Parasomnias: Sleepwalking, Night Terrors & REM Sleep Behavior Disorder
Acting out dreams, walking or talking in your sleep, waking in terror, or other unusual nighttime behaviors are known as parasomnias.
Our neurologists evaluate parasomnias and help rule out neurological causes such as nocturnal seizures.
Parasomnias can disrupt sleep, cause injury, and worry families โ but they are treatable, and some are important warning signs worth evaluating. At Mir Neurology, our board-certified neurologists diagnose and treat parasomnias in children and adults across Western Maryland, the Eastern Panhandle of West Virginia, and South-Central Pennsylvania.
Request an Appointment or call (301) 797-7600.
What Is a Parasomnia?
A parasomnia is an unwanted physical event or experience that happens while falling asleep, during sleep, or while waking up. These include abnormal movements, behaviors, emotions, perceptions, or dreams. The person is usually not fully aware during the event and often does not remember it afterward.
Parasomnias are grouped by which stage of sleep they occur in: non-REM deep sleep or REM sleep, the dreaming stage. The type matters because it points to the cause and the right treatment.
Non-REM Parasomnias
These happen during deep, non-dreaming sleep, usually earlier in the night, and are most common in children.
Sleepwalking
Getting up and walking or performing activities while asleep.
Sleep Terrors / Night Terrors
Sudden episodes of screaming, intense fear, and thrashing during sleep while the person remains asleep and hard to wake.
Confusional Arousals
Waking in a confused, disoriented state.
Common Triggers
Sleep deprivation, stress, fever, and certain medications can trigger or worsen episodes.
These are common in children, who often outgrow them, but they can occur in adults too.
REM Parasomnias
These occur during the dream stage of sleep.
REM Sleep Behavior Disorder
Acting out vivid dreams with movements, talking, or sometimes violent behaviors like punching or kicking. RBD is important to diagnose because it can be an early warning sign of certain neurological conditions, including Parkinson's disease.
Nightmare Disorder
Frequent, distressing nightmares that disrupt sleep and daytime functioning.
Sleep Paralysis
A temporary inability to move or speak while falling asleep or waking up.
Neurological Follow-Up
New dream-enactment behavior in adults should be evaluated, especially when symptoms are violent or progressive.
Parasomnia Symptoms
Signs that you or a loved one may have a parasomnia include:
- Walking, talking, eating, or other activities during sleep
- Sudden episodes of screaming or fear at night
- Acting out dreams โ moving, thrashing, or vocalizing
- Waking confused or disoriented
- Frequent, distressing nightmares
- Episodes of being unable to move when falling asleep or waking
- Injuries during sleep, or disrupted sleep for the person or their partner
What Causes Parasomnias?
Parasomnias can be triggered or worsened by:
- Sleep deprivation and irregular sleep schedules
- Stress and anxiety
- Fever, especially in children
- Certain medications and alcohol
- Other sleep disorders, such as sleep apnea or restless leg syndrome
- Underlying neurological conditions, particularly with REM sleep behavior disorder
In children, many parasomnias are part of normal development and fade with age. In adults โ especially with new-onset RBD โ an evaluation is more important to identify any underlying cause.
When to See a Neurologist
Most occasional parasomnias in children are harmless, but you should seek evaluation if:
- Episodes are frequent, violent, or cause injury
- A child's episodes persist into the teen years or worsen
- An adult develops new sleep behaviors, especially acting out dreams
- The behaviors disrupt sleep or daily functioning
- You are concerned about safety
New-onset dream-enactment behavior in adults deserves prompt evaluation, given its link to neurological conditions.
How Parasomnias Are Diagnosed
Evaluation focuses on identifying the type and any underlying cause, and may include:
- A detailed sleep history โ what happens, when, and how often, often with input from a bed partner or parent
- A review of triggers, medications, and other sleep symptoms
- A Sleep study, called polysomnography, especially helpful for diagnosing REM sleep behavior disorder and ruling out other sleep disorders
- A neurological exam when appropriate
- EEG testing when seizure activity needs to be ruled out
Parasomnia Treatment
Most parasomnias respond well to treatment. Depending on the type and cause, this may include:
- Improving sleep habits with consistent schedules and adequate sleep
- Safety measures, including securing the bedroom to prevent injury during episodes
- Treating underlying triggers such as sleep apnea, restless legs, stress, or medication effects
- Medications when episodes are frequent, severe, or pose a safety risk, often used for REM sleep behavior disorder
- Addressing related neurological conditions, particularly with REM sleep behavior disorder
- Reassurance and monitoring for the many childhood parasomnias that resolve on their own
Serving Western Maryland & the Tri-State Area
With offices in Cumberland and Hagerstown, we provide expert sleep and neurological care close to home.
Maryland
Cumberland, Hagerstown, LaVale, Frostburg, Cresaptown, Hancock, Williamsport, Smithsburg, Boonsboro
West Virginia
Martinsburg, Keyser, Romney, Berkeley Springs, Paw Paw
Pennsylvania
Waynesboro, Greencastle, Chambersburg, Mercersburg
Cumberland office: 924 Seton Dr Suite C, Cumberland, MD 21502 โ MonโSat, 7:30 AM โ 4:30 PM
Hagerstown office: 11110 Medical Campus Rd Unit 151, Hagerstown, MD 21742 โ MonโFri, 7:30 AM โ 5:00 PM
Frequently Asked Questions
What is a parasomnia?
A parasomnia is an unwanted event during sleep, such as sleepwalking, night terrors, or acting out dreams. They occur during non-REM or REM sleep, and the person is usually not fully aware during the episode.
What is the difference between night terrors and nightmares?
Night terrors are episodes of screaming and intense fear during deep sleep, with the person hard to wake and usually no memory of it. Nightmares are frightening dreams during REM sleep that the person often remembers.
Is REM sleep behavior disorder serious?
REM sleep behavior disorder can cause injury from acting out dreams, and it is important because it can be an early sign of certain neurological conditions, including Parkinson's disease.
Are parasomnias dangerous?
Most are harmless, especially in children, but some can cause injury or signal an underlying condition. Frequent, violent, or new adult-onset episodes should be evaluated.
How are parasomnias treated?
Treatment includes improving sleep habits, safety measures, treating triggers or related sleep disorders, and medications when needed โ particularly for REM sleep behavior disorder or severe episodes.
Unusual Behaviors During Sleep โ For You or Your Child?
Mir Neurology diagnoses and treats parasomnias in Cumberland and Hagerstown.