Gina Johnson
Sleep is not a passive activity, and it is possible for violent behaviours to occur during sleep, known as Violent Behaviour During Sleep (VBS). This can be a result of several sleep disorders, including sleepwalking, sleep paralysis, sleep terrors, and arousal disorders. These disorders can cause individuals to act out their dreams, which can lead to violent or unusual behaviour. Sleepwalking, or somnambulism, is an arousal disorder that occurs during the deep non-rapid eye movement (NREM) stage of sleep. It is important to wake a sleepwalker gently to avoid causing an angry outburst, as they may harm themselves or others. Sleep paralysis, on the other hand, occurs when an individual is unable to move or speak upon waking, which can be a frightening experience. Arousal disorders, such as confusional arousals, can cause individuals to wake into a disoriented state, exhibiting strange behaviours with no memory of their actions. Sleep terrors are intensely frightening episodes where individuals may scream and lash out physically. These various sleep disorders can lead to violent behaviour during sleep, and it is crucial to understand the causes and triggers to prevent harm to oneself or others.
| Characteristics | Values |
|---|---|
| Type of behaviour | Violent behaviours during sleep (VBS) |
| Prevalence | 77.8% of VBS subjects reported having vivid dreams during episodes |
| Risk factors | Childhood parasomnia, family history of parasomnia, stress, substance abuse, sleep-wake schedule disorder, drug abuse, excessive caffeine consumption, less N4 sleep |
| Timing | Occurs within 2 hours of falling asleep in 33% of cases, in the middle of the night (3-4 hours after sleep onset) in 47% of cases, and close to wake-up time in 20% of cases |
| Safety | Can be woken up safely; do so gently to avoid startling the person |
| Prevention | Establish a consistent sleep schedule, reduce stressors, treat underlying sleep disorders |
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What You'll Learn
Sleepwalking
Part of the brain remains in a deep sleep while another part is awake enough to control movement. As a result, sleepwalkers are not fully conscious and may exhibit unusual or potentially dangerous behaviours. It is a myth that waking a sleepwalker will cause them to have a heart attack or stroke. However, they may feel disoriented and distressed, and may exhibit a stress response such as lashing out in self-defence.
If you encounter someone who is sleepwalking, it is important to stay calm and assess the situation. Evaluate the environment and the sleepwalker's actions to determine the level of risk involved. If the sleepwalker is in immediate danger, it may be necessary to intervene. Avoid physical confrontation as they may react defensively or aggressively. Refrain from using force or physical contact unless it is necessary to protect the sleepwalker from harm.
Instead, approach the sleepwalker slowly and gently, and avoid sudden movements or loud noises that may startle them. If the sleepwalker won't return to their bed, you can try to wake them by making loud, sharp noises from a safe distance. They may be confused and scared when they wake up, so it is important to explain what has happened and provide reassurance as you encourage them to return to bed.
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Sleep paralysis
During an episode, the person experiencing sleep paralysis may feel scared or anxious, and may even hallucinate, sensing a dangerous presence in the room or feeling like their body is moving. They may also experience pressure on their chest, a sense of suffocation, or paranoia. However, they will still be able to move their eyes and breathe.
If you are with someone who is experiencing sleep paralysis, you can safely wake them up by touching or talking to them. However, they will not be able to indicate that they are experiencing sleep paralysis until they have recovered from the episode. To prevent future episodes, it is recommended that people with sleep paralysis address the underlying causes of their symptoms, such as improving sleep hygiene or seeking treatment for any underlying sleep disorders or mental health conditions.
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Arousal disorders
The most common confusional behaviours associated with arousal disorders are sleep terrors and sleepwalking. Sleepwalking, or somnambulism, involves getting out of bed and moving about with one's eyes open, while remaining asleep. Sleepwalkers may perform complex activities such as driving or playing a musical instrument, or engage in behaviours they wouldn't normally do, like urinating in an inappropriate area. Sleepwalking can be dangerous, as it may lead to self-harm or harm to others. Therefore, it is important to wake a sleepwalker gently to prevent them from causing harm, although this is not always necessary.
Confusional arousals, another type of arousal disorder, cause individuals to feel confused and disoriented upon waking. They may sit up, have their eyes open, or express emotions such as crying. Their speech may be slow, and they may not understand what others are saying. Episodes can last from a few minutes to hours, and this type of arousal disorder is common in childhood, tending to decrease with age.
