Parasomnias Explained: 14 Types of Unusual Sleep Behaviors

A parasomnia is a sleep disorder involving unusual behavior while falling asleep, sleeping, or waking up. These behaviors can interfere with healthy sleep and disrupt the sleep of your bed partner as well. While your actions may seem intentional to others, you are likely unconscious during a parasomnia episode—and unable to remember it. While parasomnias are common, it’s important to seek medical treatment from a professional if your behaviors are dangerous to yourself or others.

Parasomnias range can include a wide variety of abnormal behaviors:

1. 1. Sleepwalking: Sleepwalking, also known as somnambulism, occurs when you get out of bed and walk while still sleeping. It can be accompanied by other parasomnias like sleep talking or a sleep-related eating disorder. If you’re a sleepwalker, consider sleeping on the ground floor and taking precautions to put away items that you could trip on.
   
2. 2. Confusional arousals: A confusional arousal occurs when you wake up disoriented, unsure where you are or what you are doing. These disorders of arousal typically occur when you wake up within the first two hours of your sleep, and you most likely will have little to no memory of the episode.
3. 3. Nightmare disorder: This parasomnia is characterized by frequent and vivid dreams that generate intense fear and anxiety. Nightmare disorder can significantly impair the quality of your sleep. It may be related to an underlying health condition like post-traumatic stress disorder (PTSD).
4. 4. Sleep terrors: Also known as night terrors, this parasomnia involves episodes of screaming, flailing, and intense fear during sleep. It typically occurs during non-rapid eye movement (NREM) sleep. Unlike nightmare disorder, night terrors include physical actions and vocalizations. These episodes usually last for a few minutes.
5. 5. Narcolepsy: Narcolepsy is a rarer sleep disorder defined by excessive daytime sleepiness (EDS) and sudden, unexpected episodes of sleep. This sleep disorder often involves cataplexy, a sudden loss of muscle tone during your waking life.
6. 6. Obstructive sleep apnea: Obstructive sleep apnea (OSA) is a potentially dangerous sleep condition where your airway is blocked by the soft tissues in the back of your throat. Some symptoms of obstructive sleep apnea are loss of oxygen, headaches, daytime fatigue, elevated heart rate, and snoring.
7. 7. Sleep paralysis: Sleep paralysis is a common parasomnia blurring the lines between wakefulness and rapid eye movement (REM) sleep, the stage of sleep during which your muscles are paralyzed to stop you from acting out your dreams. This sleep disorder typically occurs when you are waking up or falling to sleep. It often entails hallucinations, and it may be related to other parasomnias like narcolepsy or sleep apnea.
8. 8. Sleep talking: Sleep talking, or somniloquy, is unconscious speech during sleep, with vocalizations ranging from full sentences to incoherent gibberish. Unlike other parasomnias, episodes of sleep talk can occur at any sleep stage, during both REM sleep and non-REM sleep.
9. 9. Sleep-related eating disorder: A sleep-related eating disorder involves unconsciously eating after sleep onset. It is often accompanied by sleepwalking. A sleep-related eating disorder can be a dangerous condition if you are eating raw foods or using utensils like knives during food preparation.
10. 10. Nocturnal enuresis: Also known as sleep enuresis or bedwetting, this parasomnia is defined by involuntary urination during sleep. This parasomnia can happen at any age, although it is more common among children. Nocturnal enuresis occurs when your bladder is full, and it may be a symptom of an underlying medical condition like a urinary tract infection.
11. 11. Exploding head syndrome: This parasomnia is characterized by hearing a loud noise right before falling asleep or waking up. This imagined sound can disrupt your sleep, elevate your heart rate, and cause intense anxiety.
12. 12. REM sleep behavior disorder (RBD): RBD is a sleep disorder that causes you to physically act out your dreams, often by kicking, punching, flailing, or vocalizing. This parasomnia occurs when the typical muscle atonia associated with REM sleep does not occur, allowing your body to react to your dreams. This can be a dangerous parasomnia for you and your bed partner, and it may relate to an underlying neurodegenerative disorder like Parkinson's disease or Lewy body dementia.
13. 13. Sexsomnia: Sexsomnia, or sleep sex, is a parasomnia involving acting out sexual behaviors during sleep, including thrusting and masturbation. Even if your eyes are open during an episode of sexomnia, you will likely be unable to remember your behaviors.
14. 14. Sleep bruxism: Sleep bruxism is characterized by grinding your teeth together during sleep. It is often an involuntary reaction to fear or stress, and it may be a symptom of another parasomnia like nightmare disorder.

If you believe you are experiencing a parasomnia, consult your doctor. Some parasomnias, like REM sleep behavior disorder, obstructive sleep apnea, and sleep-related eating disorder, may require immediate medical attention. If your behaviors during sleep are dangerous to yourself or your bed partner, talk with a licensed healthcare professional as soon as possible.

Your doctor may recommend a sleep medicine specialist, who can perform a professional sleep study, also known as a polysomnography, to monitor your brain waves and movements. This professional sleep study can help determine whether you are suffering from sleep disorders, sleep deprivation, an underlying medical condition, or a neurological disorder.

If you are experiencing a parasomnia, your sleep medicine specialist can recommend treatment options to suit your specific needs. Depending on your parasomnia, they might suggest behavioral therapy, psychotherapy, lifestyle changes, or medication. If you are diagnosed with obstructive sleep apnea, your sleep medicine specialist may recommend a CPAP machine designed to support your airway and normalize your breathing.

If you have a parasomnia, your sleep specialist might also recommend habits for better sleep hygiene. Consider general tips for improving your sleep hygiene:

1. 1. Stick to a consistent sleep schedule. Regularity is essential for good sleep hygiene. Aim to wake up at the same time each day, even on weekends. Your body thrives on routine, so find a sleep schedule that aligns with your circadian rhythm, the natural, internal clock that regulates your sleep patterns.
2. 2. Sleep in a cool, dark environment. Your core body temperature drops roughly two to three degrees Fahrenheit to initiate sleep. If you have a thermostat, try setting it at 65 degrees, which is an optimal sleeping temperature for most people.
3. 3. Avoid alcohol and coffee near bedtime. Even though alcohol consumption causes drowsiness, it can lead to disruptions in sleep as well as an imbalance between REM and NREM sleep stages. Similarly, avoid drinking beverages with caffeine in the afternoon and evening, as the effects can last for several hours. Consider using a sleep supplement like melatonin before bed.
4. 4. Establish a wind-down routine that works for you. Consistent behaviors before bedtime can help ease your mind into a pattern of deep sleep. Stretching, meditation, and breathing exercises are all healthy options for unwinding. Avoid screens as much as possible at night, especially in the 30 minutes leading up to bedtime.
5. 5. Monitor your sleep. You can learn more about your unconscious behaviors by using a sleep recording app or writing in a sleep diary. Keeping a record of your parasomnia episodes can help demystify the experience and perhaps give you a better handle on how to understand them.

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