Gina Johnson
Biting in one's sleep can be caused by a variety of factors, including underlying medical conditions, sleep disorders, and even bugs. Sleep-related biting can be a symptom of conditions such as epilepsy, Lyme disease, and sleep apnea. In some cases, it can be a result of violent parasomnia, sleep-related dissociative disorder, or REM sleep behavior disorder (RBD). Additionally, certain bugs such as mosquitoes, bed bugs, and scabies mites are known to bite people while they sleep. Understanding the underlying causes of sleep-related biting is important to determine the appropriate treatment or prevention methods.
| Characteristics | Values |
|---|---|
| Biting someone in your sleep | Parasomnia |
| Type of parasomnia | REM sleep behavior disorder (RBD), NREM parasomnia, sleepwalking, sleep terrors, parasomnia overlap disorder, sleep-related dissociative disorder, trauma-associated sleep disorder, post-traumatic stress disorder, etc. |
| Causes | Work stress, sleep apnea, epilepsy, seizures, facial muscle spasms, bruxism, malocclusion, MDMA, Lyme disease, etc. |
| Treatment | Bedtime clonazepam, bilevel positive airway pressure, antiseizure medications, mouthguard, therapy |
| Prevention | Good hygiene, avoiding close contact with infected people, not sharing personal items |
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What You'll Learn
Sleep-related dissociative disorder
SRDDs are typically associated with daytime dissociative episodes and a history of trauma. The diagnosis of SRDDs is based on clinical history and polysomnography, with video-polysomnography (vPSG) being a useful tool for documenting typical episodes. SRDDs are often confused with parasomnias or sleep-related hypermotor epilepsy, hence the importance of accurate diagnosis.
There have been several reported cases of SRDDs with recurrent biting behaviour. In one case, a 55-year-old man with a history of violent complex parasomnia exhibited recurrent self-biting that required surgical intervention. The cause was deemed to be non-rapid eye movement (NREM) sleep parasomnia comorbid with severe obstructive sleep apnea. Another case involved a 19-year-old male who presented with animalistic episodes during the sleep period, during which he would act like a large cat, crawl, leap, and bite objects, injuring himself on multiple occasions.
The treatment for SRDDs is limited, but psychological interventions have proven effective in some cases. Additionally, bedtime clonazepam and bilevel positive airway pressure therapy have been successful in managing SRDDs with recurrent biting behaviour.
SRDDs are not currently recognised as an official diagnostic entity in the latest editions of psychiatric and sleep diagnostic classifications. However, there is ongoing work to propose updated diagnostic criteria and reinstate SRDDs in future revisions of these classifications.
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REM sleep behaviour disorder
Biting someone in your sleep could be a symptom of a condition called REM sleep behaviour disorder (RBD). RBD is a parasomnia involving dream enactment behaviour associated with a loss of atonia during rapid eye movement (REM) sleep. During an episode of RBD, a person may act out their dreams through complex and violent movements, which can lead to self-harm or harm to their sleeping partner.
RBD can be divided into three categories: idiopathic RBD, drug-induced RBD, and secondary RBD due to a medical condition. The strongest correlation exists between RBD and comorbid neurodegenerative alpha-synucleinopathies, such as Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. In some cases, RBD has also been associated with antidepressant use and narcolepsy.
The diagnosis of RBD requires confirmation by an in-laboratory sleep study (polysomnography) with video recording. This helps to identify abnormal behaviours during REM sleep and exclude other sleep disorders. Treatment options are available, and the management of RBD typically involves a healthcare team to improve care for patients with this condition.
It is important to note that biting during sleep can also be related to other sleep disorders or parasomnias. For example, a case study reported a 19-year-old male with a history of violent parasomnia episodes where he would act like a large jungle cat, crawl, leap, and bite furniture and objects. Another case study reported a 55-year-old man with a history of violent parasomnia, which was deemed to be a non-rapid eye movement (NREM) sleep parasomnia comorbid with severe obstructive sleep apnea.
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NREM sleep parasomnias
Biting someone in your sleep could be a sign of NREM sleep parasomnias. Parasomnias are a group of sleep-related disorders that cause disruptive or unusual behaviours during sleep, as you're falling asleep or waking up. NREM parasomnias involve disordered sleep-related behaviours that occur during the first few hours of sleep, which is the non-rapid eye movement (non-REM) stage of sleep. During this stage, your eyes are still, and your body relaxes and prepares for sleep.
