There Might Be a Monster In Your Bedroom: It Is Parasomnia
Most of us hate leaving the bed in the morning. When the sun is still young, and the air is still cold, it is enough reason for us to sleep in for “just five more … Read more
Most of us hate leaving the bed in the morning. When the sun is still young, and the air is still cold, it is enough reason for us to sleep in for “just five more … Read more
Most of us hate leaving the bed in the morning. When the sun is still young, and the air is still cold, it is enough reason for us to sleep in for “just five more minutes.” For the many of us, sleeping is our favorite pastime, and we love to sneak in naps on lazy weekends. Sadly, that is the reality for only a handful of adults today. According to prominent research organizations and the American Sleep Association, about 70 million American adults suffer from some difficulty in falling asleep and staying asleep. Some of them dread the idea of going to bed at night due to the discomforts they face during sleep. These are also the people who push bedtime further back to the point they are ready to “drop dead” on their bed.
That brings many questions to our minds –
Sleeping disorders can be of various types. Almost all children experience nightmares from time to time. You may remember a couple of the unpleasant dreams you may have suffered as a child. Common recurring themes of nightmares among adults include public nudity, teeth falling out and running but not being able to move. According to sleep experts and psychologists, these nightmares are unpleasant but quite common. They do not qualify as sleep disorders unless they are causing you to wake up with physical discomfort in the middle of the night or keeping you awake for long hours. In most cases, we experience unusual dreams, but we remain asleep throughout the process. They do not cause us to frail about in our bed, strike out or to sit up and scream in a delirium. When these symptoms come in the picture, the case quickly escalates to sleeping disorders of the class parasomnia.
There are a few classic symptoms of parasomnia include the following –
Researchers define parasomnias as dissociated sleep states that lead to partial arousals. They associate these stages with transitions between REM or NREM sleep and wakefulness. Interestingly, sleep disorders do not always stem from nightmares or unpleasant dreams. Although a bizarre and scary dream may affect a person more, he or she is equally likely to act out the mundane dreams as well. It is common for children to do so, but when adults start enacting dreams of sexual nature in their sleep, it can be particularly embarrassing and scandalizing.
Considering the fact that over 10% Americans currently suffer from one kind of parasomnia or another, there must be several studies that can shed some light on the cause, treatment and potential cure of the disorder. Before we go into that, we should try and understand the classification of these sleep disorders.
The NREM parasomnias typically occur during slow-wave (stage 3 and 4 of NREM) sleep. That happens when the person is somewhere between complete sleep and wakefulness. There is physiological activation that causes the person to exit the full suspension of physiological movement, but he or she continues to sleep and dream. Research shows that these stages involve the activation of the cognitive process, the motor system and the autonomic nervous system (ANS).
Night terrors and confusional awakenings are more common during the childhood of a person than they are during adulthood. One expects these issues to go away as the child transitions into the teenage and eventually, adulthood. When the same incidents recur among adults, they likely suffer from parasomnia. Specific factors including sleep deprivation, depression, and medication for depression, physical stress and emotional stress can induce NREM parasomnias in adults.
During NREM parasomnia, a person can expect one or more of these symptoms –
Contrary to NREM parasomnias, these happen during the REM stage of sleep. The person loses atonia or muscle paralysis during this stage, which allows him or her to move about while dreaming. While REM is ubiquitous among adults, people rarely seek counsel or treatment. Patients experience a high risk of injuries resulting from the sudden movements, and they pose a threat to the co-sleeper as well. Patients do take precautionary measures that range from barricading themselves with pillows to sleeping on a low bed or mattress.
Research shows that the telltale signs of REM sleep disorders include the following –
Catathrenia is a form of REM sleep disorder during which a person is likely to hold his or her breath. It involves groaning during expiration. It does not have any known associations with obstructive sleep apnea and somniloquy. The person experiencing this sleep disorder is usually unaware of the noise, but the co-sleepers might find it disturbing. Interestingly, although the sufferer is unaware of the sound, they often find themselves awake in the middle of the night after constant groaning.
That finally brings us to insomnia. Apart from pop songs and Hollywood, social media has made ‘insomnia’ a trend. When a person suffers from the lack of sleep for two nights in a row, the person claims himself or herself as an insomniac. What we need to understand is that it is a disease that renders a person unable to fall asleep at desired or socially acceptable bedtime. As a result, the person finds himself or herself awake till 3 am or 4 am in the morning, for multiple nights in a row. When a person suffers from the lack of sleep for over two months, then the doctors and sleep experts pronounce it as a case of insomnia.
It can be recurrent and intermittent, or it can be chronic. In cases of chronic insomnia, a person is unable to fall asleep in spite of staying awake for over 24 hours at a stretch or suffering from sleep deprivation for a couple of days. It is indeed a sleep disorder, but it is not a form of parasomnia. While parasomnia involves abnormal movements and the inability of a person to remain asleep, insomnia consists of the ability of a person to fall asleep. The leading causes of it include increasing consumption of caffeine, alcohol or wakefulness stimulating drugs. It can also be a result of depression, chronic pain, psychological stress, physical injuries, restless legs, menopause, premenstrual stress syndrome, and hyperthyroidism.
Usually, cognitive therapy, sleep therapy and sleep medication help with the treatment of insomnia. Since the person has no problem staying asleep and with the quality of rest, there is no question of rectifying behavior during sleep.
