What Are Parasomnias and How Do They Affect Your Sleep?

Expert Insights from Dr. Luis Javier Peña-Hernández, MD, FCCP, a lung health specialist at PCSI, the largest integrated pulmonary and chest specialty group in Palm Beach County.

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They rob you and your bed mate of sleep, making you both irritable and cranky in the morning. They might startle you awake at night and leave you breathless with your heart racing and eyes wide open. They can even prompt you to say something you don’t really mean, eat something you don’t want, or do something completely out of character for you.

Nope, I’m not talking about your kids. I’m talking about parasomnias. And they, like your kids, come in a variety of forms.

What Are Parasomnias?

“Parasomnias are disruptive sleep disorders that can result in abnormal behavior while sleeping such as walking or talking,” explains Dr. Luis Javier Peña-Hernández.

In general, parasomnias are sleep disruptions that include unpleasant, disruptive behaviors and experiences that occur at any time during your sleep cycle. They can make getting a good night’s sleep challenging, increase stress, lead to injury and depression, and put a strain on your relationship with your significant other.

Occasional sleep disruptions are simply a part of life and can range from bad dreams to violent assaults on partners. Lots of people experience at least one parasomnia sometime in their lives. Many that occur in children resolve themselves as children grow older. But parasomnias that persist, get worse, or lead to debilitating sleep deprivation require attention.

There is usually a genetic predisposition for these phenomena, and they tend to be inherited from parents and run in families. Most are triggered by sleep deprivation from other underlying pre-existing sleep disorders (especially sleep apnea and restless legs syndrome/periodic limb movement disorder), as well as from stress, medications, alcohol abuse, etc, although they can also arise with no identifiable trigger (known as idiopathic). 

It is important to note that the occurrences are completely involuntary, and do not imply any underlying psychological disorder, as often used to be assumed.

When Snoring Is Not The Only Thing Disrupting Your Sleep

At the very least, parasomnias are annoying to you or your partner because they disrupt your sleep. But some parasomnias can be downright dangerous because they involve behaviors that are not controlled by a mind that is awake and alert.

Like snoring, a parasomnia may not be remembered by the person experiencing it. If you suspect you are having sleep disruptions, you may need your partner to help you identify the issue. Here’s what you need to know about common parasomnias.

Different Types of Parasomnias and What To Do About Them

Non-REM parasomnias occur, as the name suggests, during non-REM sleep, usually during the earlier part of the night. The most common of these include:

• Sleep talking or somniloquy
• Sleepwalking or somnambulism
• Sleep-related eating disorder (SRED)
• Sleep-sex or sexsomnia
• Night terrors
• Confusional arousals
• Exploding head syndrome
• Hypnic jerk
• Teeth grinding or bruxism
• Restless leg syndrome (RLS)

REM parasomnias, which occur during the later REM stages of sleep, include:

• REM sleep behavior disorder (RBD)
• Catathrenia or nocturnal groaning
• Sleep paralysis

We’ll go in-depth on these parasomnias below.

Confusional Arousal

What is it?

A person experiencing confusional arousal will appear “out-of-it” when they wake up in the middle of the night. They may appear to be awake but acting abnormally. If someone is experiencing confusion arousal, they may also:

• Speak slowly
• Have a hard time understanding what is going on around them
• Show poor memory
• Respond bluntly to questions
• Thrash around in bed or cry out

Morning sleep inertia is a variation of confusional arousal that occurs first thing in the morning and features the same confused behavior. People dealing with these disorders have no memory of their behavior, making it difficult to identify without a witness.

Rates of confusional arousal are higher among children and adults younger than 35. They appear in about 17% of children. Confusional arousals are usually harmless in children, although they can alarm parents watching their children behave so irregularly. Morning sleep inertia in adults can be disruptive or dangerous if it lasts into the school or workday or during the morning commute.

What can you do about it?

You should see a sleep specialist if you do not feel rested in the morning and suspect you are experiencing confusional arousals. Since confusional arousals may be caused by other disorders, treating those disorders is the first step in treating it. These potential causes include:

• Obstructive sleep apnea
• Periodic limb movement disorder
• Use of some antidepressants, stimulants, antipsychotics, mood stabilizers, antianxiety drugs
• Drug abuse
• Recovery from sleep deprivation
• Alcohol consumption

Your doctor will be able to determine if any of these issues is causing your confusional arousals. In addition to treating these conditions, you can:

• Reduce your alcohol intake or eliminate it completely
• Get a full night’s sleep consistently
• Ask your doctor about antidepressants and sleep aids that have been shown to help with confusional arousals

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Exploding Head Syndrome

What is it?

