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Parasomnias/Sleep Walking


Parasomnias are a group of sleep disorders that involve unwanted events or experiences that occur while you are falling asleep, sleeping or waking up. They can include atypical movements, behaviors, emotions, perceptions or dreams. They commonly produce physical injuries, adverse health effects, psychological disturbances and disrupted sleep. Although the behaviors that occur may be complex and seem purposeful to others, the person experience parasomnias remains asleep during often has no memory that it occurred. Many people who experience these episodes find it hard to sleep through the night.


General Diagnosis & Treatment

In order to diagnosis your parasomnia, Dr. Matin will inquire about your complete medical history, including any current and previous medications and if you have ever had any other sleep disorder. He will often ask you to complete a sleep diary for two weeks. This will give him clues to what might be causing your problems. You can also rate your sleep with the Epworth Sleepiness Scale here. This will help show how your sleep is affecting your daily life.


Our sleep specialist will try to determine if there is something else that is causing your parasomnia or making the symptoms worse, such as another sleep disorder, certain medical conditions, medications or substance abuse. Additionally, an in-home or in-lab sleep study may also be recommended.


In most cases, parasomnias can be treated with medications, behavioral therapy and lifestyle changes. Additional treatment options for different types of parasomnias are outlines below.


TAt Sleep Disorder Centers of Georgia, we are here to help. If you have any questions or concerns about any sleep parasomnia behaviors you are experiencing please contact us.


Types of Parasomnias:

Sleepwalking (Somnambulism)

Sleepwalking is a disorder that occurs when people walk or do other activity while they are still asleep. Sleepwalkers may wake up in another room or outside the home and not recall how they got there. They may sit up and look as though they are awake, get up and walk around, do complex activities such as moving furniture, going to the bathroom, and dressing or undressing when they are actually asleep. Some people even drive a car while they are asleep.


An episode can be very brief (a few seconds or minutes) or it can last for 30 minutes or longer. Most episodes last for less than 10 minutes. If they are not disturbed, sleepwalkers will go back to sleep. But they may fall asleep in a different or even unusual place.


Sleepwalking can occur at any age, but it happens most often in children ages 5 through 12. It appears to run in families.


Some people mistakenly believe that a sleepwalker should not be awakened. It is not dangerous to awaken a sleepwalker, although it is common for the person to be confused or disoriented for a short time when they wake up. There is also a misconception that a person cannot be injured while sleepwalking. Sleepwalkers are commonly injured when they trip and lose their balance.


Treatment

Safety measures may be needed to prevent injury to sleepwalkers. This may include moving objects such as electrical cords or furniture to reduce the chance of tripping and falling. Stairways may need to be blocked with a gate. In some cases, short-acting tranquilizers are helpful in reducing sleepwalking episodes.


Prevention

Sleepwalking may be prevented by the following:


Confusional Arousals

A confusional arousal is when a person acts in a way that is strange or is confused as they wake up or just after waking. They may seem like they are awake even though their state of mind is still foggy. A person experiencing a confusional arousal may speak slowly, have confused thinking, poor memory or respond to questions and requests bluntly and nonsensically. They often begin when awoken by a noise or someone else and can last from a few minutes to a few hours. People tend to have no memory of these episodes.


Confusional arousals are fairly harmless and typically occur in children before the age of five years. Children who have confusional arousals may have a tendency to sleepwalk when they are teens.


Night Terrors

Night terrors (sleep terrors) are a sleep disorder in which a person quickly wakes from sleep in a terrified state. Most often the person will not have any memory of what happened.


Causes

The cause is unknown, but night terrors may be triggered by fever, lack of sleep or periods of emotional tension, stress or conflict.


Night terrors are most common in children ages 3 through 7, and much less common after that. Night terrors may run in families. They can occur in adults, especially when there is emotional tension or alcohol use.


Treatment

Most children outgrow night terrors. Episodes usually decrease after age 10. In many cases, a child who has a night terror only needs to be comforted. Reducing stress or using coping mechanisms may reduce night terrors. Talk therapy or counseling may be needed in some cases.


