and administration of medication to treat sleep quality are not enough. You need to think about getting treatment for the underlying disorder or disease that is causing the parasomnia. Sometimes, corticosteroids are necessary for the treatment of the same.
What are some sleeping habits that can improve your quality of nightly rest?
It is understandable that your behavior during the day will impact your nighttime rest. What you eat how much physical exercise you get and how long you spend in front of the laptop will determine the quality of sleep you get during the night. You will often come across sleep advice blogs and medical experts, who will encourage you to maintain a sleep journal. Undergoing cognitive behavioral therapy can improve the quality of sleep you get each night. It can enable you to address the thoughts and habits that keep you from getting good quality rest each night.
If you are facing difficulty in getting enough rest on a regular basis, you can try the following –
- Maintain a consistent sleeping schedule. It might be difficult in the beginning, especially if you have the habit of falling asleep multiple times per day. Wake up and leave the bed at a consistent hour, even when you feel like you need more sleep.
- Do not go to bed early in the evening, even if you are sleepy. Stick to a particular bedtime that is neither too late nor too early. Going to be between 10:30 pm and 11:00 pm should give you enough time to get proper 8-hour rest.
- Make sure your bed is the place for sleep and sex only. Do not watch TV on your bed. Do not fidget with your phone or tablet.
- Stay away from electronic devices including your television right before bedtime. Switch off your mobile phone, laptop, and TV 30 minutes before bed.
- Invest in a reliable humidifier and air conditioning system. Dust your bed regularly and use clean sheets.
- You can try using a white noise machine. Sometimes, leaving the TV switched on in the next room helps people sleep due to the constant drone it generates. Moving fans, TV and the hum of home appliances can be your “natural” source of white noise.
- Do not eat within an hour of bedtime. If possible, eat a light meal devoid of too much fat and spice. If you get hungry at night while you are lying awake, get up and eat a light snack. Keep crackers handy (but out of bed).
- Always try to work out a little in the mornings. Meditation and yoga after waking up can help you boost wakefulness during the day.
- Stay away from caffeine and caffeinated drinks in the evening. Even tea has some amount of caffeine. So be careful about what you drink.
- Avoid sugary food. This step is especially critical if you suffer from hypoglycemia or diabetes. The rise and fall in glucose levels will determine your hormone content that dictates sleep.
- Do not drink alcohol, smoke cigarettes or eat junk food right before bedtime. Do not drink too much water either.
- Do not expose yourself to high-intensity blue light in the evenings. Keep the bedroom dark, comfortable and quiet.
- If you are taking any new medication that might be interfering with your sleep quality, you might want to speak with your doctor.
These are a few ways you can improve your sleep hygiene over time. These healthy sleeping habits can enhance your ability to gain the rest your body and mind deserves each night. Always remember that there is a difference between the inability to fall asleep and lousy quality sleep. That should help you understand why you need specialized therapy and treatment, or why regular sleeping medication will not help you as much as a patient suffering from insomnia.
Do you have parasomnia?
Not sleeping well night after night, yet trying to keep your calm during the day and going through the motions at office or school is a pain. It becomes even more frustrating to see people grumbling about lack of sleep over the weekend because they were partying till too late or watching a Star Wars marathon. People with parasomnias don’t just feel tired and sick all the time. They also feel alone and annoyed. It is very easy to mistake people with sleeping disorders as lazy or incompetent since they are almost always yawning and reaching for their cup of coffee. It is easy to assume that they love staying up until late chatting with friends or binge-watching Game of Thrones on Netflix. In reality, these are the people, who would give anything to sleep for 7 or 8 hours straight without a nightmare or sleep, terror. They would be the most grateful ones to be able to wake up one day without feeling bogged down with fatigue and pain.
People suffering from sleep disorders are anything but incompetent. They battle their disease even when they are asleep, and then, they show up for work or class as the others do. They go for days or weeks without enough sleep that the body and mind require to function correctly. The lack of proper rest compromises their immunity and cognition. They are the most likely to fall sick when the flu season hits. They are also the most susceptible to pre-examination stress.
What should you do if you have parasomnia?
If you can recognize these signs and symptoms, it is time for you to speak with a sleep expert. In all probability, a general physician does not have enough training in the nuances of sleep to diagnose you with RBD or NREM sleep disorders. You will need the help of a sleep expert now. The diagnostic procedure involves polysomnographs, EEG and sleep monitoring to rule out the secondary causes of parasomnia. There are times when doctors request patients to spend some time inside sleep clinics for proper observations and investigations. Your health insurance might cover the treatment for this, but it is always better to confirm with the agents before going in for the complete procedure.
Speak with your partner, family, and roommate. They need to know if you are in danger of hurting yourself in your sleep or if you are a potential threat to others. Giving them a heads-up will allow them to hide the keys to the front door and your car, lock your windows, check on you at night and keep their doors locked if you have the habit of roaming about in your sleep. Speaking with someone who shares your bed or apartment can relieve some amount of stress. It is bound to help you sleep a little better knowing that there is someone aware of your predicament.
There are no over-the-counter (OTC) treatments for any forms of parasomnia. Treating it requires experience, training, proper understanding of the causes and the thorough medical history of the affected individual. Cognitive behavior therapy, psychological counseling and sleep therapy help with redressal of symptoms. It is a long-term process that demands incredible patience and persistence on the part of the medical professional as well as the patient. If the causes lie in your genetic makeup, it might be impractical to hope for a permanent cure with therapy or medication, but continual behavioral therapy reduces the incidents and increases the gap between the two episodes.
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Co-founder of Counting Sheep and Sleepaholic