Exploding head syndrome (EHS) is a type of parasomnia that is an auditory hallucination. Those who experience EHS describe it as a loud noise they hear when falling asleep or waking up in the night.

This loud sound people report hearing is a hallucination that can sound like a bomb exploding, a gunshot, fireworks, a lightning strike, or cymbals crashing. Sometimes, this noise may be accompanied by perceiving bright flashes of light, muscle twitches, or shortness of breath, though this is likely due to an increased heart rate.

EHS is not painful or necessarily dangerous, but it can be frightening for people to experience. Some people wake up believing the noise they heard was a real event and become confused. The noise occurs most often prior to reaching deep sleep and sometimes occurs after coming out of deep sleep.

Frequency varies by the individual. A person may have several attacks a week, long periods of remission, or spontaneous patterns of attacks. The experiences reported are irregular and sporadic, showing no consistent pattern for the condition.

Some studies have been conducted to research the causes of EHS. One group of studies suggests that the “explosion” may be caused by a burst of neural activity in the brain. As we fall asleep, our body shuts down and goes into sleep paralysis to prevent us from acting out our dreams.

During the in-between period from wakefulness to sleep, the shut-down process is usually a slow, gradual transition. Occasionally, there may be a hiccup in the reticular formation—a part of the brain responsible for this shut down—that delays the turning off of some parts of the brain.

This delay causes two reactions: a suppression of the alpha brain waves which make us drowsy, and a burst of neural activity in the parts of the brain connected to sound processing. The combination of these activities could be the cause of exploding head syndrome, though more research is required to fully understand the condition.

Researchers have found that about 10% of the population experiences EHS and females tend to be more at risk than males. People over the age of 50 are also more likely to experience EHS, though it has been reported in children as young as 10.

What can you do about it?

Because exploding head syndrome is fairly harmless, many people do not seek or require treatment. In some cases, EHS can lead to considerable distress or disturb sleep patterns and lead to sleep deprivation, in which case treatment is highly recommended.

To ensure the best treatment plan for your condition, speak with a doctor about your symptoms. You should first be sure what you are experiencing is EHS. Your doctor may ask you questions about how often you hear the noise, what it sounds like, and your sleeping patterns. There are no specific tests for EHS, but a sleep specialist may encourage you to do an overnight sleep study to detect potential sleeping problems.

Some doctors have prescribed tricyclic antidepressants to treat EHS. Others have used calcium channel blockers for successful treatment. Non-drug treatments can also be successful in reducing EHS attacks. This can include reducing stress by increasing relaxation periods before bed, improving your sleep hygiene, or seeking counseling.

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Sleepwalking

What is it?

Sleepwalking, formally known as somnambulism, is a parasomnia during which a person performs complex behaviors such as walking and talking while sleeping. A sleepwalker’s eyes can be open and they may appear awake, though they are not conscious. This behavior is most common in children but can also be exhibited in adults, especially those who are sleep deprived.

Sleepwalking can include more activities than walking, including sitting up in bed and looking around, speaking, moving through rooms, leaving the house, and even driving. A person who is sleepwalking may carry on a conversation but be disoriented. It is estimated that somewhere between 1 to 15 percent of the population experiences these phenomena.

Other people may jump out of bed suddenly, talk or shout, or run away from their bedroom for no apparent reason. Often sleepwalking involves inappropriate behavior like urinating in a corner, moving furniture around, or climbing out a window.

People who sleepwalk can put themselves at risk by walking outside while they are asleep. It can be very hard to awaken a sleepwalker and sometimes they may become aggressive or violent when awakened.

Some of the causes of sleepwalking include:

• Obstructive sleep apnea
• Migraine headaches
• Fevers (in children)
• Sleep deprivation
• Physical or emotional stress
• Sleeping in a strange place
• Alcohol use or abuse
• Stroke
• Hyperthyroidism

Sleepwalking is common among people with one or both parents who were sleepwalkers. Children who sleepwalk often experienced confusional arousals when they were younger.

What can you do about it?

Sleepwalking in children is fairly common and usually stops as children grow into their teen years. Since children can get injured if they stumble downstairs or leave the house, parents should monitor their children if they walk in their sleep during the evening. Parents might consider installing a baby gate to keep younger children in their rooms during the night. Keep the bedroom floor clear of obstructions that could trip or otherwise injure the sleepwalker.

