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Parasomnias
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Authors: Hillary Eichelberger, MD
NYU Grossman School of Medicine   

Alison L. Christy, MD, PhD
Providence Pediatric Neurology at St. Vincent Medical Center—Portland, Oregon 

Reviewed: December 2022

SUMMARY

Parasomnias are behaviors that happen during sleep. These behaviors are often unusual. They may be disruptive.  

Parasomnias can include a wide spectrum of activities. These include:  

  • Sitting up in bed and appearing confused  
  • Sleep-walking 
  • Sleep-talking 
  • Sleep-eating  
  • Having nightmares 

Parasomnias are common in childhood. They often go away as a child grows older. We do not fully understand what causes parasomnias. However, for some, an increased risk may be inherited from parents.

The most important part of caring for someone with a parasomnia is ensuring they are safe while sleeping.

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Disorder Overview

DESCRIPTION

Doctors classify parasomnias according to which stage of sleep they occur in. Sleep consists of:  

  • Rapid eye movement (REM) sleep. The eyes move around quickly. The rest of the body is usually unable to move. 
  • Non-rapid eye movement (NREM) sleep. NREM includes deep sleep. 

During sleep, the brain cycles back and forth between REM and NREM sleep. More NREM sleep tends to happen at the beginning of the night. More REM sleep tends to happen in the early morning. Dreams usually happen during REM sleep.

Most parasomnias occur during NREM sleep. However, certain parasomnias may occur during REM sleep. Some parasomnias occur in any stage of sleep. 

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SIGNS AND SYMPTOMS

The signs and symptoms of parasomnias include a wide variety of behaviors during sleep. 

Some symptoms raise concern for a parasomnia. These include:  

  • Daytime sleepiness 
  • Unexplained nocturnal injuries 
  • Difficulty sleeping through the night 
  • Waking up in a different location than where they fell asleep

NREM Parasomnias 

In NREM parasomnias, the behaviors usually happen toward the beginning of the night. Most often, the child does not fully awaken. They are unlikely to remember the episode in the morning. 

Symptoms of NREM parasomnias include: 

Confusional arousals.

  • The child may wake up confused and disoriented. They may speak but are often not understandable. They will usually remain in bed, and go back to sleep after minutes to hours.  
  • Confusional arousals are very common in children.
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Sleep-walking.

  • The child leaves the bed and walks around the room or home while asleep.  
  • They may have odd behaviors. For example, they may move furniture around. They may even try to leave the home.
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Sleep terrors.

  • Sleep terrors peak when a child is one and a half years old. The child will suddenly wake up flushed, sweating, and screaming. They will have a rapid heartrate.  
  • Parents find them difficult to calm, but the child will go back to sleep. They do not remember the event when waking in the morning.
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Sleep-eating.

  • During sleep, a child may seek out and eat food.  
  • They may eat toxic or inedible substances, like uncooked or spoiled food. They usually do not eat their preferred foods. This can be very dangerous. 
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REM Parasomnias 

REM parasomnias tend to happen closer to the morning. A child may remember them when they wake up. 

Symptoms of REM parasomnias include: 

Nightmare disorder.

  • Children may describe vivid, complex dreams. They can feel sad, angry, or scared.  
  • Frequent nightmares may be associated with anxiety and post-traumatic stress disorder.
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REM sleep behavior disorder.

  • Children act out dreams while asleep.  
  • This may include talking, laughing, or even violent movements that disrupt other sleepers.
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Sleep paralysis.

  • The child will be completely unable to move or speak, usually upon waking from sleep.  
  • This is often very distressing. It may be difficult for the child to describe the experience to their caregiver.
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Other Parasomnias 

Symptoms of other parasomnias include:

Sleep-talking.

  • Children speak while asleep.  
  • The speech is more likely to be understandable and highly emotional during REM sleep. It is less likely to make sense during NREM sleep.
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Sleep enuresis (bed-wetting).

  • Some children who can control their urination during the day will urinate involuntarily at night. (This is called primary nocturnal enuresis.)  
  • Others will have episodes of bed-wetting despite being dry at night in the past. (This is called secondary nocturnal enuresis.) This can occur particularly when undergoing stressful life events.   
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CAUSES

The causes for parasomnias are not yet fully understood. It may be helpful to think about the “three Ps” to understand why parasomnias happen to some children. They are: 

Predisposition.

