Parasomnias are a group of sleep disorders. Patients sleepwalk, talk in their sleep, or go into shock. Children are more commonly affected by parasomnias than adults.
What is parasomnia?
Literally translated, parasomnia means “occurring during sleep.” By analogy, physicians refer to parasomnia when a patient suffers from behavioral abnormalities from sleep. Accordingly, parasomnias belong to the sleep disorders. As a rule, the behavioral abnormalities wake up the affected person from sleep. The patient is then unable to fall asleep or at least no longer perceives sleep as restful. Parasomnias do not necessarily have to be related to growing up, but can also refer to a change in sleep stages. All parasomnias belong to the so-called dyssomnias. By this, medicine understands subjectively perceived and objectively observed abnormalities of sleep. Children suffer from parasomnias more frequently than adults. In addition to waking disorders such as Pavor nocturnus, parasomnias include disorders of the sleep-wake transition such as sleep-onset myoclonus and REM sleep-associated disorders such as sleep paralysis. In addition, some disorders of erection are known as parasomnias, such as inform of abnormal dream behavior. Parasomnias are a relatively common phenomenon that is relatively harmless in most cases.
Causes
Research into the causes of parasomnias has not yet been completed, as sleep laboratories and sleep monitoring constitute a rather young field of medicine. Because parasomnias occur preferentially in childhood, medical science now assumes that the cause is a maturational disorder of the brain. Such a maturation disorder is usually temporary and harmless. Parasomnias in adulthood are much more complex and can be associated with abnormal behavior. In such cases, medical clarification of the sleep disorder is mandatory. As soon as the sleep disorders occur regularly in an adult, the patient’s health is at risk. Parasomnias are also stressful for the environment of the affected person. Scientific studies now suggest that the activity of the postcentral gyrus is associated with parasomnias. This area of the brain corresponds to a turn on the parietal lobe in the cerebrum. The gyrus lies posterior to the central furrow and is home to the somatosensory cortex, where tactile perception is processed. Increased activity in this brain region during deep sleep can apparently trigger parasomnias.
Symptoms, complaints, and signs
The symptoms of parasomnia are highly variable depending on the subgroup. In the waking disorder, Pavor nocturnus, patients cry out loudly several hours after falling asleep. They exhibit physical agitation with tachycardia or cold sweats. Patients appear frightened and cannot be awakened or spoken to. Disorders of the sleep-wake transition result in disorders such as sleep-onset myoclonus. A falling asleep myoclonus refers to a sudden twitching as well as lashing out of the legs trembling or twitching of the affected person’s extremities. Often, patients even lash out. REM sleep-associated parasomnias include nightmares as well as sleep paralysis. This paralysis usually corresponds to paralysis of the middle radialis, which is favored by prolonged exposure to pressure during sleep. Affected individuals are unable to move their arm during this phenomenon. Brief cardiac arrests may also occur during REM sleep, such as in REM-associated asystole. In somniloquy, patients speak in more or less differentiated monologues during sleep. In contrast, patients with jactatio capitis nocturna perform movement stereotypies during sleep. Somnambulism, in turn, belongs to the wake-up disorders and affects sleepwalking patients. The affected persons move out of bed without being awake and perform actions. In this type of parasomnia, there is guilt incapacity in the case of a criminal act. A special form of somnambulism is sexomnia, in which the patient performs mainly sexual acts.
Diagnosis and course of the disease
The diagnosis and further classification of parasomnia is based on various diagnostic classification criteria and coding systems. For example, relevant systems include the International Classification of Sleep Disorders, published by the American Academy of Sleep Medicine.The ICD-10 is also used for diagnosis. In many cases, provocation of the sleep disorder in the sleep laboratory is an important diagnostic step. In most cases there is a favorable prognosis for patients of parasomnia. Particularly in children, sleep disorders resolve during brain development.
Complications
Due to parasomnia, affected individuals usually suffer from severe sleep complaints and sleep disturbances. These complaints have a very negative effect on the patient’s quality of life and can reduce it extremely. It is not uncommon for those affected to be irritable and appear stressed or slightly aggressive. Psychological restrictions or even depression can also occur due to the parasomnia and significantly complicate the daily life of the affected person. Due to sleepwalking, parasomnia can also lead to accidents. The affected person is often not rested and tired, although the fatigue can not be compensated by sleep. Paralysis can also occur during sleep and is perceived as very unpleasant. In some cases, parasomnia can also lead to cardiac arrest. Furthermore, sleepwalking can also lead to criminal acts. The daily life of the affected person is significantly restricted by the parasomnia. Living with a partner can also lead to complications. This complaint is usually treated with medication and relaxation exercises. It cannot be universally predicted whether this will be successful.
When should you see a doctor?