Adults risk more serious injury if they sleepwalk, so they should see a sleep specialist to identify the cause of their sleepwalking. Often sleep apnea triggers a sleepwalker, so treating it can reduce sleepwalking episodes.

Although it can be dangerous, sleepwalking is usually a harmless and random event. Treatment may be able to help you reduce instances of sleepwalking, though some in sleep medicine say it cannot be cured.

In order to reduce your chances of sleepwalking, be sure you are getting enough sleep each night so you are not at risk of sleep deprivation. Most adults require seven to nine hours of sleep each night, and the amount of sleep children need varies by age.

Along with ensuring the quantity of your sleep is up to par, you should also focus on the quality. If you suffer from a sleep disorder that interrupts your sleep such as RLS or sleep apnea, treating the primary condition can help you reduce instances of sleepwalking.

Consult with your doctor for the treatment method that is best for you. You may find that medications help you sleep better throughout the night. More out-of-the-box treatment options even include meditation and hypnosis.

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Hypnic Jerk

What is it?

A hypnic jerk is essentially a startle response, which happens most often just as you are falling asleep. It is commonly described as a feeling of falling, that may or may not be accompanied by a dream or visual image. Some people report feeling like they are falling out of bed, falling off of a curb, falling out of a tree, or falling off a cliff. Others report a feeling of falling into a void. A smaller percentage of people describe a hypnic jerk episode as feeling like they are “shocked” awake. No matter the perceived experience, the body responds to the hypnic jerk with an accelerated heart rate, intensified breathing, and sometimes sweating.

The strength of a hypnic jerk can range from very mild and not even noticeable, to strong enough to fully wake you up. Hypnic jerks are not considered a comorbid sign of any other disorder; however, they may be related to certain causational factors.

Hypnic Jerks seem to occur regularly in babies and young children, who have repetitive jerking movements while sleeping. The American Academy of Sleep Medicine has found some evidence that they increase with age, but conversely others studies have shown a decrease in frequency as we grow older. More conclusive research is still needed on this point.

As of yet, there are no definite conclusions as to what causes a hypnic jerk. There seems to be a number of correlative factors that increase likelihood and frequency, and a number of theories as to what is behind the jerks. Correlative factors are all lifestyle related and tend to increase hypnic jerks. Examples include:

• High stress levels
• Anxiety
• Too much caffeine
• Evening exercise
• Sleep deprivation
• Alcohol

There are a number of theories as to the cause of the hypnic jerks. The seven most common explanations are as follows:

• Normal Body Response: As your body relaxes and breathing slows, muscle tone lowers and this natural transition at the time of sleep can cause a muscle jerk.
• Primate Response: It is believed that we might have an innate jerk response leftover from when we were primates sleeping in trees. This response let us know when we were falling out of a tree, but is no longer needed.
• Sleep Stage Transition: Some theorists postulate that the jerk happens as a part of the body transitioning from awake to stage 1 of non-REM sleep.
• Brain Perception: This theory understands the hypnic jerk as a natural response by the brain. When the brain perceives the body relaxing, it can have a momentary panic that signals the body to wake up.
• Heavy Snoring: The muscle jerks may be in response to lack of breath that can happen with heavy snoring.
• External Stimuli: This understanding associates the hypnic jerks with noise or movements happing in the environment around the sleeper. They are subconsciously perceived and wake the person with up causing a jerk.
• Neurons Misfiring: When protein builds up or other factors cause the brain neurons to misfire they may cause an associated muscle jerk.

What can you do about it?

Hypnic jerks are nothing to be concerned about and nothing needs to be done about them. However, if they are happening frequently, disturbing your sleep, or you feel concerned about them, consult your doctor for input and possibly sleep medication. There are some simple fixes that do seem to lower the intensity and frequency of hypnic jerks like:

• Practicing good sleep hygiene
• Going to bed very relaxed
• Avoiding caffeine in the second half of the day
• Limiting alcohol
• Leaving strenuous exercises for the morning

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Bruxism (Teeth Grinding)

What is it?

Bruxism is a condition marked by grinding or clenching your teeth together. There are two types of bruxism:

1. Awake bruxism: Teeth gnashing or clenching that occurs when you’re awake. This type of bruxism is more common in women than in men.
2. Sleep bruxism: Teeth grinding or clenching that occurs when you’re asleep. This type of bruxism occurs roughly equally in both men and women.