A genetic change may run in a family. A child has a higher risk for parasomnias if their parents also had parasomnias as children.

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Priming.

Children may be primed to have a parasomnia by:  

  • Certain medications 
  • Stress 
  • Fever 
  • Going to bed late  
  • Not getting enough sleep the night before  
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Precipitant.

A trigger may precipitate the parasomnia.  

  • This trigger could be another sleep disorder, such as sleep apnea. It could also be a sleep-related movement disorder (like restless leg syndrome or periodic limb movement disorder).  
  • Touch or loud sounds may also be triggers. 
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LABORATORY INVESTIGATIONS

A physician can often diagnose parasomnia by:  

  • Listening to the child’s history  
  • Performing a physical exam 

They will look for any signs or symptoms of other medical disorders that may look like parasomnias.  

They may conduct the following tests: 

An overnight sleep study (also called video polysomnography).

This may be required for diagnosis. A sleep study will help to identify the presence of any other sleep disorder, such as:  

  • A sleep-related movement disorder  
  • A sleep breathing disorder
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An electroencephalogram (EEG).

Sometimes, parasomnias can look like seizures. (A seizure is abnormal electrical activity in the brain). In these cases, an EEG may also be required. An EEG monitors the electrical activity of the brain during sleep. 

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TREATMENT AND THERAPIES

The most important part of treating parasomnias is ensuring the safety of the sleep space. The following can help: 

  • Remove dangerous items from the sleeping area. 
  • Secure furniture and pad sharp corners. 
  • Consider door alarms or door locks. (However, make sure the family can still get out easily in case of fire or another emergency.) 

Rarely, certain medications may be used before bedtime, particularly for REM sleep behavior disorder.    

Some medications may make a parasomnia occur more frequently. They may need to be stopped. Other medical conditions identified during testing will also need to be treated. These include sleep apnea, sleep-related movement disorders, and seizures.

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OUTLOOK

For most children, parasomnias will go away as they grow older. Treatment is not usually necessary. Parasomnias become less common in teenage years. They are rare in adulthood.

Resources 

Publications 

JCN: What Your Pediatric Neurologist Wants You to Know–Sleep
Podcast from SAGE Neuroscience and Neurology/Journal of Child Neurology (JCN). JCN’s Residents and Fellows Board Director, Dr. Alison Christy, interviews Dr. Samiya Ahmed from Baylor College of Medicine in San Antonio, Texas on sleep.

Childhood Stroke 1

Child Neurology Foundation (CNF) solicits resources from the community to be included on this webpage through an application process. CNF reserves the right to remove entities at any time if information is deemed inappropriate or inconsistent with the mission, vision, and values of CNF. 

Research 

ClinicalTrials.gov for Parasomnia (birth to 17 years).

These are clinical trials that are recruiting or will be recruiting. Updates are made daily, so you are encouraged to check back frequently.   

ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details.    

Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits. 

Find Clinical Trials For Parasomnia

The information in the CNF Child Neurology Disorder Directory is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. Content provided is for informational purposes only.  CNF is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. 

References

Carter KA, Hathaway NE, Lettieri CF. Common sleep disorders in children. Am Fam Physician. 2014 Mar 1;89(5):368-77. PMID: 24695508. 

Eichelberger H, Nelson ALA. Nocturnal events in children: When and how to evaluate. Curr Probl Pediatr Adolesc Health Care. 2020 Dec;50(12):100893. https://doi.org/10.1016/j.cppeds.2020.100893. Epub 2020 Nov 1. PMID: 33139210. 

Irfan M, Schenck CH, Howell MJ. NonREM Disorders of Arousal and Related Parasomnias: an Updated Review. Neurotherapeutics. 2021 Jan;18(1):124-139. https://doi.org/10.1007/s13311-021-01011-y. Epub 2021 Feb 1. PMID: 33527254; PMCID: PMC8116392. 

American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. 2014. 

Petit D, Pennestri MH, Paquet J, Desautels A, Zadra A, Vitaro F, Tremblay RE, Boivin M, Montplaisir J. Childhood Sleepwalking and Sleep Terrors: A Longitudinal Study of Prevalence and Familial Aggregation. JAMA Pediatr. 2015 Jul;169(7):653-8. https://doi.org/10.1001/jamapediatrics.2015.127. PMID: 25938617. 

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