Parasomnias And Rem Sleep: Understanding The Connection

Parasomnias are disruptive sleep disorders that involve abnormal and undesirable behaviours during sleep. They occur in the state between sleep and wakefulness, where a person may seem alert but is actually only partially awake. There are two types of parasomnias: REM-related and non-REM-related. REM-related parasomnias occur during the REM stage, the fifth stage of sleep, which is when the brain processes information from the day and we have dreams. The following parasomnias occur during REM sleep:

- Nightmare disorder

- Recurrent isolated sleep paralysis

- REM sleep behaviour disorder

Nightmare disorder

The treatment for nightmare disorder depends on the severity of the condition and can include therapy, medication, or a combination of both.

Recurrent isolated sleep paralysis

Sleep paralysis is fairly common, with estimates ranging from 5% to 40% of people experiencing it at least once in their lifetime. It tends to first appear in the teenage years and is most common in people in their 20s and 30s. It can be a frightening experience, with sufferers reporting feelings of anxiety and fear, and sometimes hallucinations. However, it is not a serious medical risk and does not affect sleep or overall health.

The exact cause of sleep paralysis is unknown, but it has been linked to several factors, including:

• Lack of sleep
• Irregular sleep schedules, such as those of shift workers
• Sleeping on your back
• Certain medications, such as those for ADHD
• Sleep disorders, such as narcolepsy
• Mental health conditions, such as bipolar disorder, PTSD, and panic disorder

If you experience repeated episodes of sleep paralysis, it is recommended to discuss this with a healthcare provider, as it may be due to an underlying medical problem. Treatment options are limited, but improving sleep hygiene and maintaining a regular sleep schedule can help. Cognitive-behavioural therapy to address anxiety and stress may also be beneficial.

REM sleep behaviour disorder

RBD is more common in middle-aged to elderly people and is more prevalent in men. The exact cause of RBD is unknown, but it is often associated with neurodegenerative diseases such as Parkinson's disease, Lewy body dementia, and multiple system atrophy. It can also be caused by certain medications, including antidepressants and sedative-hypnotics.

People with RBD may require treatment to prevent injury to themselves or their bed partner. This can include removing dangerous objects from the bedroom, using floor pads, and sleeping in separate beds. Medications such as clonazepam, melatonin, and pramipexole are also used to treat RBD.

RBD is a serious condition that can have harmful consequences. It is important to seek medical advice if you or someone you know is experiencing symptoms of RBD.

Sleep-related eating disorder

SRED episodes can occur at any time during the night, and may happen more than once a night. They are not usually driven by hunger or thirst, and people with SRED tend to prefer thick, sugary, high-calorie foods. An entire episode, from leaving the bed to returning, may last only ten minutes. During this time, people with SRED may handle food sloppily, and may not prepare food properly.

SRED may develop slowly over time, or it may begin with nightly episodes from the start. It is a long-lasting condition that does not seem to ease up over time, and it may be a factor in causing depression. This could be due to a sense of shame and failure to control the disorder. Some people with SRED may avoid eating during the day, or exercise excessively, in an attempt to prevent obesity.

SRED is more common in women, who make up 65% to 80% of patients. The average age of onset is between 22 and 29 years old. It can develop on its own, or it can be caused by certain medications, particularly those used to treat depression and sleep problems. More than half of people with SRED have another parasomnia, most commonly sleepwalking. Other sleep disorders closely linked to SRED include restless legs syndrome, periodic limb movement disorder, irregular sleep-wake rhythm, and sleep-related dissociative disorders.

To diagnose SRED, a doctor will ask about the history of the disorder, how often episodes occur, and how long they last. They will also take a complete medical history, including past and present medication use. The patient may also be asked to fill out a sleep diary for two weeks, to help the doctor understand their sleeping patterns. A sleep study (polysomnography) may also be required, to record brain waves, heart rate, breathing, and arm and leg movements during sleep.

To treat SRED, safety measures should be put in place, such as locks on kitchen doors and cabinets, and knives should be stored securely. It is also important for people with SRED to get plenty of sleep, as episodes may increase with sleep deprivation. Medication may also be prescribed, and the patient may be checked for other sleep disorders, such as sleep apnea, which can make SRED more difficult to treat.

Sleepwalking

Factors that may trigger sleepwalking episodes include genetics, sleep deprivation, medications, alcohol consumption, stress, brain injury, fever, obstructive sleep apnea, and restless leg syndrome. Treatment options for sleepwalking include eliminating safety risks, treating underlying causes, anticipated awakening, improving sleep hygiene, and cognitive behavioural therapy. In some cases, medications such as benzodiazepines, antidepressants, or melatonin may be considered.

To prevent sleepwalking, it is recommended to avoid alcohol and antidepressant medications, maintain a consistent sleep schedule, and reduce stress, anxiety, and conflict.

Frequently asked questions