Realizing when you’re having bruxism-related pain or tension can help many people with awake bruxism know that they have this condition. Unfortunately, those with sleep bruxism are often little-the wiser.

Sleep bruxism is typically the most severe type of bruxism thanks to two factors. The first is that many people with this disorder are unaware that they have it, or even if they know, are unlikely to realize how severe it is until they have a night full of teeth grinding that brings about pain or other severe consequences. Additionally, the level of damage that occurs is usually greater in those with sleep bruxism due to the inability to monitor their actions when sleeping.

Sleep bruxism is categorized as a sleep-related movement disorder, which is a type of sleep disorder that is marked by involuntary physical movement during sleep. When left untreated, sleep bruxism can cause a host of related issues, including temporomandibular joint (TMJ) disorders, tension headaches, and dental damage.

Exactly why bruxism happens is still not fully understood. Scientists believe that sleep bruxism occurs during periods of arousal during sleep when your heart and respiratory activity increase. Sleep arousal is often accompanied by a boost in muscle activity, including the muscles in the jaw.

Bruxism can be a condition all on its own with no outside cause, however, it is often a side effect that occurs from another disorder. Those with the following conditions are at an increased risk for bruxism, or teeth grinding:

• Anxiety conditions, chronic stress, or other negative emotions
• Obstructive sleep apnea
• Snoring
• Sleep paralysis
• Sleep talking
• REM sleep behavioral disorder
• Malocclusion (abnormal teeth alignment)

Additionally, certain medications and other substances can cause bruxism, including anxiety and depression medications, Parkinson’s disease and Huntington’s disease medications, coffee and other caffeinated beverages, tobacco, and alcohol.

Bruxism is most common in children, with parents reporting that 38% of their children under 17 years old grind their teeth, and the least common in adults over 65.

What can you do about it?

While some people with extremely mild bruxism may not need treatment, others will require help to reduce teeth grinding and clenching.

If you notice that someone in your family is doing some weird things with their mouth while they’re sleeping, it’s important to bring it to their attention. Whether it’s yourself, your spouse, or your children who grind their teeth, the next step is seeking professional treatment.

This typically includes scheduling a visit with your dentist. They can evaluate you and decide whether to give you a mouth guard or refer you to a sleep specialist. During visits with your sleep specialist, they may have you do a sleep study to further examine your symptoms.

One of the most common ways to help those with bruxism is the use of dental treatments that can improve symptoms, including mouth guards, splints, and Mandibular Advancement Devices (MADs), a treatment often used for sleep apnea that can help those with bruxism. For some, sleep medications like muscle relaxants are used to encourage a relaxed jaw.

Sometimes you will need to seek care for an underlying cause of bruxism, for example, if you have obstructive sleep apnea or anxiety difficulties. This might include behavioral therapy, a sleep apnea machine, or other treatments depending on your situation.

No matter what your course of treatment, you will likely be given a custom mouth guard that can protect your teeth from the dangers imposed by teeth grinding. This can save you thousands in dental bills (a cracked tooth can lead to the need for a root canal or even a tooth implant).

Additionally, the right kind of mouth guard may be able to help both bruxism and another condition, like TMJ disorder, where patients experience pain and trouble with their jaws that can become permanent.

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Sleep Terrors

What is it?

Sleep terrors are one of the more alarming parasomnias that startle both the person experiencing it as well as bed partners and others in the household. A person experiencing a sleep terror, or night terror, will often scream or shout, kick, and thrash about the bed. They will look and feel terrified, with a contorted facial expression, racing heart, and heavy breathing. They may even bolt out of bed and run around the house.

Sleep terrors are more common among children than adults but still not a widespread problem. It affects an estimated 6.5% of children and only 2.2% of adults. Adults who have sleep terrors are likely to have a history of one of the following:

• Bipolar disorder
• Some depressive disorders
• Anxiety disorders

Sleep terrors and sleepwalking share many of the same causes including:

• Sleep deprivation
• Hyperthyroidism
• Migraine headaches
• Head injury
• Stroke
• Premenstrual period
• Physical or emotional stress
• Obstructive sleep apnea
• Travel
• Alcohol use or abuse
• Fevers (in children)

Sleep terrors can last as long as twenty minutes. During this time, it may be very hard to rouse or comfort the person experiencing a sleep terror. As a result, partners and household members may feel frightened and helpless during an episode.