Medicines prescribed for use at bedtime will often reduce night terrors, but are rarely used to treat this disorder. Contact our sleep team if night terrors occur often, disrupt sleep on a regular basis, or if the episode cause or almost cause injuries.


REM Sleep Behavior Disorder (RBD)

This potentially dangerous sleep disorder causes a person to act out vivid dreams as they sleep. The dreams are filled with action and may even be violent. REM sleep behavior disorder differs from sleepwalking in that the person rarely walks, opens their eyes or leaves the room. Instead they may kick, punch or flail in response to the dream. It is typically easy to wake a person with RBD who is acting out a dream. Once awake, he or she is also able to recall clear details of the vivid dream.


Although less than one percent have RBD, it most often occurs in men and most often begins after age 50, but can appear at any age. It appears more often in the elderly and in people with some neurologic disorders such as Parkinson’s disease and multiple system atrophy.


Treatment

People tend to respond well to treatment with medications such as Clonazepam. However, treatment for RBD also requires the following:

Since episodes get worse over time and may result in an injury to themselves or to their partner, contact our sleep team at Sleep Disorders Center of Georgia if you think you might have REM sleep behavior disorder.


Nightmares

A nightmare is a bad dream that brings out strong feelings of fear, terror, distress, or anxiety. Everyone has them now and then but a person with a nightmare disorder has frequent nightmares that disturb their sleep.


Nightmares usually begin before age 10 and are most often considered a normal part of childhood. Nightmares may be triggered by seemingly routine events, such as starting at a new school, taking a trip, or a mild illness in a parent. Nightmares may continue into adulthood and is just one way our brain has of dealing with the stresses and fears of everyday life. One or more nightmares over a short period of time may be caused by major life events, increased stress, newly prescribed medications, alcohol and drugs and over-the-counter sleep aids.


A nightmare disorder may also be a sign of other sleep disorders such as sleep apnea, narcolepsy or sleep terrors, post-traumatic stress disorder, anxiety and depression.


Treatment

Practice good sleep habits. Go to bed at the same time each night and wake up at the same time each morning. Avoid long-term use of tranquilizers, as well as caffeine and other stimulants. Try to follow a regular fitness routine, with aerobic exercise and make more time for personal interests and hobbies. Try relaxation techniques, such as guided imagery, listening to music, doing yoga, or meditating. With some practice, these techniques could help reduce the stress causing the nightmares


Contact us at the Sleep Disorders Center of Georgia if you have nightmares more than once a week, or if they are preventing you from getting a good night's rest or from keeping up with your daily activities.


Sleep Paralysis

People with sleep paralysis are not able to move their body or limbs when falling asleep or waking up. Brief episodes of partial or complete skeletal muscle paralysis can occur during sleep paralysis. Sometimes sleep paralysis runs in families, but the cause is not known and is not associated with another sleep disorder. However, many times sleep deprivation and irregular sleep-wake schedules can cause sleep paralysis episodes to happen.


Episodes of sleep paralysis can last a few seconds to 1 or 2 minutes. During these episodes the person is unable to move or speak. Breathing is not affected. These spells end on their own or when the person is touched or moved. In rare cases, the person may have dream-like sensations or hallucinations.


This disorder is not harmful, but people experiencing sleep paralysis often are very fearful because they do not know what is happening. Often just correcting the cause, such as getting enough sleep, often resolves the condition.


Bedwetting

Adults or children may accidentally urinate during sleep. Primary bedwetting typically results from a failure to wake up when the bladder is full. This often occurs in children, as bladder control and waking before wetting the bed are skills that you acquire as you grow and develop. Secondary bedwetting occurs often in children who have recently faced strong social or mental stress. In adults, secondary bedwetting may be a sign of another medical problem such as diabetes or a urinary tract infection. In some cases, bedwetting maybe linked to sleep apnea and other health concerns.


If your parasomnia behaviors are dangerous to yourself or others, it is critical that you seek help from a sleep specialist. Please contact us at 404-257-0080.



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