You wake up in the kitchen with no memory of how you got there. Your partner says you screamed in your sleep last night—but you don’t remember a thing. Maybe you’ve been told you thrash around violently, act out dreams, or talk in complete sentences while sound asleep.
These experiences can feel unsettling, even frightening. But they’re not signs that you’re “broken” or losing your mind. They’re symptoms of parasomnias—real, medically recognized sleep disorders that happen during sleep or while transitioning between sleep and wakefulness.
What Are Parasomnias?
Parasomnias are a category of sleep disorders defined by unusual behaviors, experiences, or physical events that occur during sleep. These aren’t problems with falling or staying asleep—they’re about what happens while you’re asleep, often without you being aware of it.
Common examples include sleepwalking, night terrors, sleep talking, or acting out dreams. In most cases, the person won’t remember the episode. Parasomnias may seem bizarre or alarming, but they are real medical conditions, not character flaws or psychological breakdowns.
Types of Parasomnias
Parasomnias are usually grouped by which sleep stage they occur in: Non-REM (NREM) or REM sleep.
Non-REM Parasomnias
These happen during deep sleep, especially in the first third of the night, when the brain is caught between being awake and asleep.
- Sleepwalking: Walking around, performing tasks, or even leaving the house while technically asleep
- Sleep terrors: Suddenly sitting up, screaming, or appearing terrified—but with no memory of it afterward
- Confusional arousals: Sitting up, talking nonsense, crying, or seeming disoriented when partially awakened
During these events, the person is usually unresponsive, confused if awakened, and has no memory the next day.
REM Parasomnias
These occur during REM sleep—the dream phase—usually in the second half of the night or early morning.
- REM Sleep Behavior Disorder (RBD): The muscle paralysis that normally prevents acting out dreams is absent. People may punch, kick, yell, or jump out of bed. Unlike NREM parasomnias, people with RBD usually remember the dream.
- Nightmare disorder: Recurrent, intense nightmares that cause distress and waking
- Isolated sleep paralysis: Temporary inability to move when falling asleep or waking up, often with hallucinations
Other Parasomnias
- Sleep-related groaning (catathrenia)
- Bedwetting beyond typical toilet training age
- Exploding head syndrome: A sudden loud noise or explosion-like sensation in the head while falling asleep—harmless but alarming
What Triggers Parasomnias?
Parasomnias are usually caused or worsened by factors that disrupt normal sleep:
- Sleep deprivation
- Stress or anxiety
- Fever or illness
- Certain medications, especially antidepressants
- Alcohol use
- Irregular sleep schedules
- Other sleep disorders like sleep apnea or restless legs syndrome
- Neurological conditions (especially in REM behavior disorder, linked to Parkinson’s and other neurodegenerative diseases)
Some parasomnias, especially NREM ones, are more common in children and often run in families.
When to Get Help
Not all parasomnias require treatment. Occasional sleep talking or isolated nightmares are typically harmless. However, seek medical advice when:
- Episodes involve dangerous or violent behavior
- Events happen frequently or escalate in intensity
- Sleep is so disrupted it causes daytime fatigue or cognitive problems
- Adult-onset parasomnias appear that weren’t present before
- There’s no memory of actions, or behaviors are disruptive or frightening to others
- Concern exists about an underlying neurological disorder, especially in older adults with new REM-related symptoms
If safety is at risk or symptoms interfere with daily life, evaluation is warranted.
How Parasomnias Are Diagnosed and Treated
Diagnosis starts with a detailed history. A sleep specialist will ask about the episodes, including descriptions from bed partners or family members. A sleep diary may help identify patterns or triggers.
At Whitney Sleep Center, we use overnight sleep studies with video monitoring to observe behaviors during sleep and differentiate parasomnias from other conditions like seizures or sleep apnea.
Treatment often includes:
- Sleep hygiene improvements: Consistent bedtime, adequate sleep, stress management
- Safety measures: Removing sharp objects, locking doors and windows, padding around the bed
- Medications when needed: Low-dose benzodiazepines for NREM parasomnias, melatonin or clonazepam for REM behavior disorder
- Therapy: Cognitive behavioral therapy for stress-related episodes or image rehearsal therapy for recurring nightmares
Most parasomnias can be managed successfully with the right combination of strategies. You’re not alone, and help is available to make your nights—and your family’s nights—safer and more restful.