What can you do about it?

Sleep terrors can be extremely upsetting to partners and family members. Children usually grow out of their tendency to have sleep terrors, and they typically do not need treatment. Adults are at a greater risk of injury, so those who experience frequent sleep terrors should see a sleep specialist.  Like many other parasomnias, sleep terrors are often caused by the sleep disruptions associated with obstructive sleep apnea. Treating sleep apnea may decrease episodes of sleep terror.

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Sleep Talking

What is it?

Sleep talking, or somniloquy, is a common parasomnia that is harmless unless it is very disruptive to a sleep partner. The talk may be incomprehensible, very lucid, or anything in between. As many 50% of young children talk in their sleep and gradually grow out of the disorder as they become teenagers. Only 5% of adults talk in their sleep. Like sleepwalking, sleep talking appears to run in families.

What can you do about it?

Usually nothing. Sleep talking alone is rarely severe enough to require treatment. If it is associated with another more serious sleep disorder, a sleep specialist should be consulted for treatment of that disorder which may eliminate sleep talking.

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Sleep Related Eating Disorder (SRED)

What is it?

Episodes of SRED tend to occur when a person is only partially awake and consist of compulsive eating and drinking, usually in a frantic manner. Most people with SRED experience episodes almost every night that don’t seem to be triggered by hunger or thirst. Oddly, people with SRED will eat foods during the night that are often not what they prefer during their waking hours and are usually high in sugar and calories. They often respond with anger or resistance to attempts to stop them from eating. Rousing them is difficult when they are binging in their sleep.

Many more women than men experience sleep-related eating disorder, representing 65% – 80% of SRED patients. More than half of all SRED patients experience at least one other parasomnia, the most common being sleepwalking.

What can you do about it?

Sleep-related eating disorders should not be ignored. The effects of nighttime binging can lead to poor nutrition, weight gain, and depression as well as interfere with your sleep. People with SRED may also become ill from consuming toxic or inedible substances, or uncooked foods.

A sleep specialist can determine if another sleep disorder is triggering binging while asleep. Treating associated sleep disorders can improve the quality of your sleep and improve the symptoms of SRED. Medications and therapies used to reduce stress and anxiety can also reduce episodes of nighttime binging. 

Other sleep disorders associated with SRED include:

• Restless leg syndrome
• Periodic limb movement disorder
• Obstructive sleep apnea
• Irregular sleep-wake rhythm
• Sleep-related dissociative disorder

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REM Sleep Behavior Disorder (RBD)

What is it?

People with this disorder act out the events of their dreams. It gets its name from the REM sleep stage in which it occurs. The dreaming person may:

• Shout
• Swear
• Flail their arms
• Grab something nearby
• Punch the air, a pillow, or a partner
• Kick the covers
• Jump out of bed
• Throwing a pillow

Early episodes tend to be milder than subsequent ones and so are often ignored. Left untreated, RBD episodes can become more violent that can lead to injury of the person experiencing RBD or their bed partner.

RBD is often confused with sleepwalking and night terrors, which also involve disruptive movements in and out of bed. RBD differs from these in that it is easy to wake a person during an RBD episode.

People with RBD have a higher risk of experiencing other sleep disorders such as:

• Narcolepsy
• Periodic limb movement disorder
• Sleep apnea

What can you do about it?

Seek treatment of associated sleep disorders from a sleep specialist. The doctor can also prescribe medication to treat RBD and advise you about what medications should be avoided because they increase RBD symptoms.

Get the recommended amount of sleep for your age since sleep deprivation will exacerbate RBD. Take precautions to keep the bedroom safe for nighttime movements. Remove lamps and other objects from the nearby nightstand and keep the bedside floor clear of obstacles.

Because RBD can indicate the onset of Parkinson’s disease or multiple system atrophy, alert your doctor if you have tremors or other Parkinson’s symptoms.

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Sleep Paralysis

What is it?

You wake up in the middle of the night, frozen in bed, terrified, and feeling like it is hard to breathe. You sense the presence of someone in the room. If this has happened to you, you’ve experienced an episode of sleep paralysis.

Sleep paralysis is experienced differently by different people, but all report the inability to move or speak. Some people feel pressure on their chest, some people feel like they are choking. Others experience hallucinations, believing that something or someone is sitting on them, or lurking in the room wanting to hurt them. This can be a very scary experience and the paralysis is often accompanied by heightened anxiety or outright panic.

