What Are Parasomnias?

Have you ever heard a strange sound while falling asleep? Or have you woken up and not been able to move? Or maybe someone’s told you that you talk, scream, or even walk in your sleep — but you can’t remember it. If so, you may be experiencing parasomnias. 

A parasomnia is an unusual activity that someone does while they’re asleep. If you have parasomnias, you’re not alone. Many people experience parasomnias — either once or multiple times. If you or someone you love is experiencing parasomnias, here’s everything you need to know about these sleep conditions. 

What is a parasomnia?

Parasomnias refer to unusual events that can happen during sleep. But not every abnormal thing that happens while you sleep is a parasomnia. These events need to be unwelcome. For example, a dream can be a pleasant experience that doesn’t disrupt your quality of sleep. Such a dream doesn’t fit the definition of a parasomnia. But not all dreams are enjoyable. Ongoing nightmares are parasomnias. 

A parasomnia can happen at different points in the sleep cycle, including while you’re:

• Falling asleep

• Sleeping

• Waking up

Parasomnias can be physical actions you do like:

• Walking

• Talking 

• Screaming

• Eating

Or they can be more passive experiences like:

• Hearing things

• Seeing things

• Having unpleasant dreams, feelings, or perceptions

It’s not always clear why some people have parasomnias. But studies show that many people experience parasomnias at least once during their lives. 

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Other people experience parasomnias more often. These people might also have another sleep disorder or a medical condition like sleep apnea or periodic limb movement disorder. People who don’t get enough sleep or have shift work sleep disorder may also experience parasomnias more often. 

What are the different types of parasomnias?

There are many types of parasomnias. To help keep track of them all, experts divide them into three main groups:

1. Non-rapid eye movement (NREM) parasomnias

2. Rapid eye movement (REM) parasomnias

3. Other parasomnias

NREM and REM refer to stages of sleep — both types are important for keeping the brain and body healthy. During a normal night’s sleep, you move between NREM and REM sleep many times. Sometimes these stages overlap a bit, and as the brain moves from one stage to the next, you can experience parasomnias. 

Non-rapid eye movement parasomnias

NREM parasomnias happen when you partially wake up during NREM sleep. In these parasomnias, people usually move, walk, talk, or yell. 

People aren’t aware of what they’re doing and don’t typically remember the events. 

NREM parasomnias include:

• Sleep-walking: People usually walk, run, or move things. Most episodes only last about 10 minutes. 

• Sleep terrors: These are also called “night terrors.” People with night terrors scream and may also move or walk. They’re more common in children than adults.

• Confusional arousals: People will often behave strangely and look awake because their eyes are open and they often talk or make sounds. People don’t get out of bed or move around. 

• Sleep-related eating disorder: People will get up to eat during the night. They may even try to cook and use the stove or knives. Sleep-related eating disorder isn’t the same thing as night eating syndrome. People don’t remember eating. 

• Sexsomnia: People perform sexual behaviors but do not remember the events. 

Rapid eye movement parasomnias

REM parasomnias happen during “dream sleep.” In this part of sleep, the brain temporarily paralyzes the body, so you don’t act out your dreams at night. So people who have REM parasomnias don’t move or talk. Instead they have unusual experiences or sensations. 

Unlike with NREM parasomnias, people with REM parasomnias do remember the events. 

REM parasomnias include:

• Recurrent isolated sleep paralysis: People start to wake up but can’t move. This happens because they’re still partially in the REM state when muscles are paralyzed. 

• Nightmare disorders: At some point, everyone has a nightmare. But people with nightmare disorders have frequent, terrifying dreams. The dreams are so upsetting that they may have a hard time sleeping. Children may refuse to sleep.

• Sleep related hallucinations: Some people experience hallucinations as they fall asleep or wake up. They might hear, feel, or see things that aren’t really there. Some people might feel like they’re falling. 

Other parasomnias

This category includes all the parasomnias that aren’t linked to a specific stage of sleep. 

These parasomnias include:

• Exploding head syndrome: People hear a very loud noise, like an explosion, and might even see flashes of light. Although people don’t feel any pain, the event can be frightening. This usually happens as they’re falling asleep. 

• Sleep talking: People talk in their sleep — sometimes it makes sense, but not always. It can happen during REM and NREM sleep, which is why it’s in the “other” category. Many experts aren’t sure if this is technically a parasomnia because it doesn’t usually cause distress. 

This category also includes parasomnias with causes from medications, sleep disorders, and other medical conditions. 

Do I need treatment for parasomnias?

Not everyone needs treatment for parasomnias. Some people only experience parasomnias once in a while. And others aren’t bothered by their parasomnias. In these cases, people often choose to simply live with their experiences and adjust their routines. 

But parasomnias can be disruptive, frightening, or even dangerous. In these cases, people will often seek treatment. 

Treatment for parasomnias includes:

• Tests for other sleep disorders: Healthcare providers will make sure your parasomnias aren’t due to another sleep condition, like narcolepsy or sleep apnea. If you have a parasomnia because of another common sleep disorder, the first step is to treat that condition to see if your parasomnia goes away.

• Sleep hygiene: This might include changing your sleep patterns, room setup, or bedtime habits to help you sleep better. Your provider might ask you to track your sleep patterns with a medical device.

• Cognitive behavioral therapy (CBT): With CBT, you work with a therapist to develop tools to manage or decrease parasomnias. Hypnosis, desensitization, and planned nighttime awakenings can help. 

• Medications: Medications can help decrease or even stop parasomnias.

• Safety planning: People who experience NREM parasomnias can get hurt because they move around during their parasomnias. They may fall down stairs, burn themselves while trying to cook, or have another accident. If you have NREM parasomnias, make sure your home is set up for safety. Remove stove dials and close doors, especially near stairs. 

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Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who is passionate about achieving optimal health through healthy lifestyles. Clements is a diplomate of the American Board of Obesity Medicine and the American Board of Integrative Medicine.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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