Understanding Parasomnias With Dr. Morse

As noted by Cleveland Clinic, parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt sleep. They include sleep terrors, sleepwalking, and even sleep sex and eating. Dr. Anne Marie Morse provided DocWire News with a clearer picture of parasomnias, and how they affect quality of life in people who have them.

Parasomnias are definitely something that people are fascinated by. However, it is important to remember that these are behaviors that do represent a sleep-wake disorder. Now, when I say that people are fascinated by it, you can go on any social media platform right now, and I guarantee you, you can find someone who has definitely raised to fame just based on a recording of their own parasomnia experience.

So when I’m talking about parasomnias, what am I actually speaking on? I am speaking about wake-related behaviors that are occurring out of sleep and a person actually is still asleep while looking like they’re performing tasks that are completely awake. Now, these are things that you probably have seen on the news because people can experience things like sleep-related driving. There also have been forensic scientists who have had to testify in court related to things like sleep sex and whether or not a sexual assault case was based on a true sleep-wake pathology.

However thankfully, most times when we’re seeing parasomnias, they’re not occurring in a capacity where there are legal ramifications, but is something that we very frequently think about when we are addressing people who are experiencing a parasomnia.

When we’re talking about parasomnias, they’re generally coming in two flavors. Those two flavors are REM parasomnia and non REM parasomnias. Well, let’s talk a little bit first about non-REM parasomnias just because of the fact that these tend to be a lot more common. Non-REM parasomnias are some of the things that you probably are very familiar with. Things like people sleepwalking, sleep eating, they may even potentially have night terrors in our little ones or confusional arousals. These also are packaged with those things that I had alluded to earlier in regards to the forensics of there can be sleep-related driving and even the sleep sex that can occur.

Now, when do these things tend to occur? They specifically occur most commonly out of slow-wave sleep or non-REM 3 sleep. This is our deepest stage of sleep. Now, one would ask, “Well then why are these going to occur coming out of these stages of sleep?” Well, when we’re talking about non-REM parasomnia, there generally is a perfect storm that may occur. We tend to see these in people who may be genetically susceptible, meaning that we tend to see these run in families. I can tell you personally, I was a sleepwalker, sleep talker, and so are my kids, and thankfully they didn’t have as many night terrors that I did when I was a little kiddo. With that stated, why do we tend to see that this runs in families and why do we tend to see it happen in children?

Well, we look at the ultradian cycling, meaning how we actually rotate through sleep throughout the night. In our younger age groups, they actually are spending a lot more time in slow-wave sleep. The other reason why we may see these continue to perpetuate is because everyone is currently sleep-deprived. And when we are sleep-deprived, it actually causes us to rebound into more stage non-REM 3 sleep in an attempt to actually pay back that sleep debt, giving us just greater opportunity for us to experience that non-REM parasomnia. Now, other things that can definitely play a factor into that is also including whether or not I have any other type of sleep disorder that may intrude into my non-REM 3. So if I have restless leg or periodic limb movement or I have obstructive sleep apnea, those are things that definitely can fragment my slow-wave sleep and therefore make me more likely to experience this.

Times that you definitely want to think about this is whether there’s an individual who never had this experience before and now you’re seeing it occur even if it’s relatively infrequently or the person who had the history of having this as a one-off and now you’re seeing this ramp up. This is where we tend to look at this and try to understand what are the drivers behind it?

Now separately, if we want to talk about the other form of parasomnia, this is going to be your REM parasomnia, which is your rapid eye movement parasomnias. Now, these are ones that are very specific and many times are calling into action your fellow neurologist, so let me put on that hat. Why? Well, because of the fact that when we see people who have REM parasomnia, especially REM behavior disorder, this is a period where individuals are experiencing dream enactment behaviors. And not to be confused with people who are sleepwalking, because generally, even though people think that that’s a dream enactment behavior, it generally and people are walking, they might be doing things, they can potentially even go and find something to eat. Those types of things.

People who experience REM behavior disorder generally have a very explosive nature to what it is that they’re experiencing. And it’s not uncommon because of the fact that REM sleep is the period of time where we have very vivid dreaming that the response to the dreaming is quite intense. And it also is not uncommon that these dreams are actually more in the flavor of a nightmare, being either persecutory or potentially even harmful or perceived harm. And so it’s not uncommon that you see someone explode, jumping out of their bed trying to fight, being combative. This can actually be injurious to not only the individual experiencing the dream enactment behavior, but not uncommonly, their bed partners. So this is something that neurologists tend to be involved with because of the fact that when we do see these conditions, they can have an association with other neurologic disorders. In the adult population, we commonly become concerned about something like Parkinson’s disease and that being a precursor or finding that can predict the development of that.

For myself as a person who sees children with neurologic disorders, when I see a REM behavior disorder, it actually makes me go, “I’m thinking narcolepsy until proven otherwise.” And the reason for that is because narcolepsy is a condition that is marked by REM dissociation and therefore having this inappropriate relationship between REM sleep and wakefulness, resulting in something like a REM behavior disorder.

Other times you may see a condition like this actually can be as a result of withdrawal from certain medications. If I’m on a medication that is REM suppressing or I’m a chronic user of something like alcohol that also can be REM suppressing, when I abruptly stop it or withdraw from it, this actually can be provoking through REM behavior disorder.

When we’re looking at the parasomnias, the call to action really is to say, “Are we dealing with something that number one is a REM parasomnia or REM behavior disorder? And if so, then we really do need to launch a further investigation to understand what is at the basis of it.” When we’re talking about non-REM parasomnia, although the common response to that is generally, “Your child will outgrow it,” or, “There’s not anything to worry about, there’s no pathology.” The truth is there sometimes is the reason to pause and say, “What is it that is impairing your quality of sleep, that is making you experience this more frequently?” It is important for both of those to be considered and if there is ongoing concern, to make sure that you’re doing the appropriate investigations and ensuring that you’re delivering the right treatment to improve the quality of sleep so that person can have the best quality of life.