Even knowing there is nothing supernatural about sleep paralysis, it is a disconcerting experience. It is considered common and generally starts during the teen years. Researchers think there may be a genetic link as it does seem to occur in families. It is not harmful to your health, but it can be a symptom of other problems like narcolepsy. If you have sleep paralysis, along with unexpected bouts of falling asleep during the day, consult your doctor. There are a number of contributing factors, or triggers, which might increase your likelihood of having sleep paralysis. Some of these include:

• Poor sleep hygiene
• Sleep deprivation
• Sleep apnea
• Changing schedules
• Jet lag
• Panic disorder
• Post-traumatic stress disorder
• Lots of stress
• Night leg cramps
• Substance abuse
• Bipolar disorder
• Narcolepsy
• Some ADHD medications

What can you do about it?

In spite of how frightening sleep paralysis can feel, it is important to remember that it is not a serious disorder. Consequently, most doctors don’t treat it at all; they just reassure their patients that nothing is really wrong.

If you think your case is severe, or if you are having other symptoms like being very tired during the day, you might want to get some help from your doctor or consult a sleep specialist. In general, however, treatment for sleep paralysis is mostly palliative as the condition has not been extensively researched.

Some common suggestions to help lessen the condition are to practice good sleep hygiene, especially to incorporate a regular bedtime, and to get enough sleep. You can try CBD oil which is available over the counter or ask your physician for an anti-depressant as some have shown promise in curbing sleep paralysis.

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Sleep Hallucinations

What is it?

A person experiencing sleep hallucinations believes imaginary sights and sounds are real. They can also have hallucinations that involve touch, taste, and smell.

Unlike dreams or nightmares that are clearly not real, sleep hallucinations are mistaken for reality and, as such, can be very disturbing. They typically occur when a person is about to fall asleep or is just starting to wake up.

If sleep hallucinations occur during the day, they may be a sign of narcolepsy.

What can you do about it?

Sleep hallucinations appear to be very common, usually affecting teens and young adults. They tend to decrease in frequency as you get older. If they are troublesome in the meantime, consult with your doctor to determine if they are related to other issues.

Sleep hallucinations can be caused by other conditions such as:

• Past alcohol use
• Anxiety
• Current drug use
• Mood disorders
• Insomnia

Treatment for these conditions can decrease or eliminate sleep hallucinations. If they are a sign of narcolepsy, your doctor will prescribe narcolepsy medication. You can help yourself by:

• Getting the recommended amount of sleep
• Keeping a regular schedule
• Limiting alcohol consumption
• Avoiding certain drugs and medications that may contribute to hallucinations. Your doctor can give you specific advice.

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Maybe if I ignore it, it will go away

Maybe. But when parasomnias occur frequently and/or increase in severity, it’s time to take action. Some parasomnias will go away on their own, but others can escalate or be a sign of a more serious condition.

“If you experience any abnormal behavior while sleeping, you may be experiencing a parasomnia such as confusional arousal, somniloquy, somnambulism, night terrors, bruxism, restless leg syndrome, or another sleep disorder,” says Dr. Peña-Hernández. “Speak with your primary care physician about your symptoms for a personalized recommendation for treatment.”

Parasomnias should not be ignored when:

• They lead to sleep deprivation for anyone in the household
• There is a risk of injury either to the person experiencing them or to others in the household
• They escalate in severity or increase in frequency
• They could be an indication of a medical or psychological problem
• They are causing a strain on relationships at home

As disruptive and seemingly deliberate as some of these behaviors may appear, it is important for bed partners to understand that a person experiencing parasomnias has no intention of causing disruption or harm and usually will not even remember the episode in the next day. Partners can help by compassionately expressing their observations and feelings about the sleep disruptions and encouraging their partners to seek treatment from a doctor.

Many parasomnias are the result of lifestyle choices that can be adjusted for greater well-being. They tend to improve when a person:

• Gets sufficient sleep regularly
• Reduces stress and anxiety
• Seeks alternatives to medications that may contribute to parasomnias
• Consults with a doctor about medications that can help them sleep better

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Parasomnias can be very frightening to experience as well as to witness. The fact that they happen in the dark when all else is quiet and peaceful magnifies the shock and alarm. And while the person behaving disruptively cannot control their behavior, they can take steps to help themselves, including consulting with a doctor.