We should get about 8 hours of sleep each night. Experiencing parasomnia can keep you from getting the rest you require. Here are the six most common types of parasomnia that can keep you up at night and doze during the daytime –
We have gone through the six most prominent types of parasomnias among people. These sleep disorders interfere with sleep quality and lead people to feel sleep deprived. It is only fair that the sufferers get to know what causes their fatigued sleep and sleep disturbances. However, even with the advent of medical technology, the understanding of these disorders is limited. Medical professionals, psychologists, and sleep experts are still trying to figure out the exact causes of these disorders and the triggers for individual episodes.
There have been certain theorizations and facts that point towards possible causes. Here’s a list of factors that might be keeping you from getting proper rest –
Parasomnia is a heterogeneous disease. There are several categories and subcategories. Therefore, it is only fair that there are multiple potential causes of the same, instead of just one.
Sometimes, the inability to get enough rest per night does not stem from heredity or physiological stress. Sometimes, disorders of other organ systems lead to disturbances in sleep quality and duration. Typically, arrhythmias, dyskinesias, convulsions, and regurgitation can lead to disturbances during sleep. Sleep apnea, allergic reactions, and breathing difficulties often keep people in a delusional stage when they are trying to fall asleep. Evidence suggests that high fevers from diseases like malaria and dengue usually keep people in such semi-awakened states. These stages of semi-wakefulness also qualify as parasomnias, but unlike RBD and sleepwalking, the causes are not in the brain.
When separate organ systems (either one or multiple) contribute to such confused states of sleep and wakefulness, researchers and doctors prefer to call it secondary parasomnia. Idiopathic or primary parasomnias are prevalent among male patients, but secondary forms of the disorder depend on the incidence of the disease that causes the disturbances of sleep. For the treatment of secondary parasomnias, cognitive behavior therapy, modulation of sleep hygiene and administration of medication to treat sleep quality are not enough. You need to think about getting treatment for the underlying disorder or disease that is causing the parasomnia. Sometimes, corticosteroids are necessary for the treatment of the same.
It is understandable that your behavior during the day will impact your nighttime rest. What you eat how much physical exercise you get and how long you spend in front of the laptop will determine the quality of sleep you get during the night. You will often come across sleep advice blogs and medical experts, who will encourage you to maintain a sleep journal. Undergoing cognitive behavioral therapy can improve the quality of sleep you get each night. It can enable you to address the thoughts and habits that keep you from getting good quality rest each night.
If you are facing difficulty in getting enough rest on a regular basis, you can try the following –
These are a few ways you can improve your sleep hygiene over time. These healthy sleeping habits can enhance your ability to gain the rest your body and mind deserves each night. Always remember that there is a difference between the inability to fall asleep and lousy quality sleep. That should help you understand why you need specialized therapy and treatment, or why regular sleeping medication will not help you as much as a patient suffering from insomnia.
Not sleeping well night after night, yet trying to keep your calm during the day and going through the motions at office or school is a pain. It becomes even more frustrating to see people grumbling about lack of sleep over the weekend because they were partying till too late or watching a Star Wars marathon. People with parasomnias don’t just feel tired and sick all the time. They also feel alone and annoyed. It is very easy to mistake people with sleeping disorders as lazy or incompetent since they are almost always yawning and reaching for their cup of coffee. It is easy to assume that they love staying up until late chatting with friends or binge-watching Game of Thrones on Netflix. In reality, these are the people, who would give anything to sleep for 7 or 8 hours straight without a nightmare or sleep, terror. They would be the most grateful ones to be able to wake up one day without feeling bogged down with fatigue and pain.
People suffering from sleep disorders are anything but incompetent. They battle their disease even when they are asleep, and then, they show up for work or class as the others do. They go for days or weeks without enough sleep that the body and mind require to function correctly. The lack of proper rest compromises their immunity and cognition. They are the most likely to fall sick when the flu season hits. They are also the most susceptible to pre-examination stress.
If you can recognize these signs and symptoms, it is time for you to speak with a sleep expert. In all probability, a general physician does not have enough training in the nuances of sleep to diagnose you with RBD or NREM sleep disorders. You will need the help of a sleep expert now. The diagnostic procedure involves polysomnographs, EEG and sleep monitoring to rule out the secondary causes of parasomnia. There are times when doctors request patients to spend some time inside sleep clinics for proper observations and investigations. Your health insurance might cover the treatment for this, but it is always better to confirm with the agents before going in for the complete procedure.
Speak with your partner, family, and roommate. They need to know if you are in danger of hurting yourself in your sleep or if you are a potential threat to others. Giving them a heads-up will allow them to hide the keys to the front door and your car, lock your windows, check on you at night and keep their doors locked if you have the habit of roaming about in your sleep. Speaking with someone who shares your bed or apartment can relieve some amount of stress. It is bound to help you sleep a little better knowing that there is someone aware of your predicament.
There are no over-the-counter (OTC) treatments for any forms of parasomnia. Treating it requires experience, training, proper understanding of the causes and the thorough medical history of the affected individual. Cognitive behavior therapy, psychological counseling and sleep therapy help with redressal of symptoms. It is a long-term process that demands incredible patience and persistence on the part of the medical professional as well as the patient. If the causes lie in your genetic makeup, it might be impractical to hope for a permanent cure with therapy or medication, but continual behavioral therapy reduces the incidents and increases the gap between the two episodes.
Co-founder of Counting Sheep and Sleepaholic