If night terrors, sleepwalking, and other unusual symptoms occur repeatedly, a doctor should be consulted. Parasomnias manifest themselves through various signs that need to be clarified and treated. Otherwise, accidents and falls may occur during the uncontrolled actions. Therefore, even the first signs of parasomnia should be clarified and treated by a doctor. The physician can determine the diagnosis on the basis of a medical history and a physical examination in the sleep laboratory and initiate further measures. If this is done early, serious complications can be avoided. People who already have Parkinson’s disease or have another REM behavior disorder in addition to parasomnia are particularly at risk. People with psychological complaints or neurological diseases also belong to the risk groups and should consult a doctor if the symptoms mentioned occur repeatedly and do not subside on their own. Behavioral abnormalities during the day must also be clarified. If excessive daytime sleepiness or nighttime awakenings become more frequent, a visit to the sleep laboratory is recommended. Other serious complications should also be clarified if they occur frequently and severely limit well-being. In addition to the family doctor, the neurologist or an internist may be consulted.
Treatment and therapy
Many sleep disorders do not require therapy. This is true, for example, for falling asleep myoclonia or the Pavor nocturnus. Particularly in children, parents of a parasomniac are advised of the harmlessness of the disorder and encouraged to continue sending the child on school trips, for example, despite the parasomnia. Affected individuals should not develop avoidance strategies simply because other people may witness the sleep disorder. Cardiovascular arrests during sleep require therapy, usually initially associated with a stay in the sleep laboratory. If the arrest occurs, cardiopulmonary resuscitation is performed. The primary causes must be clarified in more detail and, if necessary, remedied surgically or with medication. Talking during sleep may be treated with clonazepam if the monologues negatively affect roommates. Relaxation exercises usually help against jactatio capitis nocturna. If there is no improvement, medications such as antidepressants may provide relief. Sleepwalkers with a tendency to act aggressively are usually treated with sedative psychotropic drugs. Especially in adults, certain parasomnias may mark the onset of a psychotic illness. In this case, psychotherapy is required.
Outlook and prognosis
The prognosis of parasomnias are to be evaluated individually according to personal health conditions. In children and adolescents, sleep disorders are transient in most cases.During the growth process, the irregularities often occur, which are temporary in nature. Spontaneous healing is often documented. Short-term relapses are also possible in the course of life. There are no reasons for concern in such a course of the disease. They are considered harmless because they have only a short-term occurrence. In case of persistent sleep disorders with a severe intensity, the prognosis worsens. These sufferers may develop secondary disorders and other diseases. The interruptions and disturbances of sleep lead to severe impairments in coping with everyday life. Irregularities of the cardiovascular system may occur. Similarly, paralysis symptoms are to be expected. In severe cases, sudden death of the affected person may occur. If medical care is not sought, the prognosis is further worsened. In addition to the organic disorders, psychological stress states can occur, leading to secondary diseases. Anxiety disorders, depression and other mental illnesses can develop, leading to a significant deterioration in health. The risk of accidents or substance abuse is also increased in parasomnia. Often, sufferers are severely distressed and require adequate medical care to improve the overall situation.
Prevention
To date, parasomnias cannot be prevented because the causes have not been conclusively researched. As a general measure, relaxation exercises can be performed for a more relaxing sleep.
Aftercare
Since parasomnia is a collective term for a whole range of different sleep disorders, the type of aftercare varies depending on the disorder. In some cases, no follow-up is necessary. Night terrors (Pavor nocturnus), as the most harmless form, occur preferably in young children and disappear by themselves and without consequences at the latest with puberty – usually earlier. Some other sleep disorders, such as nightmares, twitching to fall asleep, or talking in one’s sleep, also do not require treatment, as long as they occur only temporarily and do not lead to a permanent burden on the person affected. Sleep paralysis is also one of the phenomena that do not require treatment and are basically harmless and do not require follow-up care. If the patient suffers greatly from the experience, behavioral therapy may be useful to help cope with the condition. In the case of sleepwalkers, unless the cause can be eliminated, there is a need to secure the sleeping premises in such a way that the risk of self-harm is minimized. If, in the case of snoring, the cause of the disorder cannot be eliminated (such as surgical correction of the nasal septum or removal of adenoids), there are various methods to alleviate the symptoms. In severe cases associated with sleep apnea, it may be necessary to monitor sleep consistently. Measures such as weight reduction or abstaining from alcohol are useful.
What you can do yourself
People affected by parasomnia should inform themselves comprehensively about the condition so that fears and uncertainties can be reduced. At the same time, knowledge should be shared with relatives or people in one’s household. Proper management of a sleepwalker is necessary to prevent an increase in symptoms. Due to an emergency that can occur at any time, doors and emergency exits should never be completely closed. Despite sleepwalking, an escape route must always be freely accessible. On the other hand, measures that contribute to an increase in security are helpful. Alarm systems can be installed in the home to signal to fellow residents that the person is trying to leave the front door while asleep. Optimizations of the sleep hygiene can contribute to a decrease of the sleep disturbances. The bedding, mattress and environmental influences should be checked and, in the event of irregularities, adjusted to the needs of the affected person. Ambient noise should be minimized and sufficient oxygen should be available. A regular sleep-wake rhythm is also conducive to improvement. In addition to external conditions, reducing internal stressors helps many patients. Emotional and psychological problems of everyday life can lead to a worsening of parasomnia. Supportive is the use of relaxation techniques such as yoga or mediation, as well as the offer of psychotherapeutic accompaniment.
