Parasomnia Disorders

Parasomnias are sleep disruptions. They can happen in the early stages of sleep, known as non-rapid eye movement (non-REM) sleep. Or they can happen during REM sleep (the later stages when vivid dreaming happens). Your body typically cycles between non-REM and REM sleep every 90 to 110 minutes (nearly two hours).  

Non-REM parasomnias

Non-REM parasomnias are genetic (inherited). Stress, not getting enough sleep and certain medications can trigger them. They can range from minor confusion and feeling disoriented to sleep walking (somnambulism), waking up in a terrified state (sleep terror), sleep-related eating disorders or even sexsomnia (doing sexual behaviors during sleep). You’re not awake when any of things happen, and you might not respond when people interact with you. You also won’t remember anything the next day.  

REM parasomnias

REM parasomnias are often caused by a neurological disorder, like Parkinson’s disease, multiple system atrophy (MSA), Lewy body dementia or stroke. These parasomnias can cause you to do things like talk, swear, laugh, shout, punch or kick in response to dreams. They can cause nighttime disorders or recurrent isolated sleep paralysis, which makes you feel like you can’t move.  

Other parasomnias

There are still more parasomnias that aren’t tied into sleep cycles: 

• Your brain may trick you into thinking you hear explosions in your head (Exploding head syndrome).  
• You may have sleep-related seizures, hallucinations or groan during the night (catathrenia). 
• You might have bedwetting (nocturnal enuresis) that happens at least two times a week for at least three months.  

Diagnosing Parasomnias at Cleveland Clinic

When you have a parasomnia, it can be hard to sleep through the night. Or you might wake up feeling confused, disoriented or tired. You might also find cuts or bruises that you don’t remember getting. Or your bed partner might tell you that you were kicking and yelling. And you don’t remember that, either. If any of this sounds familiar, it’s time to talk with a healthcare provider who specializes in sleep disorders.

What to expect at your first visit

When you come to your first appointment, your provider will start by getting to know you. Your story is an important part of diagnosing what’s going on. So, they’ll ask you a lot of questions, like:

• When did you start acting out in your sleep?
• What sort of things are you doing while you sleep?
• Are you leaving your bed while asleep?
• How are your nighttime activities affecting your life?
• Do you have a bed partner?
• How do your nighttime activities affect your bed partner?
• Have you been diagnosed with any health conditions?
• What medications are you taking?
• Do you drink alcohol regularly?
• Are you under any stress?

Then, they’ll do a physical exam to check your overall health. And they may order tests to learn more about your condition.

Testing for parasomnias

A sleep diary is a great way to start tracking parasomnias. You (and your bed partner, if you have one) will log your nighttime activity and the time of the night when they tend to happen. You’ll also note any medications you’ve taken and if you’ve had alcohol or caffeine. This lets us see if there are any noticeable patterns.

You may also spend the night in one of our sleeping labs for a sleep study (polysomnography). This lets us track your behavior and muscle activity while you sleep. We may do a video electroencephalogram (EEG) to record your brain waves (brain activity).

A neurological exam, combined with imaging tests like MRIs (magnetic resonance imaging), can help us see if your symptoms come from problems in your brain.

Your provider may ask you to record abnormal activity at home.

Meet Our Parasomnias Team

We believe in teamwork at Cleveland Clinic. That’s why you’ll get care from providers from different specialties. We build this expert team based on your needs. And they work together to make a correct diagnosis and offer the most personalized treatment. Our neurologists or pediatricians specializing in sleep disorders lead this team of other providers, which may include:

• Pulmonologists.
• Psychiatrists.
• Psychologists.
• Primary care providers.

We plan your treatment based on what we learn from testing. We’ll look at what’s triggering your parasomnias. And we’ll consider any other sleep problems or health conditions you may have. We may recommend:

Taking safety precautions

Besides helping you sleep better, treatment must first focus on keeping you safe. We want you to avoid getting hurt or injuring others while you’re asleep. A few tips include:

• Removing dangerous or sharp objects from your bedroom.
• Securing lamps on nightstands so you don’t knock them over.
• Putting pads on the floor to cushion you if you fall.
• Adding padding to the edges of furniture.
• Using plastic cups instead of glass at bedside.
• Installing alarms on windows or doors if you sleepwalk.
• Sleeping in a separate bed from your partner if you punch, kick or have other aggressive behaviors during the night.

Planning for better sleep

We can manage non-REM and REM sleep disorders by helping you follow good sleep patterns. This includes getting seven to nine hours of sleep each night in a cool room with no lights. Children may need longer period of sleep. We’ll also ask you to avoid caffeine, alcohol and strenuous exercise before bedtime. And we’ll want you to go to bed and wake up at the same times each day.

Taking medications

While there are no FDA-approved medications for non-REM parasomnias, we may prescribe benzodiazepines (benzos) or tricyclic antidepressants if your episodes are severe or could cause injury. For REM behavior disorder (RBD), treatments include clonazepam, melatonin, pramipexole and rivastigmine. If we think the medications you’re taking are causing your RBD, we may have you safely stop taking them under supervision.

Psychological and alternative therapies

You may find relief in psychological and complementary medicine treatments like:

• Cognitive behavioral therapy.
• Psychotherapy.
• Stress management.
• Relaxation.
• Meditation.

Taking the Next Step

Missing out on a good night’s sleep can mess with your days and nights and take a toll on your physical and mental health, too. Our sleep experts are here to help you get the rest you need. We’ll listen carefully to your story, answer your questions and give you expert and compassionate care for your parasomnia. We want to help you rest easily at night so you can feel better during the day.