There are several types of NREM parasomnias, including sleepwalking, sleep terrors, confusional arousals, and sexsomnia. Sleepwalking usually happens during stage 3 of NREM sleep and is characterised by routine activities such as sitting up or walking while asleep. Sleep terrors, or night terrors, are episodes of intense fear and terror during sleep and are more common in children than adults. Confusional arousals are episodes of wakefulness characterised by disorientation, confusion, and memory-related symptoms. Sexsomnia, or sleep sex, involves sexual behaviours and activities during sleep.
Other types of parasomnias include sleep enuresis (bedwetting), sleep-related groaning (catathrenia), exploding head syndrome, sleep-related hallucinations, and sleep-related eating disorders. While the exact causes of NREM parasomnias are not fully understood, they typically occur during stage 3 or 4 of NREM sleep, and disruptions during these stages appear to play a significant role in causing these behaviours. Potent priming factors that may contribute to NREM parasomnias include sleep deprivation, medications such as hypnotic drugs, and stress.
If you believe you may be experiencing NREM parasomnias, it is recommended to consult a doctor who will review your symptoms and medical history. Treatment for NREM parasomnias typically involves a combination of approaches, including medication, therapy, and lifestyle measures. Cognitive behavioural therapy (CBT) and melatonin have shown promise in managing NREM parasomnias. Additionally, addressing sleep hygiene, treating co-morbid sleep disorders, and managing stress and anxiety are important components of the treatment approach.
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Sleepwalking
Biting during sleep can be associated with various conditions, including sleepwalking, sleep terrors, and REM sleep behaviour disorder (RBD). In one notable case, a man with RBD exhibited aggressive and violent behaviour during sleep, including biting his wives while dreaming, which ultimately led to his divorce. Additionally, sleepwalking has been linked to a family history of sleep disorders, with some families demonstrating greater vulnerability to sleepwalking and other parasomnias.
The underlying causes of sleepwalking are not fully understood, but it is believed to be influenced by various factors, including genetics, sleep deprivation, stress, and certain medications. Treatment options for sleepwalking typically involve addressing any underlying medical conditions, improving sleep hygiene, and implementing safety measures to prevent harm during sleepwalking episodes.
In some cases, sleepwalking can be a symptom of a more serious sleep disorder or underlying medical condition, such as obstructive sleep apnea, epilepsy, or nocturnal seizures. If sleepwalking is frequent or accompanied by violent behaviour, it is important to seek medical advice to determine the underlying cause and receive appropriate treatment.
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Sleep terrors
In some cases, parasomnias can involve violent and injurious behaviours, such as biting. For example, a case study reported a 55-year-old man with a history of violent parasomnia who experienced recurrent self-biting, sometimes requiring surgical intervention. His parasomnia was attributed to severe obstructive sleep apnea (OSA), and treatment with bedtime clonazepam and bilevel positive airway pressure (BPAP) therapy was effective in managing his symptoms.
Another case study described a 19-year-old male who, during sleep, exhibited animalistic behaviour, crawling and leaping about, and biting objects. This behaviour was attributed to a sleep-related dissociative disorder. Video-polysomnography (PSG) revealed that these episodes arose from EEG wakefulness, with intermittent growling preceding the full behavioural episode.
While sleep terrors themselves do not necessarily involve biting, they can be a symptom of underlying parasomnias or sleep disorders that, in rare cases, may include biting behaviours. If sleep terrors or violent parasomnias are a concern, seeking professional help from healthcare providers or sleep specialists is essential for proper diagnosis and treatment.
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Frequently asked questions
Violent behaviour during sleep is a common problem, affecting more than 2% of the population over 15 years old. Sleep-related biting can be a symptom of REM sleep behaviour disorder (RBD), NREM sleep parasomnias, parasomnia overlap disorder, sleep apnea, sleep-related dissociative disorder, trauma-associated sleep disorder, and more.
Treatments for sleep-related biting vary depending on the underlying cause. For example, in the case of a 55-year-old man with a history of violent parasomnia, therapy with bedtime clonazepam and bilevel positive airway pressure was effective. In another case, a man with RBD was prescribed 1 mg of clonazepam at bedtime, which stopped the nocturnal events.
Sleep-related biting is often associated with dream enactment. If you wake up at unusual times in the night without any reason, this could be a sign of sleep-related biting. Additionally, if you find bite marks on your body or the body of your bed partner, it could indicate sleep-related biting.
