Parasomnias and Abnormal Sleep Behaviors

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Parasomnias are abnormal sleep behaviors that can undermine your -- and your bed partner’s -- ability to rest. From mild issues like sleep talking to more serious and dangerous conditions like REM sleep behavior disorder, Duke’s sleep medicine specialists can help pinpoint the problem and manage your symptoms, oftentimes without medication.

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Types of Parasomnias

Parasomnias are divided into two main categories based on whether or not they occur during REM (rapid eye movement) sleep.

Non-REM (NREM) Related Parasomnias
NREM-related parasomnias include behaviors like walking, talking, eating, urinating, or initiating sexual activity during sleep. These normally occur in the first half of the night and are generally related to repeated partial arousals from sleep. To a bed partner, you may seem distant or “zombie-like.” Despite being asleep, your eyes may be open. You probably won’t remember these episodes in the morning. Other common NREM parasomnias include confusional arousals -- stirring from sleep, maybe even sitting up in bed, and seeming confused -- and sleep terrors.

REM-Related Parasomnias
REM-related parasomnias normally occur in the second half of the night during “dream sleep.” These include nightmares and sleep paralysis (temporarily being unable to move as you wake up).

REM sleep behavior disorder -- or RBD -- is the most common REM-related parasomnia. Rather than staying paralyzed during sleep, you physically act out your dreams. Your behaviors and actions will seem purposeful (for example, punching or kicking), can be violent, and may be dangerous to you or your bed partner. Usually, your eyes stay closed. When you wake up, you quickly become alert and will often remember your dream. RBD can be a precursor to neurodegenerative diseases like Parkinson’s disease.

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Diagnosing Parasomnias

Sleep medicine specialists usually identify parasomnia by learning about your symptoms and experiences. Your doctor may order a sleep study to rule out contributing sleep disorders, like sleep apnea or periodic limb movement disorder. If your parents have a history of parasomnia, you are more likely to have abnormal sleep behaviors as well.

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Safety Measures
Tools like door alarms and locks can help keep you safe during parasomnia episodes. 

Sleep deprivation contributes to abnormal sleep behavior, so it’s important to prioritize sleep with a consistent schedule and healthy sleep habits. Avoiding alcohol, limiting stress, and managing other environmental factors can improve or eliminate symptoms. If you notice your abnormal sleep behavior happens at a consistent time during the night, set an alarm to wake yourself about 15 minutes beforehand. This can help your body reset and avoid unwanted behaviors.

Your doctor may recommend melatonin or prescription medications to help reduce parasomnia symptoms. Some powerful sleep aids and other medications can make parasomnia symptoms worse, so it’s important to discuss potential side effects with your sleep doctor.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

This page was medically reviewed on 03/15/2022