Parasomnias are unwanted physical or behavioural events that occur during sleep or around sleep-wake transitions. They can include sleepwalking, sleep terrors, confusional arousals, nightmares, sleep paralysis and dream enactment.
The pattern varies by parasomnia. Some events occur during partial arousals from non-REM sleep, while others occur in REM sleep or at the transition between sleep and wakefulness.
Walking or carrying out complex behaviours while not fully awake, often with little or no memory of the episode afterward.
Episodes of marked confusion or intense fear and autonomic arousal, typically arising from non-REM sleep.
Movements or vocalisations associated with acting out dreams, which may require specialist assessment for REM sleep behavior disorder.
Disturbing dreams or temporary inability to move at sleep-wake transitions can also fall within the parasomnia spectrum.
Parasomnias can be influenced by sleep deprivation, irregular schedules, stress, medications, alcohol or other substances and coexisting sleep disorders. In children, many non-REM parasomnias are common and often lessen with age.
A detailed sleep history is often the starting point. Information from a bed partner or family member and a home video, when available, can be very helpful in describing an event.
The timing, behaviours, vocalisations, awareness, recall, triggers and frequency of episodes are reviewed.
Sleep schedule, sleep deprivation, medicines, alcohol or other substances and coexisting sleep symptoms are considered.
Clinicians may consider obstructive sleep apnea, nocturnal seizures, REM sleep behavior disorder and other conditions that can produce unusual nighttime events.
An overnight sleep study with video may be appropriate when events are atypical, frequent, injurious or need differentiation from seizures or another sleep disorder.
Many parasomnias are managed with safety measures, regular sleep and treatment of contributing factors or coexisting sleep disorders. Medication is not automatically required.
Adequate sleep opportunity and a consistent sleep-wake schedule can reduce events associated with sleep deprivation and irregular schedules.
Remove hazards, secure doors or windows when appropriate and reduce objects that could cause injury during sleepwalking or dream enactment.
When obstructive sleep apnea or another sleep disorder contributes to events, treating the underlying condition may be an important part of management.
Selected parasomnias may benefit from behavioural approaches, scheduled awakenings or clinician-directed medication after the diagnosis is established.
Dr. Prakash Kothari G provides online Sleep Medicine consultations for adults and children. Consultation can help clarify the likely type of parasomnia, identify contributing factors and decide whether a sleep study or further evaluation is appropriate.
A structured Sleep Medicine assessment can help distinguish common parasomnias from other sleep or neurological conditions and identify practical safety measures.