Treatment for arousal disorders involves addressing any underlying sleep disorders or health problems that may be triggering the episodes. Establishing a consistent sleep schedule and reducing stressful conditions can also help resolve associated health problems. In some cases, nocturnal polysomnography may be recommended to evaluate the disorder and confirm a diagnosis.
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Sleep terrors
The exact cause of sleep terrors is unknown, but they are believed to be triggered by various factors, including sleep deprivation, fever, stress, anxiety, emotional tension, alcohol consumption, and intrinsic sleep disorders. In some cases, sleep terrors can be associated with underlying mental health conditions such as post-traumatic stress disorder (PTSD) and anxiety disorders. Sleepwalking and frontal lobe epilepsy have also been linked to sleep terrors.
If someone is experiencing a sleep terror, it can be challenging to wake or calm them down. However, it is important to do so gently and safely to prevent them from harming themselves or others. Here are some general strategies to wake someone safely:
- Use music: Finding the right song or style of music can help wake someone up, reducing the sensation of sleep inertia, which is a state of low mood, low energy, and poor thinking skills upon awakening.
- Gradual lighting: Instead of abruptly turning on the lights, use smart light bulbs that gradually get brighter or rely on natural light by cracking the blinds to let in the morning sunlight.
- Enticing scents: The smell of coffee or breakfast cooking in the kitchen can be enticing enough to wake a deep sleeper.
- Alarm clock: Set an alarm clock or phone on the other side of the room to force the person to get up and turn it off. Ensure the alarm is loud enough to be heard, and encourage the person to stay out of bed after turning it off.
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Sleep-wake schedule disorders
When an individual experiences a sleep-wake schedule disorder, their sleep schedule may be inconsistent, shifting over time, or misaligned with the light-dark schedule of their location. This can lead to insufficient sleep and other poor lifestyle behaviours. One such disorder is delayed sleep-wake phase disorder (DSWPD), where individuals experience a delayed sleep schedule, often going to bed around 2 a.m. and waking up around 10 a.m. This can result in insomnia and excessive daytime sleepiness. DSWPD is more prevalent in adolescents and young adults, affecting up to 4.6% of this demographic.
On the other hand, advanced sleep-wake phase disorder (ASWPD) causes individuals to go to sleep and wake up much earlier than normal, making it challenging to stay awake in the early evening. This disorder is common and can interfere with daily responsibilities. Irregular sleep-wake rhythm disorder (ISWRD) results in a chaotic sleep schedule, with individuals experiencing short, unpredictable sleep bouts throughout the day and night. This disorder is commonly associated with neurodevelopmental disorders, traumatic brain injuries, or neurodegenerative diseases.
Non-24-hour sleep-wake rhythm disorder (N24SWD) occurs when an individual's circadian rhythm extends beyond the regular 24-hour cycle, causing their sleep schedule to gradually shift later each day. This disorder typically arises when external factors, such as light exposure, do not properly regulate the circadian rhythm. Additionally, shift work or jet lag can also lead to temporary disruptions in sleep patterns.
To prevent sleep-wake schedule disorders, individuals can make healthy lifestyle changes to improve their sleep habits. Establishing a consistent sleep schedule every day can help align the body's internal clock with its environment, making it easier to fall asleep and wake up at regular times.
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Frequently asked questions
There are several sleep disorders that can cause violent behaviour during sleep. Some of the most common causes are sleep paralysis, sleepwalking, sleep terrors, and confusional arousals. Stress and sleep deprivation can also play a role in triggering these disorders.
If someone is attacking in their sleep, it is important to wake them gently to avoid startling them or causing an angry outburst. You can try calling their name or touching them lightly. If they are sleepwalking, you should guide them back to bed.
If the person does not wake up or continues to act violently, you may need to restrain them or remove any dangerous objects from their reach until the episode passes. You can also try to wake them by using loud noises, bright lights, or strong smells, such as coffee or bacon.
People with violent sleep behaviour disorders often report having vivid dreams, feeling disoriented when they wake up, and having difficulty falling asleep due to fear of another episode. They may also exhibit unusual or disruptive behaviour during sleep, such as screaming, lashing out, or sleepwalking.
If you or someone you know is experiencing violent sleep behaviour, it is important to seek professional help. Consult a healthcare provider or a sleep specialist who can perform a physical exam, sleep evaluation, and recommend appropriate treatment options.
