Parasomnias are unwanted behaviors, movements, emotions, or experiences that occur while falling asleep, during sleep, or while waking. Examples can include sleepwalking, sleep terrors, confusional arousals, dream enactment, and other nighttime events.
Because some parasomnias can resemble seizures, breathing-related arousals, medication effects, or other conditions, evaluation should focus on describing the event accurately and determining whether specialized testing is needed.
Non-REM parasomnias can include sleepwalking, sleep terrors, or confused behavior arising from deeper sleep. REM-related events can include dream enactment, in which movements or vocalizations appear connected to dream content. Nightmares and recurrent sleep paralysis are other sleep-related experiences that may warrant discussion.
A website description cannot determine which type of event is occurring.
The clinician may ask about the event’s timing, movements, vocalizations, responsiveness, recall, injuries, triggers, frequency, and change over time. Sleep schedule, sleep deprivation, alcohol or substance use, medications, breathing symptoms, neurological history, and family observations can be important.
With consent and when safe to obtain, a bed partner’s description or recording may help. No one should place themselves at risk to record an event.
Until the event is evaluated, reasonable precautions may include securing doors and windows, reducing access to stairs or dangerous objects, protecting against falls, and informing household members. A person with potentially dangerous dream enactment or wandering should receive prompt clinical guidance tailored to the home environment.
Some parasomnias are assessed primarily through history, while others may require attended video polysomnography or neurological evaluation. Helyx’s home sleep apnea test does not diagnose parasomnias, REM sleep behavior disorder, or nocturnal seizures.
Treatment depends on the type and cause. It may include improving sleep opportunity and schedule, addressing triggers, reviewing medications or substances, treating another sleep condition, changing the environment for safety, or considering medication after evaluation. No single intervention — CPAP, benzodiazepines, melatonin, or CBT — is recommended before the condition is clarified.
Seek prompt medical attention for injury, dangerous behavior, possible seizure, new neurological symptoms, breathing difficulty, or a sudden change in nighttime behavior. Call 911 for an immediate emergency.
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