Challenges with Sleep Disorders | Epilepsy Foundation

Many other sleep disorders exist, including “parasomnias” consisting of abnormal sleep phenomenon either occurring during sleep or wakefulness. These disorders do not always significantly disrupt sleep, but can be confusing in that some can have the appearance of a seizure. Parasomnias are described here.

Arousal Disorders

These typically occur in non-REM sleep, especially in the deeper stages (slow wave sleep). All are more common in children, and occur more frequently whenever sleep is deeper (such as after sleep deprivation).

  • Confusional arousals (“sleep drunkenness”) consists of confusion, sometimes accompanied by stumbling and slurring, on awakening and can last for several minutes. Sometimes there will be no memory of the awakening whatsoever.
  • Sleep terrors consist of sudden awakening, often accompanied by screaming and a brief, frightening image. In this case the person may also be confused and disoriented for several minutes.
  • Sleepwalking is also considered a disorder of arousal.

Sleep-Wake Transition Disorders

These disorders usually occur as the person is falling asleep or waking up. Examples include:

  • Sleep starts (sudden sometimes violent jerking on falling asleep) and sleep talking (“somniloquy”).
  • Head banging (rhythmic movement disorder) is relatively common in young children and consists of rocking or banging movements as the child is falling asleep; these can sometimes be fairly violent.

Other Parasomnias

  • Teeth grinding (bruxism) can cause problems with sleep if it results in frequent awakenings. It also damages the teeth; a mouth guard used at night can prevent this.
  • Bedwetting (sleep enuresis) is common in children and usually of no long term consequence.
  • Snoring can occur in the absence of sleep apnea (“primary snoring”); This may not be a problem for the sleeper if he or she is not awakened by it, but can disrupt the sleep of bed partners.

Parasomnias Associated With REM Sleep

These generally consist of behaviors occurring during REM sleep that normally happen while awake, or a disruption of normal processes during REM sleep.

  • Sleep paralysis occurs when the normal paralysis present during REM persists into wakefulness. It is usually brief and resolves spontaneously, but can be frightening. Similarly, hypnic hallucinations are dream images that persist into wakefulness. Both can occur in normal people occasionally, particularly when sleep deprived, but also are common in narcolepsy.
  • Cataplexy is the sudden onset of paralysis (as occurs in REM sleep) when the person is fully awake. For reasons that are not well understood, this seems to occur in the presence of strong emotion (laughter or fear). This phenomenon also occurs in narcolepsy.
  • Finally, REM sleep behavior disorder consists of the absence of normal paralysis during REM sleep. Because muscles remain functional, these people can move about as they dream, sometimes leaving the room or (if the dream is frightening) having aggressive behavior that can result in injury.

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