Updated June 08, 2015.

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Parasomnias include a variety of conditions that consist of abnormal behaviors that occur during or around sleep. Some are quite familiar, such as sleepwalking or sleep talking, but others occur less frequently. These disorders may frequently affect children, but some persist into adulthood and others even begin much later in life. Do parasomnias ever go away? What is the long-term prognosis associated with each of these specific conditions?

If you or a loved one experience behaviors in sleep suggestive of parasomnias, you may be interested in learning the answers to these questions. Let us consider each of the more common conditions in turn:

Sleepwalking

Sleepwalking (somnambulism) is the most common parasomnia, often afflicting young children. It occurs out of deep or slow-wave sleep. The affected person will often be deeply sleeping when they get up unconsciously and walk around the bedroom, house, or even outside. They are frequently not fully aware of their environment, though they may negotiate obstacles and avoid falls. This can be highly dangerous, however, especially in certain situations.

Many children will outgrow their sleepwalking tendency. As we get older, the amount of slow-wave sleep we have in the first part of the night naturally decreases. Therefore, the risk of having the behavior also declines. It can nevertheless persist into adulthood. Therefore, it can be important to take certain safety precautions to prevent harm.

It may occur more commonly during periods of sleep deprivation or when sleep is fragmented. Therefore, it can be important to observe recommendations for good sleep hygiene and treat sleep apnea or other conditions that may aggravate the sleepwalking. In some cases, medications such as Klonopin may be prescribed to improve the sleepwalking.

Sleep Talking

Sleep talking (given the lovely Latin name "somniloquy") may also occur in sleep. Typically a few words are uttered, and these may or may not make sense or have any basis in reality. Some individuals are more conversant and people may laugh or scream while sleeping. Sleep talkers are often concerned that they will disclose secrets or unveil subconscious feelings while asleep, but this is unlikely to occur. More often than not, the speech that occurs is slurred and non-sensical. It is possible to question some people while sleep talking, but their answers may not be reliable. Sleep talking may occur more during periods of stress or in relation to sleep deprivation or fragmentation. It is a benign condition and treatment is typically not recommended. If another cause is identified, such as sleep apnea leading to fragmented sleep, treatment of this condition may reduce the frequency of the talking.

Sleep Eating

In what is a surprisingly common complaint, eating can occur while a person remains partially or completely asleep. Sleep eating typically occurs after at least a brief period of sleep. The episodes may be partially remembered or completely forgotten. The foods consumed may be unusual, even toxic, and sleep eating may occur most nights of the week. In 80 percent of people, the cause of the sleep eating is another sleep disorder such as obstructive sleep apnea or restless legs syndrome. It may also be due to medications, including sleeping pills such as Ambien. Fortunately, treatment can be highly effective, especially if the underlying cause can be eliminated.

Sleep Terrors

Sleep terrors (or night terrors) often afflict young children. The affected child will frequently arouse in the first part of the night and be inconsolable and upset. The episode may consist of fear, screaming, crying, gasping, and even moaning. The child may breathe quickly or be noted to have a fast pulse. It typically lasts on the order of minutes (not seconds or hours). Nevertheless, the anxiety and panic may be extreme and quite upsetting to parents. It is difficult to fully wake a child having a sleep terror, and the events are often not remembered the next morning. Children will eventually outgrow these episodes as their nervous system (especially the brain) matures. Sleep terrors rarely persist into adulthood, and if it does this can be treated with medication. As the child does not remember having the experience, it is typically not necessary to treat them with medications. Education and reassurance is generally sufficient.

REM Behavior Disorder

Older adults may be subject to another sleep disorder called rapid eye movement (REM) behavior disorder or RBD. REM is the period of sleep when our muscles should be paralyzed to prevent acting out of dreams. Unfortunately, this system can break down and this leads to violent dream enactment. This condition typically affects men older than age 50. It is often an early sign of a developing neurodegenerative disorder such as Parkinson’s disease or Alzheimer’s disease, and it can precede these conditions by decades. People with RBD will often kick or punch during sleep, occasionally injuring bed partners or even themselves. These actions are brief and routinely associated with vivid dream content, such as fighting off an intruder. Although the underlying condition is not curable, it can be effectively treated with medications such as Klonopin or high doses of melatonin. It is also important to observe standard safety precautions to prevent harm.

Other Behaviors and Causes

Beyond the conditions described above, there are other behaviors that may occur during sleep and be classified as parasomnias. These activities may include sex, texting, driving, criminal acts (rape or murder), and any number of other behaviors. It can be important to evaluate these if they are always the same (stereotyped) with an overnight sleep study to rule out seizures as a potential cause. In addition, medications are notorious triggers, and these should be carefully reviewed as contributors. Other sleep disorders such as sleep apnea and restless legs syndrome may also contribute by fragmenting sleep, which allows elements of both wakefulness and sleep to simultaneously occur, and treatment of these conditions can be helpful. It can also be important to keep a regular sleep schedule and observe standard guidelines to improve sleep. This may also help to prevent these behaviors from occurring in the future.

If you experience troublesome behaviors during sleep, start by speaking with your doctor and work together to identify the most likely cause so that it can be corrected to help your parasomnia to go away.

<sub>Source:

Kryger, MH et al. "Principles and Practice of Sleep Medicine." Elsevier, 5th edition. 2011.</sub>