They sit up in bed screaming, eyes open but unseeing. They walk through the house while completely asleep. They thrash violently, acting out their dreams. They wake paralyzed, sensing a presence in the room.
These are parasomnias—abnormal behaviors, experiences, or physiological events that occur during sleep or sleep transitions. Strange, sometimes frightening, but more common than you might think.
What Are Parasomnias?
The Simple Explanation
Parasomnias are a group of sleep disorders involving abnormal movements, behaviors, emotions, perceptions, or dreams during sleep. They can occur during falling asleep, during sleep, or during the transition from sleep to wakefulness. Most parasomnias represent a mixed state—part asleep, part awake—where behaviors occur without conscious awareness.
Think of it like this: Normally, sleep and wakefulness are distinct states with clear boundaries. In parasomnias, these boundaries blur. Part of the brain is asleep while another part activates behaviors, movements, or experiences. It’s like a glitch in the sleep-wake transition—the body or mind doing things that usually only happen in one state while actually being in another.
The Categories
NREM Parasomnias:
– Occur during non-REM (deeper) sleep
– Sleepwalking, sleep terrors, confusional arousals
– More common in children
REM Parasomnias:
– Occur during REM (dream) sleep
– REM sleep behavior disorder, sleep paralysis, nightmares
– More common in adults
Disorders of Arousal (NREM Parasomnias)
Sleepwalking (Somnambulism)
What it is:
– Walking or performing complex behaviors while asleep
– Eyes may be open, but person is not conscious
– May perform routine activities
– Usually no memory afterward
What it looks like:
– Getting out of bed and walking
– Opening doors, going outside
– Eating (sleep-related eating)
– Getting dressed
– Moving furniture
– Blank, glassy stare
– Hard to wake up
– Confused if awakened
Who’s affected:
– Most common in children (peaks ages 8-12)
– Often runs in families
– Usually outgrown
– Can occur in adults (often more complex behaviors)
Sleep Terrors (Night Terrors)
What they are:
– Episodes of intense fear during sleep
– Screaming, thrashing, rapid heartbeat
– Occur during deep NREM sleep
– Person is difficult to console or wake
– No memory afterward
What they look like:
– Sudden bolt upright in bed
– Screaming or crying out
– Appearing terrified
– Sweating, rapid breathing
– May push away or fight
– Eyes open but not recognizing anyone
– Inconsolable
– No recollection next morning
Different from nightmares:
– Nightmares: remember the dream, fully wake up
– Sleep terrors: no memory, don’t fully wake
Confusional Arousals
What they are:
– Waking up confused and disoriented
– Slowed speech and thinking
– Inappropriate behavior
– May last minutes to hours
What they look like:
– Acting confused or slow
– Difficulty understanding questions
– Strange responses
– May be aggressive if forced to wake
– Usually no memory
REM Sleep Behavior Disorder
What It Is
Acting out dreams:
– Normal REM sleep includes muscle paralysis (so you don’t act out dreams)
– In RBD, this paralysis fails
– Person physically acts out dreams
– Often violent or action-oriented dreams
What it looks like:
– Punching, kicking, jumping from bed
– Shouting, talking, screaming
– May injure self or bed partner
– Usually remembers the dream if awakened
– Dream content matches the behavior
Who’s Affected
The profile:
– More common in older adults (over 50)
– More common in males
– Associated with neurological conditions (Parkinson’s, Lewy body dementia)
– May precede these conditions by years
Why It Matters
The significance:
– Can cause injury
– May be early sign of neurodegenerative disease
– Needs medical evaluation
– Treatment available
Sleep Paralysis
What It Is
Paralysis during transitions:
– Inability to move when falling asleep or waking up
– Fully conscious
– Often accompanied by hallucinations
– Frightening but not dangerous
– Lasts seconds to minutes
What it feels like:
– Can’t move any muscles
– May feel pressure on chest
– May sense presence in room
– Vivid hallucinations possible
– Terror despite knowing it’s not real
Why It Happens
The explanation:
– REM sleep includes muscle paralysis
– Sometimes this paralysis persists into wakefulness
– Brain is awake, body still in REM paralysis
– Hallucinations are dream intrusions
How Common
Prevalence:
– Very common—40% of people experience at least once
– Usually isolated events
– Can be recurrent in some
What Causes Parasomnias?
Triggers and Risk Factors
Common triggers:
– Sleep deprivation
– Irregular sleep schedules
– Stress
– Fever (in children)
– Certain medications
– Alcohol
– Sleeping in unfamiliar environments
Why Some People Are Affected
Contributing factors:
– Genetic predisposition
– Age (children for NREM, adults for REM)
– Other sleep disorders
– Medical conditions
– Medications
Treatment
For Disorders of Arousal
Management includes:
– Improving sleep quality and duration
– Regular sleep schedule
– Managing triggers (stress, sleep deprivation)
– Safety measures
– Medication if severe or dangerous
Safety First
Protecting the sleepwalker:
– Lock doors and windows
– Remove obstacles
– Consider alarms
– Sleep on ground floor if possible
– Remove weapons or dangerous items
Guiding Them Back to Bed
When they’re sleepwalking:
– Stay calm
– Gently guide back to bed
– Don’t try to wake them forcefully
– Speak softly and reassuringly
– They’ll usually comply
For REM Sleep Behavior Disorder
Treatment:
– Melatonin often helps
– Clonazepam if needed
– Safety measures (padding, removing furniture)
– Bed partner may need to sleep separately
– Evaluate for underlying neurological conditions
For Sleep Paralysis
What helps:
– Improving sleep habits
– Reducing stress
– Regular sleep schedule
– Reassurance that it’s not dangerous
– Focusing on moving one small muscle to break it
When to Get Help
Seek Evaluation If
Concerning signs:
– Injuries occurring
– Very frequent episodes
– Affecting sleep quality
– Causing significant distress
– New onset in adulthood
– Behaviors are dangerous or complex
What Doctors Do
Evaluation may include:
– Sleep history
– Sleep study (polysomnography)
– Assessment of triggers
– Ruling out other conditions
For Families
Understanding It
What to know:
– They’re not conscious during episodes
– They won’t remember
– They’re not doing this on purpose
– It can be managed
How to Respond
During episodes:
– Stay calm
– Ensure safety
– Don’t shake them awake forcefully
– Guide them gently
– Watch but don’t overreact
After episodes:
– Reassure them
– Don’t shame or tease
– Discuss with doctor if frequent
– Implement safety measures
Moving Forward
Parasomnias are strange and sometimes frightening—both for the person experiencing them and for those who witness them. Watching someone scream in terror, walk through the house asleep, or violently act out dreams is disturbing. But these are sleep disorders, not psychological problems or spiritual experiences.
Most parasomnias in children are outgrown. Adult parasomnias can usually be managed with sleep hygiene, trigger avoidance, and sometimes medication. REM sleep behavior disorder in older adults warrants evaluation for underlying conditions.
The key messages: stay calm, prioritize safety, understand that consciousness is absent during these episodes, and seek help if needed. The nighttime may be strange, but morning always comes.
This article is for educational purposes only and is not a substitute for professional evaluation or treatment. If parasomnias are frequent, dangerous, or distressing, please consult a sleep specialist. Arise Counseling Services offers compassionate support for individuals and families throughout Pennsylvania.
Ready to Take the Next Step?
If you'd like support in working through these issues, I'm here to help.
Schedule a Session